Study Guide/Review for Final Exam
Practice Questions for Exam 1
Endocarditis/Pericarditis
The pericardium layer consists of a fibrous layer that is made up of two layers
called the parietal and visceral layers.
a.True
b.False
A patient is recovering from a myocardial infarction (MI) and develops chest pain
on day 3 that increases when taking a deep breath and is relieved by leaning
forward. Which action should the nurse take next?
a. Assess the feet for pedal edema.
b. Palpate the radial pulses bilaterally.
c. Auscultate for a pericardial friction rub.
d. Check the heart monitor for dysrhythmias.
True or False: Endocarditis only affects the atrioventricular and semi-lunar valves
in the heart.
False
Rationale: Endocarditis can affect not only the heart valves but the interventricular
septum and chordae tendineae as well.
You're providing discharge teaching to a patient being treated for endocarditis.
Which statement by the patient demonstrated they understood your teaching
about this condition?
A. "I will stop taking the antibiotics once my fever is gone in order to prevent antibiotic
resistance."
B. "I will only wash my hands with soap and water."
C. "I will inform my dentist about my history of endocarditis prior to any invasive
procedures."
D. "I will avoid eating fish and organ meats."
A patient being treated for infective endocarditis is complaining of very sharp
radiating abdominal pain that goes to the left shoulder and back. As the nurse
familiar with complications of infective endocarditis, what do you suspect is the
cause of this patient finding?
A. Renal embolic event
B. Pulmonary embolic event
C. Central nervous system embolic event
D. Splenic embolic event
You are providing care to a patient with pericarditis. Which of the following is NOT
a proper nursing intervention for this patient?
A. Monitor the patient for complications of cardiac tamponade.
B. Administer Ibuprofen as scheduled.
C. Place the patient in supine position to relieve pain.
D. Monitor the patient for pulsus paradoxus and muffled heart sounds.
A patient with severe pericarditis has developed a large pericardial effusion. The
patient is symptomatic. The physician orders what type of procedure to help treat
this condition?
A. Pericardiectomy
B. Heart catheterization
,C. Thoracotomy
D. Pericardiocentesis
A child is admitted to the pediatric unit with a diagnosis of infective endocarditis. Which of
the following interventions should the healthcare provider anticipate? Select all that apply.
1. Seizure precautions
2. Contact isolation
3.Echocardiogram
4. Intravenous antibiotics
5. Blood cultures
The nurse conducts a complete physical assessment on a patient admitted with infective
endocarditis. Which finding is significant?
a. Respiratory rate of 18 and heart rate of 90
b. Regurgitant murmur at the mitral valve area
c. Heart rate of 94 and capillary refill time of 2 seconds
d. Point of maximal impulse palpable in fourth intercostal space
Rationale: B ---A regurgitant murmur of the aortic or mitral valves would indicate valvular
disease, which is a complication of endocarditis. All the other findings are within normal
limits.
When caring for a patient with infective endocarditis, the nurse will assess the patient for
which vascular manifestations (select all that apply)?
a. Osler's nodes
b. Janeway's lesions
c. Splinter hemorrhages
d. Subcutaneous nodules
e. Erythema marginatum lesions
Rationale: Osler's nodes, Janeway's lesions, and splinter hemorrhages are all
vascular manifestations of infective endocarditis. Subcutaneous nodules and
erythema marginatum lesions occur with rheumatic fever.
The patient with pericarditis is complaining of chest pain. After assessment,
which intervention should the nurse expect to implement to provide pain relief?
a. Corticosteroids
b. Morphine sulfate
c. Proton pump inhibitor
d. Nonsteroidal antiinflammatory drugs
Rationale: Nonsteroidal antiinflammatory drugs (NSAIDs) will control pain and inflammation.
Corticosteroids are reserved for patients already taking corticosteroids for autoimmune
conditions or those who do not respond to NSAIDs. Morphine is not necessary. Proton pump
,inhibitors are used to decrease stomach acid to avoid the risk of GI bleeding from the
NSAIDs.
The nurse completes a nursing history with a patient with infective endocarditis.
A significant finding that constitutes a risk factor for infective endocarditis is:
a. A recent myocardial infarction
b. Recent cardiac catheterization
c. Hypertension
d. Recent streptococcal pharyngitis
While caring for a patient who has acute pericarditis, the nurse suspects the
development of cardiac tamponade based on which assessment finding?
a. A pulsus paradoxus of 8 mmHg
b. Jugular vein distention
c. Increased systolic blood pressure with widening pulse pressure
d. Hiccoughs and hoarseness
The nurse has identified a nursing diagnosis of pain related to inflammatory process for a
patient who has acute pericarditis. Which nursing intervention planned by the nurse ismost
appropriate for this problem?
a. Force fluids to 3000 mL/day to decrease fever and inflammation
b. Teach the patient to take shallow, rapid respirations to control the pain
c. Position the patient in Fowler's position, leaning forward on a padded overbed table
d. Consult with the physician to provide intravenous narcotic analgesics for pain control
Rationale: NOT SUPINE !!!
The nurse is caring for a client admitted for acute pericarditis. Which nursing
diagnosis should take priority during the first 24 hours of nursing care?
0 Risk for falls related to weakness, pain, and dizziness
0 Acute pain related to inflammation of the pericardium
0 Imbalanced nutrition: less than body requirements related to decreased intake, nausea
and anorexia
0 Activity intolerance related to fatigue and physical weakness
Rationale: There is acute pain associated with the inflammation of the pericardium.
Pericarditis causes severe pain with rapid onset that worsens with breathing,
coughing, and/or changing positions. Leaning forward can help alleviate the pain. Such
pain prevents the ability to help respiratory efforts. It worsens as excessive
accumulation of fluid in the pericardial sac occurs. The result is decreased stroke volume
and compression of the heart. Another very common finding with pericarditis is a pleural
friction rub. A pleural friction rub has a scratching, grating sound similar to leather rubbing
against leather.
, Part of the plan of care for a client who recently received mechanical valve
prosthesis is discharge education for home management. Which information will
the nurse determine to have the most priority?
0 The need to reschedule valve replacement within 5 years
0 Report near high or low blood pressure and heart rates
0 Strategies for preventing atherosclerosis
0 Strategies for infection prevention
Rationale: Bacterial (infective) endocarditis is a condition which can occur if a person
has received a mechanical valve prosthesis. To help reduce this risk, the client should
be taught infection prevention (handwashing, avoidance of sick individuals and
taking prophylactic antibiotics prior to any invasive procedure, including dental
procedures). Bacterial endocarditis is an infection that can be caused by bacteria which
enters the bloodstream and attaches itself to the heart valve or cardiac blood vessel. This
vegetation grows within the heart valve or vessel and can result in serious heart damage or
death related to emboli.
A client reports a cough, fatigue, and a low-grade fever. Which medical history of
a client should the nurse report immediately since it is most commonly associated
with pericarditis?
Recent strep infection
Recent influenza infection
20 year history of osteoarthritis
Hypoparathyroidism
Rationale Recent Strep infection is not correct because a recent bacterial, strep infection is a rare
cause of pericarditis. Pericarditis most often has an unknown etiology, but a medical history of recent
viral illnesses, such as influenza, Epstein-Barr, mumps, varicella, and rubella, are associated with the
condition. However, an inadequately treated strep bacterial infection is an etiology for
rheumatic fever that can cause endocarditis, but not pericarditis.
A nurse performing triage on a client suspects the client of having endocarditis. Which
symptom(s) support this suspicion? Select all that apply.
Recent stomach virus
Chest discomfort with breathing
Night sweats
Aching muscles and joints
Fever and chills
Rationale: Symptoms of bacterial (infective) endocarditis include chest discomfort with
breathing, night sweats, fever, chills, and aching joints and muscles.Bacterial
(infective) endocarditis is an infection that can be caused by bacteria which enters the
bloodstream and attaches itself to the heart valve or cardiac blood vessel. This vegetation
grows within the heart valve or vessel and can result in serious heart damage or death
Practice Questions for Exam 1
Endocarditis/Pericarditis
The pericardium layer consists of a fibrous layer that is made up of two layers
called the parietal and visceral layers.
a.True
b.False
A patient is recovering from a myocardial infarction (MI) and develops chest pain
on day 3 that increases when taking a deep breath and is relieved by leaning
forward. Which action should the nurse take next?
a. Assess the feet for pedal edema.
b. Palpate the radial pulses bilaterally.
c. Auscultate for a pericardial friction rub.
d. Check the heart monitor for dysrhythmias.
True or False: Endocarditis only affects the atrioventricular and semi-lunar valves
in the heart.
False
Rationale: Endocarditis can affect not only the heart valves but the interventricular
septum and chordae tendineae as well.
You're providing discharge teaching to a patient being treated for endocarditis.
Which statement by the patient demonstrated they understood your teaching
about this condition?
A. "I will stop taking the antibiotics once my fever is gone in order to prevent antibiotic
resistance."
B. "I will only wash my hands with soap and water."
C. "I will inform my dentist about my history of endocarditis prior to any invasive
procedures."
D. "I will avoid eating fish and organ meats."
A patient being treated for infective endocarditis is complaining of very sharp
radiating abdominal pain that goes to the left shoulder and back. As the nurse
familiar with complications of infective endocarditis, what do you suspect is the
cause of this patient finding?
A. Renal embolic event
B. Pulmonary embolic event
C. Central nervous system embolic event
D. Splenic embolic event
You are providing care to a patient with pericarditis. Which of the following is NOT
a proper nursing intervention for this patient?
A. Monitor the patient for complications of cardiac tamponade.
B. Administer Ibuprofen as scheduled.
C. Place the patient in supine position to relieve pain.
D. Monitor the patient for pulsus paradoxus and muffled heart sounds.
A patient with severe pericarditis has developed a large pericardial effusion. The
patient is symptomatic. The physician orders what type of procedure to help treat
this condition?
A. Pericardiectomy
B. Heart catheterization
,C. Thoracotomy
D. Pericardiocentesis
A child is admitted to the pediatric unit with a diagnosis of infective endocarditis. Which of
the following interventions should the healthcare provider anticipate? Select all that apply.
1. Seizure precautions
2. Contact isolation
3.Echocardiogram
4. Intravenous antibiotics
5. Blood cultures
The nurse conducts a complete physical assessment on a patient admitted with infective
endocarditis. Which finding is significant?
a. Respiratory rate of 18 and heart rate of 90
b. Regurgitant murmur at the mitral valve area
c. Heart rate of 94 and capillary refill time of 2 seconds
d. Point of maximal impulse palpable in fourth intercostal space
Rationale: B ---A regurgitant murmur of the aortic or mitral valves would indicate valvular
disease, which is a complication of endocarditis. All the other findings are within normal
limits.
When caring for a patient with infective endocarditis, the nurse will assess the patient for
which vascular manifestations (select all that apply)?
a. Osler's nodes
b. Janeway's lesions
c. Splinter hemorrhages
d. Subcutaneous nodules
e. Erythema marginatum lesions
Rationale: Osler's nodes, Janeway's lesions, and splinter hemorrhages are all
vascular manifestations of infective endocarditis. Subcutaneous nodules and
erythema marginatum lesions occur with rheumatic fever.
The patient with pericarditis is complaining of chest pain. After assessment,
which intervention should the nurse expect to implement to provide pain relief?
a. Corticosteroids
b. Morphine sulfate
c. Proton pump inhibitor
d. Nonsteroidal antiinflammatory drugs
Rationale: Nonsteroidal antiinflammatory drugs (NSAIDs) will control pain and inflammation.
Corticosteroids are reserved for patients already taking corticosteroids for autoimmune
conditions or those who do not respond to NSAIDs. Morphine is not necessary. Proton pump
,inhibitors are used to decrease stomach acid to avoid the risk of GI bleeding from the
NSAIDs.
The nurse completes a nursing history with a patient with infective endocarditis.
A significant finding that constitutes a risk factor for infective endocarditis is:
a. A recent myocardial infarction
b. Recent cardiac catheterization
c. Hypertension
d. Recent streptococcal pharyngitis
While caring for a patient who has acute pericarditis, the nurse suspects the
development of cardiac tamponade based on which assessment finding?
a. A pulsus paradoxus of 8 mmHg
b. Jugular vein distention
c. Increased systolic blood pressure with widening pulse pressure
d. Hiccoughs and hoarseness
The nurse has identified a nursing diagnosis of pain related to inflammatory process for a
patient who has acute pericarditis. Which nursing intervention planned by the nurse ismost
appropriate for this problem?
a. Force fluids to 3000 mL/day to decrease fever and inflammation
b. Teach the patient to take shallow, rapid respirations to control the pain
c. Position the patient in Fowler's position, leaning forward on a padded overbed table
d. Consult with the physician to provide intravenous narcotic analgesics for pain control
Rationale: NOT SUPINE !!!
The nurse is caring for a client admitted for acute pericarditis. Which nursing
diagnosis should take priority during the first 24 hours of nursing care?
0 Risk for falls related to weakness, pain, and dizziness
0 Acute pain related to inflammation of the pericardium
0 Imbalanced nutrition: less than body requirements related to decreased intake, nausea
and anorexia
0 Activity intolerance related to fatigue and physical weakness
Rationale: There is acute pain associated with the inflammation of the pericardium.
Pericarditis causes severe pain with rapid onset that worsens with breathing,
coughing, and/or changing positions. Leaning forward can help alleviate the pain. Such
pain prevents the ability to help respiratory efforts. It worsens as excessive
accumulation of fluid in the pericardial sac occurs. The result is decreased stroke volume
and compression of the heart. Another very common finding with pericarditis is a pleural
friction rub. A pleural friction rub has a scratching, grating sound similar to leather rubbing
against leather.
, Part of the plan of care for a client who recently received mechanical valve
prosthesis is discharge education for home management. Which information will
the nurse determine to have the most priority?
0 The need to reschedule valve replacement within 5 years
0 Report near high or low blood pressure and heart rates
0 Strategies for preventing atherosclerosis
0 Strategies for infection prevention
Rationale: Bacterial (infective) endocarditis is a condition which can occur if a person
has received a mechanical valve prosthesis. To help reduce this risk, the client should
be taught infection prevention (handwashing, avoidance of sick individuals and
taking prophylactic antibiotics prior to any invasive procedure, including dental
procedures). Bacterial endocarditis is an infection that can be caused by bacteria which
enters the bloodstream and attaches itself to the heart valve or cardiac blood vessel. This
vegetation grows within the heart valve or vessel and can result in serious heart damage or
death related to emboli.
A client reports a cough, fatigue, and a low-grade fever. Which medical history of
a client should the nurse report immediately since it is most commonly associated
with pericarditis?
Recent strep infection
Recent influenza infection
20 year history of osteoarthritis
Hypoparathyroidism
Rationale Recent Strep infection is not correct because a recent bacterial, strep infection is a rare
cause of pericarditis. Pericarditis most often has an unknown etiology, but a medical history of recent
viral illnesses, such as influenza, Epstein-Barr, mumps, varicella, and rubella, are associated with the
condition. However, an inadequately treated strep bacterial infection is an etiology for
rheumatic fever that can cause endocarditis, but not pericarditis.
A nurse performing triage on a client suspects the client of having endocarditis. Which
symptom(s) support this suspicion? Select all that apply.
Recent stomach virus
Chest discomfort with breathing
Night sweats
Aching muscles and joints
Fever and chills
Rationale: Symptoms of bacterial (infective) endocarditis include chest discomfort with
breathing, night sweats, fever, chills, and aching joints and muscles.Bacterial
(infective) endocarditis is an infection that can be caused by bacteria which enters the
bloodstream and attaches itself to the heart valve or cardiac blood vessel. This vegetation
grows within the heart valve or vessel and can result in serious heart damage or death
