NUR 4090 EXAM 3 QUESTIONS AND
ALL CORRECT ANSWERS.
regurgitation - Answer the valve does not CLOSE properly; and blood back-flows through the
valve
stenosis - Answer the valve does not OPEN completely; narrows
valve prolapse - Answer the STRETCHING of the atrioventricular valve into the atrium during
diastole
aortic landmark - Answer right of sternum, 2nd intercostal space
pulmonic landmark - Answer left of sternum, 2nd intercostal space
erb's point landmark - Answer left of sternum, 3rd intercostal space (middle of the heart)
tricuspid landmark - Answer left of sternum, 4th intercostal space
mitral landmark - Answer left of sternum, 5th intercostal space (APEX of heart)
mitral valve disorders - Answer mitral valve:
regurgitation, stenosis, prolapse
mitral valve prolapse - Answer CAUSES:
inherited connective tissue disorder
PATHOPHYSIOLOGY:
mitral valve leaflets balloon back into the atrium during systole
blood regurgitates into left atrium
MANAGEMENT:
limit caffeine, alcohol, tobacco use
prophylactic abx NOT required for dental visits
may require valve repair/replacement, if severe
NURSING MANAGEMENT:
mitral click
, reduce risk of endocarditis
reduce alcohol, caffeine, tobacco, ephedrine, epinephrine
mitral valve regurgitation - Answer back-flow of blood from LV into LA during diastole
CAUSES:
degeneration of mitral valve
ischemia of left ventricle
rheumatic heart dx & its sequelae
PATHOPHYSIOLOGY:
problems w/ mitral valve leaflets, chordae tendinae, papillary muscles
left atrium hypertrophic, then dilated due to back-flow of blood into it
MANAGEMENT:
same tx as heart failure
**ACE inhibitors**
**beta blockers**
activity restriction
valve repair/replacement
mitral valve stenosis - Answer a NARROWED opening between the LA to LV
CAUSES:
rheumatic endocarditis, progressively thickens mitral valve leaflets & chordae tendinae
PATHOPHYSIOLOGY:
mitral valve narrows to width of a pencil
poor LV filling causes decreased CO
RV forced to contract over extremely high pressures
RV hypertrophies, dilates, fails
HR increase, CO decrease, pulmonary pressures increase
mitral valve stenosis (cont.) - Answer CLINICAL MANIFESTATIONS:
dyspnea on exertion
symptoms more clear once valve shrinks to 1/3 its size
dry cough/wheezing
palpitations
paroxysmal nocturnal dyspnea
LOW-PITCHED DIASTOLIC MURMUR
ALL CORRECT ANSWERS.
regurgitation - Answer the valve does not CLOSE properly; and blood back-flows through the
valve
stenosis - Answer the valve does not OPEN completely; narrows
valve prolapse - Answer the STRETCHING of the atrioventricular valve into the atrium during
diastole
aortic landmark - Answer right of sternum, 2nd intercostal space
pulmonic landmark - Answer left of sternum, 2nd intercostal space
erb's point landmark - Answer left of sternum, 3rd intercostal space (middle of the heart)
tricuspid landmark - Answer left of sternum, 4th intercostal space
mitral landmark - Answer left of sternum, 5th intercostal space (APEX of heart)
mitral valve disorders - Answer mitral valve:
regurgitation, stenosis, prolapse
mitral valve prolapse - Answer CAUSES:
inherited connective tissue disorder
PATHOPHYSIOLOGY:
mitral valve leaflets balloon back into the atrium during systole
blood regurgitates into left atrium
MANAGEMENT:
limit caffeine, alcohol, tobacco use
prophylactic abx NOT required for dental visits
may require valve repair/replacement, if severe
NURSING MANAGEMENT:
mitral click
, reduce risk of endocarditis
reduce alcohol, caffeine, tobacco, ephedrine, epinephrine
mitral valve regurgitation - Answer back-flow of blood from LV into LA during diastole
CAUSES:
degeneration of mitral valve
ischemia of left ventricle
rheumatic heart dx & its sequelae
PATHOPHYSIOLOGY:
problems w/ mitral valve leaflets, chordae tendinae, papillary muscles
left atrium hypertrophic, then dilated due to back-flow of blood into it
MANAGEMENT:
same tx as heart failure
**ACE inhibitors**
**beta blockers**
activity restriction
valve repair/replacement
mitral valve stenosis - Answer a NARROWED opening between the LA to LV
CAUSES:
rheumatic endocarditis, progressively thickens mitral valve leaflets & chordae tendinae
PATHOPHYSIOLOGY:
mitral valve narrows to width of a pencil
poor LV filling causes decreased CO
RV forced to contract over extremely high pressures
RV hypertrophies, dilates, fails
HR increase, CO decrease, pulmonary pressures increase
mitral valve stenosis (cont.) - Answer CLINICAL MANIFESTATIONS:
dyspnea on exertion
symptoms more clear once valve shrinks to 1/3 its size
dry cough/wheezing
palpitations
paroxysmal nocturnal dyspnea
LOW-PITCHED DIASTOLIC MURMUR
