[Year]
Med surg exam final_Study guide/Review
, 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
, 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.
Med surg exam final_Study guide/Review
, 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
, 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.
