Which subjective or objective assessment finding would the nurse expect to find in a client with severe aortic stenosis?

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11ecbb05_c955_3dfc_b433_9b8dd22dec36_MD0009_00 Aortic stenosis is a narrowing of the aortic valve, which obstructs blood flow from the left ventricle to the aorta. As stenosis progresses, the heart cannot overcome the worsening obstruction, and ejects a smaller fraction of blood volume from the left ventricle during systole. This decreased ejection fraction results in a narrowed pulse pressure (ie, the difference between systolic and diastolic blood pressures) and weak, thready peripheral pulses. With exertion, the volume of blood that is pumped to the brain and other parts of the body is insufficient to meet metabolic demands, resulting in exertional dyspnea, anginal chest pain, and syncope. (Option A) In aortic stenosis, pulses are weak due to obstruction of outflow from the left ventricle. Pulses would be bounding in aortic regurgitation due to more blood being pumped each time (blood accumulation from regurgitation of the previous systole). (Option B) On auscultation, aortic stenosis produces a loud, ejection systolic murmur over the aortic area as blood is ejected from the left ventricle through the stenosed aortic valve during systole. (Option C) The second heart sound (S2) is produced by the closure of aortic and pulmonic valves. When these valves are stiff and difficult to close (as with aortic stenosis), S2 is soft or absent. Educational objective: Aortic stenosis obstructs blood flow during systole from the left ventricle to the aorta. Clients will develop exertional dyspnea, chest pain, and syncope as the heart is unable to overcome the obstruction to pump enough blood to meet metabolic demands. A systolic ejection murmur over the aortic area, soft or absent second heart sounds, and weak peripheral pulses are characteristic.

Which Subjective or Objective Assessment Finding Would the Nurse Expect