During discharge teaching with a 68-year-old patient who had a ...

[stephzh]

During discharge teaching with a 68-year-old patient who had a mitral valve replacement with a mechanical valve, the nurse instructs the patient on the
 
  a. use of daily aspirin for anticoagulation.
  b. correct method for taking the radial pulse.
  c. need for frequent laboratory blood testing.
  d. need to avoid any physical activity for 1 month.

Question 2

While caring for a patient with aortic stenosis, the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow. A priority nursing intervention for this patient would be to
 
  a. promote rest to decrease myocardial oxygen demand.
  b. teach the patient about the need for anticoagulant therapy.
  c. teach the patient to use sublingual nitroglycerin for chest pain.
  d. raise the head of the bed 60 degrees to decrease venous return.

[ghepp]

Answer to Question 1

ANS: C
Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to prevent clotting on the valve. This will require frequent international normalized ratio (INR) testing. Daily aspirin use will not be effective in reducing the risk for clots on the valve. Monitoring of the radial pulse is not necessary after valve replacement. Patients should resume activities of daily living as tolerated.

Answer to Question 2

ANS: A
Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain. The patient with aortic stenosis requires higher preload to maintain cardiac output, so nitroglycerin and measures to decrease venous return are contraindicated. Anticoagulation is not recommended unless the patient has atrial fibrillation.

[stephzh]

TYSM

[tkempin]

Excellent