TEST BANK FOR LEWIS'S MEDICAL SURGICAL NURSING IN
CANADA 5TH EDITION BY JANE TYERMAN, SHELLEY
COBBETT CHAPTER 1-72 COMPLETE GUIDE
A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral
stenosis. When explaining the advantage of valvuloplasty instead of valve replacement to the patient,
which information will the nurse include?
a. Biologic replacement valves require the use of immunosuppressive drugs.
b. Mechanical mitral valves require replacement approximately every 5 years.
c. Lifelong anticoagulant therapy is needed after mechanical valve replacement.
d. Ongoing cardiac care by a health care provider is unnecessary after valvuloplasty. - CORRECT
ANSWERS-ANS: c
Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict
decisions about career and childbearing in this patient. Mechanical valves are durable and last longer
than biologic valves. All valve repair procedures are palliative, not curative, and require lifelong health
care. Biologic valves do not activate the immune system, and immunosuppressive therapy is not needed.
While caring for a 23-year-old patient with mitral valve prolapse (MVP) without valvular regurgitation,
the nurse determines that discharge teaching has been effective when the patient states that it will be
necessary to
a. take antibiotics before any dental appointments.
b. limit physical activity to avoid stressing the heart.
c. take an aspirin a day to prevent clots from forming on the valve.
d. avoid use of over-the-counter (OTC) medications that contain stimulant drugs. - CORRECT
ANSWERS-ANS: D
Use of stimulant medications should be avoided by patients with MVP because these may exacerbate
symptoms. Daily aspirin and restricted physical activity are not needed by patients with mild MVP.
Antibiotic prophylaxis is needed for patients with MVP with regurgitation but will not be necessary for
this patient.
,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 - CORRECT ANSWERS-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. - CORRECT ANSWERS-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. - CORRECT ANSWERS-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. -
CORRECT ANSWERS-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. -
CORRECT ANSWERS-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. - CORRECT
ANSWERS-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).
CANADA 5TH EDITION BY JANE TYERMAN, SHELLEY
COBBETT CHAPTER 1-72 COMPLETE GUIDE
A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral
stenosis. When explaining the advantage of valvuloplasty instead of valve replacement to the patient,
which information will the nurse include?
a. Biologic replacement valves require the use of immunosuppressive drugs.
b. Mechanical mitral valves require replacement approximately every 5 years.
c. Lifelong anticoagulant therapy is needed after mechanical valve replacement.
d. Ongoing cardiac care by a health care provider is unnecessary after valvuloplasty. - CORRECT
ANSWERS-ANS: c
Long-term anticoagulation therapy is needed after mechanical valve replacement, and this would restrict
decisions about career and childbearing in this patient. Mechanical valves are durable and last longer
than biologic valves. All valve repair procedures are palliative, not curative, and require lifelong health
care. Biologic valves do not activate the immune system, and immunosuppressive therapy is not needed.
While caring for a 23-year-old patient with mitral valve prolapse (MVP) without valvular regurgitation,
the nurse determines that discharge teaching has been effective when the patient states that it will be
necessary to
a. take antibiotics before any dental appointments.
b. limit physical activity to avoid stressing the heart.
c. take an aspirin a day to prevent clots from forming on the valve.
d. avoid use of over-the-counter (OTC) medications that contain stimulant drugs. - CORRECT
ANSWERS-ANS: D
Use of stimulant medications should be avoided by patients with MVP because these may exacerbate
symptoms. Daily aspirin and restricted physical activity are not needed by patients with mild MVP.
Antibiotic prophylaxis is needed for patients with MVP with regurgitation but will not be necessary for
this patient.
,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 - CORRECT ANSWERS-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. - CORRECT ANSWERS-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. - CORRECT ANSWERS-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. -
CORRECT ANSWERS-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. -
CORRECT ANSWERS-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. - CORRECT
ANSWERS-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).
