NUR 257 – Concepts of Aging and Chronic Illness – Exam 2
(200 Multiple-Choice Practice Questions With Answers &
Explanations)
PART 1: VALVULAR HEART DISEASE & SURGICAL INTERVENTIONS
1. A client is admitted to the hospital with aortic stenosis. What assessment findings would indicate the
development of left ventricular failure?
A) Orthopnea, nausea, pedal edema
B) Distended jugular veins, pedal edema, nausea
C) Dyspnea, orthopnea, pulmonary edema
D) Dyspnea, distended jugular veins, orthopnea
Answer: C
Explanation: Left ventricular failure results in backward fluid accumulation into the pulmonary
circulation. Dyspnea, orthopnea (difficulty breathing when lying flat), and pulmonary edema are classic
signs of left-sided heart failure.
2. The nurse is caring for a client who has been diagnosed with aortic stenosis. The client is prescribed
digoxin. What is the rationale for the medication?
A) Left ventricular dysfunction
B) Angina
C) Dyspnea
D) Edema
Answer: A
Explanation: Digoxin is prescribed to improve contractility in left ventricular dysfunction secondary to
aortic stenosis, helping to manage symptoms of heart failure.
,3. A client has a mechanical valve replacement. The nurse should teach the client that the therapeutic
international normalized ratio (INR) range for a mechanical heart valve is typically:
A) 1.5–2.0
B) 2.0–3.0
C) 2.5–3.5
D) 3.0–4.0
Answer: C
Explanation: The therapeutic INR range for mechanical heart valves is typically 2.5–3.5. An INR
exceeding this range indicates an increased risk of bleeding complications, warranting provider
notification for possible dose adjustment.
4. A nurse is teaching a client about valve replacement surgery. The nurse explains that the two major
types of replacement valves are:
A) Mechanical and tissue
B) Bioprosthetic and xenograft
C) Autograft and allograft
D) Porcine and bovine
Answer: A
Explanation: The two major categories of prosthetic heart valves are mechanical valves and tissue valves
(bioprosthetic). Each has specific advantages and disadvantages regarding durability and anticoagulation
requirements.
5. A client with a mechanical mitral valve is taking warfarin. The INR result is 3.8. What action should the
nurse take?
A) Continue the current dose as ordered
B) Hold the next dose and notify the provider
C) Administer vitamin K immediately
D) Increase the dose by 25%
Answer: B
,Explanation: An INR of 3.8 exceeds the therapeutic range of 2.5–3.5, indicating an increased risk of
bleeding. The nurse should hold the next dose and notify the provider for possible dose adjustment.
6. A client with aortic regurgitation is being discharged. Which statement indicates the client
understands the discharge teaching?
A) "I should immediately call my doctor if I develop chest pain or shortness of breath."
B) "I can take over-the-counter decongestants for my allergies."
C) "I only need to take my medications when I feel symptomatic."
D) "I should avoid all physical activity to rest my heart."
Answer: A
Explanation: Clients with valvular heart disease should be instructed to report chest pain, dyspnea,
palpitations, or signs of heart failure promptly. Decongestants may increase blood pressure, medications
must be taken as prescribed, and moderate activity is encouraged with provider approval.
7. A nurse is caring for a client with infective endocarditis. Which assessment finding would the nurse
expect?
A) Weight gain and improved appetite
B) Fever, new or changing heart murmur, and petechiae
C) Bradypnea and bradycardia
D) Hypertension and tachycardia
Answer: B
Explanation: Classic findings in infective endocarditis include fever, a new or changing heart murmur,
petechiae, splinter hemorrhages, Janeway lesions, and Osler nodes.
8. Prior to a valve replacement surgery, the nurse expects which diagnostic test to confirm the diagnosis
and severity of the valvular disease?
A) Chest x-ray
B) Electrocardiogram (ECG)
, C) Echocardiogram
D) Complete blood count (CBC)
Answer: C
Explanation: An echocardiogram (transthoracic or transesophageal) is the primary diagnostic tool to
assess valve structure, function, and the severity of stenosis or regurgitation.
9. A client with aortic stenosis is scheduled for a balloon valvuloplasty. The nurse explains that this
procedure:
A) Requires open heart surgery and bypass
B) Involves a catheter with a balloon to open the stenotic valve
C) Permanently replaces the valve with a mechanical device
D) Is performed only for mitral regurgitation
Answer: B
Explanation: Balloon valvuloplasty is a less invasive procedure in which a catheter with a balloon is
threaded into the heart and inflated to widen a stenotic valve. It is often a palliative procedure in high-
risk patients.
10. A client is prescribed warfarin after a mechanical valve replacement. Which statement indicates the
need for further teaching?
A) "I will avoid eating large amounts of leafy green vegetables."
B) "I will have my blood drawn regularly to check my INR."
C) "I can take ibuprofen for my headaches."
D) "I will report any unusual bleeding to my provider."
Answer: C
Explanation: Clients on warfarin should avoid NSAIDs like ibuprofen, which increase the risk of bleeding.
Acetaminophen (Tylenol) is a safer alternative for pain.
(200 Multiple-Choice Practice Questions With Answers &
Explanations)
PART 1: VALVULAR HEART DISEASE & SURGICAL INTERVENTIONS
1. A client is admitted to the hospital with aortic stenosis. What assessment findings would indicate the
development of left ventricular failure?
A) Orthopnea, nausea, pedal edema
B) Distended jugular veins, pedal edema, nausea
C) Dyspnea, orthopnea, pulmonary edema
D) Dyspnea, distended jugular veins, orthopnea
Answer: C
Explanation: Left ventricular failure results in backward fluid accumulation into the pulmonary
circulation. Dyspnea, orthopnea (difficulty breathing when lying flat), and pulmonary edema are classic
signs of left-sided heart failure.
2. The nurse is caring for a client who has been diagnosed with aortic stenosis. The client is prescribed
digoxin. What is the rationale for the medication?
A) Left ventricular dysfunction
B) Angina
C) Dyspnea
D) Edema
Answer: A
Explanation: Digoxin is prescribed to improve contractility in left ventricular dysfunction secondary to
aortic stenosis, helping to manage symptoms of heart failure.
,3. A client has a mechanical valve replacement. The nurse should teach the client that the therapeutic
international normalized ratio (INR) range for a mechanical heart valve is typically:
A) 1.5–2.0
B) 2.0–3.0
C) 2.5–3.5
D) 3.0–4.0
Answer: C
Explanation: The therapeutic INR range for mechanical heart valves is typically 2.5–3.5. An INR
exceeding this range indicates an increased risk of bleeding complications, warranting provider
notification for possible dose adjustment.
4. A nurse is teaching a client about valve replacement surgery. The nurse explains that the two major
types of replacement valves are:
A) Mechanical and tissue
B) Bioprosthetic and xenograft
C) Autograft and allograft
D) Porcine and bovine
Answer: A
Explanation: The two major categories of prosthetic heart valves are mechanical valves and tissue valves
(bioprosthetic). Each has specific advantages and disadvantages regarding durability and anticoagulation
requirements.
5. A client with a mechanical mitral valve is taking warfarin. The INR result is 3.8. What action should the
nurse take?
A) Continue the current dose as ordered
B) Hold the next dose and notify the provider
C) Administer vitamin K immediately
D) Increase the dose by 25%
Answer: B
,Explanation: An INR of 3.8 exceeds the therapeutic range of 2.5–3.5, indicating an increased risk of
bleeding. The nurse should hold the next dose and notify the provider for possible dose adjustment.
6. A client with aortic regurgitation is being discharged. Which statement indicates the client
understands the discharge teaching?
A) "I should immediately call my doctor if I develop chest pain or shortness of breath."
B) "I can take over-the-counter decongestants for my allergies."
C) "I only need to take my medications when I feel symptomatic."
D) "I should avoid all physical activity to rest my heart."
Answer: A
Explanation: Clients with valvular heart disease should be instructed to report chest pain, dyspnea,
palpitations, or signs of heart failure promptly. Decongestants may increase blood pressure, medications
must be taken as prescribed, and moderate activity is encouraged with provider approval.
7. A nurse is caring for a client with infective endocarditis. Which assessment finding would the nurse
expect?
A) Weight gain and improved appetite
B) Fever, new or changing heart murmur, and petechiae
C) Bradypnea and bradycardia
D) Hypertension and tachycardia
Answer: B
Explanation: Classic findings in infective endocarditis include fever, a new or changing heart murmur,
petechiae, splinter hemorrhages, Janeway lesions, and Osler nodes.
8. Prior to a valve replacement surgery, the nurse expects which diagnostic test to confirm the diagnosis
and severity of the valvular disease?
A) Chest x-ray
B) Electrocardiogram (ECG)
, C) Echocardiogram
D) Complete blood count (CBC)
Answer: C
Explanation: An echocardiogram (transthoracic or transesophageal) is the primary diagnostic tool to
assess valve structure, function, and the severity of stenosis or regurgitation.
9. A client with aortic stenosis is scheduled for a balloon valvuloplasty. The nurse explains that this
procedure:
A) Requires open heart surgery and bypass
B) Involves a catheter with a balloon to open the stenotic valve
C) Permanently replaces the valve with a mechanical device
D) Is performed only for mitral regurgitation
Answer: B
Explanation: Balloon valvuloplasty is a less invasive procedure in which a catheter with a balloon is
threaded into the heart and inflated to widen a stenotic valve. It is often a palliative procedure in high-
risk patients.
10. A client is prescribed warfarin after a mechanical valve replacement. Which statement indicates the
need for further teaching?
A) "I will avoid eating large amounts of leafy green vegetables."
B) "I will have my blood drawn regularly to check my INR."
C) "I can take ibuprofen for my headaches."
D) "I will report any unusual bleeding to my provider."
Answer: C
Explanation: Clients on warfarin should avoid NSAIDs like ibuprofen, which increase the risk of bleeding.
Acetaminophen (Tylenol) is a safer alternative for pain.
