Valsalva maneuver should not be advised in-

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2024

Explanation

The Valsalva maneuver is contraindicated in patients with high blood pressure (hypertension).
The primary danger is the 'overshoot' in Phase IV, where arterial blood pressure can rise sharply and significantly above the resting level.
This sudden spike in pressure increases the risk of severe cardiovascular events, such as hemorrhagic stroke, aortic dissection, or myocardial infarction in susceptible individuals.

Option B: This is a primary indication for the maneuver, not a contraindication.
Option C: This is a common and appropriate use of the maneuver.
Option D: This option is incorrect because two of the other options (restoring heart rhythm and clearing a clogged ear) are valid indications for the Valsalva maneuver.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications for Valsalva Maneuver as background academic context rather than a clinical decision trigger.
Nurses must assess for contraindications like severe hypertension, recent myocardial infarction, or known aortic aneurysm before instructing a patient to perform a Valsalva maneuver.
When used to treat SVT, continuous cardiac monitoring (ECG) is essential to observe the rhythm response and identify any adverse effects like bradycardia or asystole.
Patient safety during the maneuver includes having the patient in a supine or recumbent position to prevent injury from fainting (syncope) if blood pressure drops significantly.

How to Approach the Question

First, identify the negative framing of the question with the keyword 'not'. This means you are looking for a contraindication or a reason to avoid the procedure.
Next, recall the definition and physiological effects of the Valsalva maneuver: a forced exhalation against a closed airway, which significantly impacts intrathoracic pressure, blood pressure, and heart rate.
Evaluate each option against this knowledge:
Does it affect blood pressure? Yes, it causes a sharp spike. This would be dangerous for someone with already high blood pressure.
Is it used for heart rhythm? Yes, it's a standard vagal maneuver for SVT.
Is it used for ears? Yes, to equalize pressure.

Concept Tested & Keywords

Concept Tested: Contraindications for Valsalva Maneuver
Stem keywords: Valsalva maneuver, not be advised
Lead-in keywords: not
Negative lead-in flag: The question asks for a contraindication, meaning a situation where the procedure should NOT be performed.

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E6 Medicine Harrison 22e Part 1 p. 1975-1977

E6 Medicine Harrison 22e Part 2 p. 1670-1672

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