Test Bank For Medical-Surgical Nursing: Assessment and
Management of Clinical Problems 9th Edition By Sharon Lewis,
Shannon Dirksen, Margaret Heitkemper, Linda Bucher
9780323086783 Chapter 1-69 Complete Guide .
The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has
symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate?
a. "Do you have a history of a heart attack?"
b. "Is there a family history of endocarditis?"
c. "Have you had any recent immunizations?"
d. "Have you had dental work done recently?" - ANSWER: ANS: d.
Dental procedures place the patient with a prosthetic mitral valve at risk for infective endocarditis
(IE). Myocardial infarction (MI), immunizations, and a family history of endocarditis are not risk
factors for IE.
During the assessment of a 25-year-old patient with infective endocarditis (IE), the nurse would
expect to find
a. substernal chest pressure.
b. a new regurgitant murmur.
c. a pruritic rash on the chest.
d. involuntary muscle movement. - ANSWER: ANS: B
New regurgitant murmurs occur in IE because vegetations on the valves prevent valve closure.
Substernal chest discomfort, rashes, and involuntary muscle movement are clinical manifestations of
other cardiac disorders such as angina and rheumatic fever.
The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency
for the patient with infective endocarditis (IE) based on which assessment finding(s)?
a. Fever, chills, and diaphoresis
b. Urine output less than 30 mL/hr
c. Petechiae on the inside of the mouth and conjunctiva
d. Increase in heart rate of 15 beats/minute with walking - ANSWER: ANS: B
Decreased renal perfusion caused by inadequate cardiac output will lead to decreased urine output.
Petechiae, fever, chills, and diaphoresis are symptoms of IE, but are not caused by decreased cardiac
output. An increase in pulse rate of 15 beats/minute is normal with exercise.
When planning care for a patient hospitalized with a streptococcal infective endocarditis (IE), which
intervention is a priority for the nurse to include?
a. Monitor labs for streptococcal antibodies.
b. Arrange for placement of a long-term IV catheter.
c. Teach the importance of completing all oral antibiotics.
d. Encourage the patient to begin regular aerobic exercise. - ANSWER: ANS: B
Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy in order to eradicate the bacteria,
which will require a long-term IV catheter such as a peripherally inserted central catheter (PICC) line.
Rest periods and limiting physical activity to a moderate level are recommended during the treatment
for IE. Oral antibiotics are not effective in eradicating the infective bacteria that cause IE. Blood
cultures, rather than antibody levels, are used to monitor the effectiveness of antibiotic therapy.
A patient is admitted to the hospital with possible acute pericarditis. The nurse should plan to teach
the patient about the purpose of
a. echocardiography.
b. daily blood cultures.
, c. cardiac catheterization.
d. 24-hour Holter monitor. - ANSWER: ANS: A
Echocardiograms are useful in detecting the presence of the pericardial effusions associated with
pericarditis. Blood cultures are not indicated unless the patient has evidence of sepsis. Cardiac
catheterization and 24-hour Holter monitor is not a diagnostic procedure for pericarditis.
To assess the patient with pericarditis for evidence of a pericardial friction rub, the nurse should
a. listen for a rumbling, low-pitched, systolic murmur over the left anterior chest.
b. auscultate by placing the diaphragm of the stethoscope on the lower left sternal border.
c. ask the patient to cough during auscultation to distinguish the sound from a pleural friction rub.
d. feel the precordial area with the palm of the hand to detect vibrations with cardiac contraction. -
ANSWER: ANS: B
Pericardial friction rubs are heard best with the diaphragm at the lower left sternal border. The nurse
should ask the patient to hold his or her breath during auscultation to distinguish the sounds from a
pleural friction rub. Friction rubs are not typically low pitched or rumbling and are not confined to
systole. Rubs are not assessed by palpation.
The nurse suspects cardiac tamponade in a patient who has acute pericarditis. To assess for the
presence of pulsus paradoxus, the nurse should
a. note when Korotkoff sounds are auscultated during both inspiration and expiration.
b. subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP).
c. check the electrocardiogram (ECG) for variations in rate during the respiratory cycle.
d. listen for a pericardial friction rub that persists when the patient is instructed to stop breathing. -
ANSWER: ANS: A
Pulsus paradoxus exists when there is a gap of greater than 10 mm Hg between when Korotkoff
sounds can be heard during only expiration and when they can be heard throughout the respiratory
cycle. The other methods described would not be useful in determining the presence of pulsus
paradoxus.
The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a
patient with acute pericarditis. The priority intervention by the nurse for this problem is to
a. teach the patient to take deep, slow breaths to control the pain.
b. force fluids to 3000 mL/day to decrease fever and inflammation.
c. remind the patient to request opioid pain medication every 4 hours.
d. place the patient in Fowler's position, leaning forward on the overbed table. - ANSWER: ANS: D
Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis.
Forcing fluids will not decrease the inflammation or pain. Taking deep breaths will tend 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).
The nurse is admitting a patient with possible rheumatic fever. Which question on the admission
health history will be most pertinent to ask?
a. "Do you use any illegal IV drugs?"
b. "Have you had a recent sore throat?"
c. "Have you injured your chest in the last few weeks?"
d. "Do you have a family history of congenital heart disease?" - ANSWER: ANS: B
Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal infection.
Although illicit IV drug use should be discussed with the patient before discharge, it is not a risk factor
for rheumatic fever, and would not be as pertinent when admitting the patient. Family history is not a
risk factor for rheumatic fever. Chest injury would cause musculoskeletal chest pain rather than
rheumatic fever.
A patient with rheumatic fever has subcutaneous nodules, erythema marginatum, and polyarthritis.
Based on these findings, which nursing diagnosis would be most appropriate?
a. Pain related to permanent joint fixation
b. Activity intolerance related to arthralgia
Management of Clinical Problems 9th Edition By Sharon Lewis,
Shannon Dirksen, Margaret Heitkemper, Linda Bucher
9780323086783 Chapter 1-69 Complete Guide .
The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral valve who has
symptoms of infective endocarditis (IE). Which question by the nurse is most appropriate?
a. "Do you have a history of a heart attack?"
b. "Is there a family history of endocarditis?"
c. "Have you had any recent immunizations?"
d. "Have you had dental work done recently?" - ANSWER: ANS: d.
Dental procedures place the patient with a prosthetic mitral valve at risk for infective endocarditis
(IE). Myocardial infarction (MI), immunizations, and a family history of endocarditis are not risk
factors for IE.
During the assessment of a 25-year-old patient with infective endocarditis (IE), the nurse would
expect to find
a. substernal chest pressure.
b. a new regurgitant murmur.
c. a pruritic rash on the chest.
d. involuntary muscle movement. - ANSWER: ANS: B
New regurgitant murmurs occur in IE because vegetations on the valves prevent valve closure.
Substernal chest discomfort, rashes, and involuntary muscle movement are clinical manifestations of
other cardiac disorders such as angina and rheumatic fever.
The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency
for the patient with infective endocarditis (IE) based on which assessment finding(s)?
a. Fever, chills, and diaphoresis
b. Urine output less than 30 mL/hr
c. Petechiae on the inside of the mouth and conjunctiva
d. Increase in heart rate of 15 beats/minute with walking - ANSWER: ANS: B
Decreased renal perfusion caused by inadequate cardiac output will lead to decreased urine output.
Petechiae, fever, chills, and diaphoresis are symptoms of IE, but are not caused by decreased cardiac
output. An increase in pulse rate of 15 beats/minute is normal with exercise.
When planning care for a patient hospitalized with a streptococcal infective endocarditis (IE), which
intervention is a priority for the nurse to include?
a. Monitor labs for streptococcal antibodies.
b. Arrange for placement of a long-term IV catheter.
c. Teach the importance of completing all oral antibiotics.
d. Encourage the patient to begin regular aerobic exercise. - ANSWER: ANS: B
Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy in order to eradicate the bacteria,
which will require a long-term IV catheter such as a peripherally inserted central catheter (PICC) line.
Rest periods and limiting physical activity to a moderate level are recommended during the treatment
for IE. Oral antibiotics are not effective in eradicating the infective bacteria that cause IE. Blood
cultures, rather than antibody levels, are used to monitor the effectiveness of antibiotic therapy.
A patient is admitted to the hospital with possible acute pericarditis. The nurse should plan to teach
the patient about the purpose of
a. echocardiography.
b. daily blood cultures.
, c. cardiac catheterization.
d. 24-hour Holter monitor. - ANSWER: ANS: A
Echocardiograms are useful in detecting the presence of the pericardial effusions associated with
pericarditis. Blood cultures are not indicated unless the patient has evidence of sepsis. Cardiac
catheterization and 24-hour Holter monitor is not a diagnostic procedure for pericarditis.
To assess the patient with pericarditis for evidence of a pericardial friction rub, the nurse should
a. listen for a rumbling, low-pitched, systolic murmur over the left anterior chest.
b. auscultate by placing the diaphragm of the stethoscope on the lower left sternal border.
c. ask the patient to cough during auscultation to distinguish the sound from a pleural friction rub.
d. feel the precordial area with the palm of the hand to detect vibrations with cardiac contraction. -
ANSWER: ANS: B
Pericardial friction rubs are heard best with the diaphragm at the lower left sternal border. The nurse
should ask the patient to hold his or her breath during auscultation to distinguish the sounds from a
pleural friction rub. Friction rubs are not typically low pitched or rumbling and are not confined to
systole. Rubs are not assessed by palpation.
The nurse suspects cardiac tamponade in a patient who has acute pericarditis. To assess for the
presence of pulsus paradoxus, the nurse should
a. note when Korotkoff sounds are auscultated during both inspiration and expiration.
b. subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP).
c. check the electrocardiogram (ECG) for variations in rate during the respiratory cycle.
d. listen for a pericardial friction rub that persists when the patient is instructed to stop breathing. -
ANSWER: ANS: A
Pulsus paradoxus exists when there is a gap of greater than 10 mm Hg between when Korotkoff
sounds can be heard during only expiration and when they can be heard throughout the respiratory
cycle. The other methods described would not be useful in determining the presence of pulsus
paradoxus.
The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a
patient with acute pericarditis. The priority intervention by the nurse for this problem is to
a. teach the patient to take deep, slow breaths to control the pain.
b. force fluids to 3000 mL/day to decrease fever and inflammation.
c. remind the patient to request opioid pain medication every 4 hours.
d. place the patient in Fowler's position, leaning forward on the overbed table. - ANSWER: ANS: D
Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis.
Forcing fluids will not decrease the inflammation or pain. Taking deep breaths will tend 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).
The nurse is admitting a patient with possible rheumatic fever. Which question on the admission
health history will be most pertinent to ask?
a. "Do you use any illegal IV drugs?"
b. "Have you had a recent sore throat?"
c. "Have you injured your chest in the last few weeks?"
d. "Do you have a family history of congenital heart disease?" - ANSWER: ANS: B
Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal infection.
Although illicit IV drug use should be discussed with the patient before discharge, it is not a risk factor
for rheumatic fever, and would not be as pertinent when admitting the patient. Family history is not a
risk factor for rheumatic fever. Chest injury would cause musculoskeletal chest pain rather than
rheumatic fever.
A patient with rheumatic fever has subcutaneous nodules, erythema marginatum, and polyarthritis.
Based on these findings, which nursing diagnosis would be most appropriate?
a. Pain related to permanent joint fixation
b. Activity intolerance related to arthralgia
