1.1. Question Among the following signs and symptoms, which would most likely be present in a client with mitral regurgitation? o A. Altered level of consciousness o B. Exertional Dyspnea o C. Increase creatine phosphokinase concentration o D. Chest pain Correct Answer: B. Exertional Dyspnea Mitral regurgitation (MR) is defined as an abnormal reversal of blood flow from the left ventricle (LV) to the left atrium (LA). Weight gain due to retention of fluids and worsening heart failure causes exertional dyspnea in clients with mitral regurgitation. The patient will usually complain of significant dyspnea at rest, exacerbated in the supine position, as well as cough with clear or pink, frothy sputum. o Option A: An altered level of consciousness does not occur in clients with mitral regurgitation. Physical examination may reveal altered mental status, tachycardia (or bradycardia if there is ischemic involvement of the conduction system), hypotension, tachypnea, hypoxemia, and cyanosis. o Option C: Creatine phosphokinase (CPK) is an enzyme in the body. It is found mainly in the heart, brain, and skeletal muscle. High levels of CPK may be seen in people who have brain injury, convulsions, heart attack, myocarditis, and myopathy. o Option D: The client feels no chest pain, but may feel palpitations as a result of chronic atrial dilatation. They may also endorse symptoms associated with myocardial ischemia, such as chest pain radiating to the neck, jaw, shoulders, or upper extremities, nausea, and diaphoresis.  2. Question Kris with a history of chronic infection of the urinary system complains of urinary frequency and burning sensation. To figure out whether the current problem is of renal origin, the nurse should assess whether the client has discomfort or pain in the: o A. Urinary meatus o B. Pain in the labium o C. Suprapubic area o D. Right or left costovertebral angle Correct Answer: D. Right or left costovertebral angle Discomfort or pain is a problem that originates in the kidney. It is felt at the costovertebral angle on the affected side. Flank or costovertebral angle (CVA) tenderness is most commonly unilateral over the involved kidney, although bilateral discomfort may be present. Discomfort varies from absent to severe. This finding is usually not subtle and may be elicited with mild or moderately firm palpation. o Option A: Pain or discomfort in the urinary meatus can also be indicative of urethritis or acute urinary tract infection. In both men and women, common causes of urethral pain include sexually transmitted diseases (STDs) such as chlamydia, local irritation from soaps or spermicides, and urinary tract infections (UTIs). In men, prostatitis isn’t an uncommon cause, whereas in women, vaginal dryness due to menopause can be an issue. o Option B: Pain in the labium can be due to a swollen labia or vulva. Chronic yeast infections and bacterial infections can both cause pain that ranges from mild discomfort and itching to severe burning or throbbing. Viral and bacterial infections, such as bacterial