WGU 446 ADULT HEALTH II FINAL EXAM 225
QUESTIONS WITH VERIFIED ANSWERS 2026
C
Rationale: Dental procedures place the patient with a prosthetic mitral valve at
risk for infectious endocarditis (IE). Myocardial infarction (MI), immunizations, and
a family history of endocarditis are not risk factors for IE. - CORRECT ANSWER The
nurse obtains a health history from a patient with a prosthetic mitral valve who
has symptoms of infective endocarditis. Which question by the nurse is most
appropriate?
a. "Do you have a history of a heart attack?"
b. "Have you any recent immunizations?"
c. "Have you been to the dentist lately?"
d. "Is there a family history of endocarditis?"
A
Rationale: Treatment of the IE with antibiotics should be started as quickly as
possible, but it is essential to obtain blood cultures before initiating antibiotic
therapy to obtain accurate sensitivity results. The ECG and ASA should also be
accomplished rapidly, but the blood cultures (and then administration of the
antibiotic) have highest priority. - CORRECT ANSWER The health care provider
writes the following admitting orders for a patient with suspected IE who has
fever and chills: ceftriaxone (Rocephin) 1.0 g intravenous piggyback (IVPB) q12hr,
acetylsalicylic acid (ASA) for temperature above 102° F (38.9° C), and blood
cultures 2, complete blood cell count (CBC), and electrocardiogram (ECG). When
admitting the patient, the nurse gives the highest priority to
a. obtaining the blood cultures.
,b. initiating the IV antibiotic.
c. scheduling the ECG.
d. administering the ASA.
D
Rationale: New regurgitant murmurs occur in IE because vegetation on the valves
prevents valve closure. Splinter hemorrhages occur on the nailbeds. Chest pain for
pressure is not typical for the patient with IE and would be more consistent with
angina or MI. Although dyspnea may occur as a result of heart failure, a moist
cough would be expected rather than a dry, hacking cough. - CORRECT ANSWER
During the assessment of a patient with IE, the nurse would expect to find
a. substernal chest pain and pressure.
b. splinter hemorrhages of the lips.
c. dyspnea and a dry, hacking cough.
d. a new regurgitant murmur.
C
Rationale: The patient's clinical manifestations and history of IE indicate
embolization. Sudden onset flank pain is not typical of pyelonephritis, septicemia,
or glomerulonephritis. - CORRECT ANSWER A patient hospitalized with IE develops
sharp left flank pain and hematuria. The nurse notifies the health care provider,
recognizing that these symptoms may indicate
a. septicemia.
b. acute pyelonephritis.
c. vegetative embolization.
d. glomerulonephritis.
,B
Rationale: The JVD indicates that the patient may have developed cardiac
tamponade and may need rapid intervention to maintain adequate cardiac
output. Hypertension would not be associated with complications of pericarditis,
and the BP is not high enough to indicate that there is any immediate need to call
the health care provider. A pulsus paradoxus of 8 mm Hg is normal. Level 6/10
chest pain should be treated but is not unusual with pericarditis. - CORRECT
ANSWER Which of these assessment data obtained by the nurse when assessing a
patient with acute pericarditis should be reported immediately to the health care
provider?
a. Blood pressure (BP) of 166/96
b. Jugular vein distension (JVD) to the level of the jaw
c. Pulsus paradoxus 8 mm Hg
d. Level 6/10 chest pain with deep inspiration
C
Rationale: Sitting upright and leaning forward frequently will decrease the pain
associated with pericarditis. Forcing fluids will not decrease the inflammation or
pain. Taking deep respirations tends to increase pericardial pain. Opioids are not
very effective at controlling pain caused by acute inflammatory conditions and are
usually ordered PRN. The patient would receive scheduled doses of a nonsteroidal
antiinflammatory drug (NSAID). - CORRECT ANSWER The nurse has identified a
nursing diagnosis of acute pain related to inflammatory process for a patient with
acute pericarditis. The most appropriate intervention by the nurse for this
problem is to
a. force fluids to 3000 ml/day to decrease fever and inflammation.
b. teach the patient to take deep, slow respirations to control the pain.
, c. position the patient in Fowler's position, leaning forward on the overbed table.
d. remind the patient to ask for the opioid pain medication every four hours.
B
Rationale: Anticoagulation with warfarin (Coumadin) is needed for a patient with
mechanical valves to prevent clotting on the valve. There is no need to avoid high-
voltage electrical fields. Mechanical valves are durable and would last longer than
7 to 10 years. Monitoring of radial pulse is not necessary after valve replacement.
- CORRECT ANSWER During postoperative teaching with a patient who had a
mitral valve replacement with a mechanical valve, the nurse instructs the patient
regarding
a. the need to avoid high-voltage electrical fields.
b. how to monitor anticoagulation therapy.
c. the need for valve replacement in 7 to 10 years.
d. how to check the radial pulse.
B
Rationale: Crackles that are audible throughout the lungs indicate that the patient
is experiencing severe left ventricular failure and needs immediate interventions
such as diuretics. A diastolic murmur and palpable thrill would be expected in a
patient with mitral stenosis. Although 4+ peripheral edema indicates a need for a
change in therapy, it does not need to be addressed urgently. - CORRECT ANSWER
Which information obtained by the nurse when assessing a patient admitted with
mitral valve stenosis should be communicated to the health care provider
immediately?
a. The patient has a loud diastolic murmur all across the precordium.
b. The patient has crackles audible to the lung apices.
QUESTIONS WITH VERIFIED ANSWERS 2026
C
Rationale: Dental procedures place the patient with a prosthetic mitral valve at
risk for infectious endocarditis (IE). Myocardial infarction (MI), immunizations, and
a family history of endocarditis are not risk factors for IE. - CORRECT ANSWER The
nurse obtains a health history from a patient with a prosthetic mitral valve who
has symptoms of infective endocarditis. Which question by the nurse is most
appropriate?
a. "Do you have a history of a heart attack?"
b. "Have you any recent immunizations?"
c. "Have you been to the dentist lately?"
d. "Is there a family history of endocarditis?"
A
Rationale: Treatment of the IE with antibiotics should be started as quickly as
possible, but it is essential to obtain blood cultures before initiating antibiotic
therapy to obtain accurate sensitivity results. The ECG and ASA should also be
accomplished rapidly, but the blood cultures (and then administration of the
antibiotic) have highest priority. - CORRECT ANSWER The health care provider
writes the following admitting orders for a patient with suspected IE who has
fever and chills: ceftriaxone (Rocephin) 1.0 g intravenous piggyback (IVPB) q12hr,
acetylsalicylic acid (ASA) for temperature above 102° F (38.9° C), and blood
cultures 2, complete blood cell count (CBC), and electrocardiogram (ECG). When
admitting the patient, the nurse gives the highest priority to
a. obtaining the blood cultures.
,b. initiating the IV antibiotic.
c. scheduling the ECG.
d. administering the ASA.
D
Rationale: New regurgitant murmurs occur in IE because vegetation on the valves
prevents valve closure. Splinter hemorrhages occur on the nailbeds. Chest pain for
pressure is not typical for the patient with IE and would be more consistent with
angina or MI. Although dyspnea may occur as a result of heart failure, a moist
cough would be expected rather than a dry, hacking cough. - CORRECT ANSWER
During the assessment of a patient with IE, the nurse would expect to find
a. substernal chest pain and pressure.
b. splinter hemorrhages of the lips.
c. dyspnea and a dry, hacking cough.
d. a new regurgitant murmur.
C
Rationale: The patient's clinical manifestations and history of IE indicate
embolization. Sudden onset flank pain is not typical of pyelonephritis, septicemia,
or glomerulonephritis. - CORRECT ANSWER A patient hospitalized with IE develops
sharp left flank pain and hematuria. The nurse notifies the health care provider,
recognizing that these symptoms may indicate
a. septicemia.
b. acute pyelonephritis.
c. vegetative embolization.
d. glomerulonephritis.
,B
Rationale: The JVD indicates that the patient may have developed cardiac
tamponade and may need rapid intervention to maintain adequate cardiac
output. Hypertension would not be associated with complications of pericarditis,
and the BP is not high enough to indicate that there is any immediate need to call
the health care provider. A pulsus paradoxus of 8 mm Hg is normal. Level 6/10
chest pain should be treated but is not unusual with pericarditis. - CORRECT
ANSWER Which of these assessment data obtained by the nurse when assessing a
patient with acute pericarditis should be reported immediately to the health care
provider?
a. Blood pressure (BP) of 166/96
b. Jugular vein distension (JVD) to the level of the jaw
c. Pulsus paradoxus 8 mm Hg
d. Level 6/10 chest pain with deep inspiration
C
Rationale: Sitting upright and leaning forward frequently will decrease the pain
associated with pericarditis. Forcing fluids will not decrease the inflammation or
pain. Taking deep respirations tends to increase pericardial pain. Opioids are not
very effective at controlling pain caused by acute inflammatory conditions and are
usually ordered PRN. The patient would receive scheduled doses of a nonsteroidal
antiinflammatory drug (NSAID). - CORRECT ANSWER The nurse has identified a
nursing diagnosis of acute pain related to inflammatory process for a patient with
acute pericarditis. The most appropriate intervention by the nurse for this
problem is to
a. force fluids to 3000 ml/day to decrease fever and inflammation.
b. teach the patient to take deep, slow respirations to control the pain.
, c. position the patient in Fowler's position, leaning forward on the overbed table.
d. remind the patient to ask for the opioid pain medication every four hours.
B
Rationale: Anticoagulation with warfarin (Coumadin) is needed for a patient with
mechanical valves to prevent clotting on the valve. There is no need to avoid high-
voltage electrical fields. Mechanical valves are durable and would last longer than
7 to 10 years. Monitoring of radial pulse is not necessary after valve replacement.
- CORRECT ANSWER During postoperative teaching with a patient who had a
mitral valve replacement with a mechanical valve, the nurse instructs the patient
regarding
a. the need to avoid high-voltage electrical fields.
b. how to monitor anticoagulation therapy.
c. the need for valve replacement in 7 to 10 years.
d. how to check the radial pulse.
B
Rationale: Crackles that are audible throughout the lungs indicate that the patient
is experiencing severe left ventricular failure and needs immediate interventions
such as diuretics. A diastolic murmur and palpable thrill would be expected in a
patient with mitral stenosis. Although 4+ peripheral edema indicates a need for a
change in therapy, it does not need to be addressed urgently. - CORRECT ANSWER
Which information obtained by the nurse when assessing a patient admitted with
mitral valve stenosis should be communicated to the health care provider
immediately?
a. The patient has a loud diastolic murmur all across the precordium.
b. The patient has crackles audible to the lung apices.
