Lewis: Medical-Surgical Nursing
Study online at https://quizlet.com/_av7kly
1. 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?": 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.
2. 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.: 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.
3. The nurse identifies the nursing diagnosis of decreased cardiac output relat-
ed 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: 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.
4. When planning care for a patient hospitalized with a streptococcal infective
endocarditis (IE), which intervention is a priority for the nurse to include?
, Lewis: Medical-Surgical Nursing
Study online at https://quizlet.com/_av7kly
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.: 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.
5. 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.: 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.
6. 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.: 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.
, Lewis: Medical-Surgical Nursing
Study online at https://quizlet.com/_av7kly
7. The nurse suspects cardiac tamponade in a patient who has acute pericardi-
tis. 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 respira-
tory cycle.
d. listen for a pericardial friction rub that persists when the patient is instructed
to stop breathing.: 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.
8. The nurse has identified a nursing diagnosis of acute pain related to inflam-
matory 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.-
: 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).
9. The nurse is admitting a patient with possible rheumatic fever. Which ques-
tion 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?": ANS: B
Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal infection. Although illicit IV drug
Study online at https://quizlet.com/_av7kly
1. 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?": 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.
2. 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.: 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.
3. The nurse identifies the nursing diagnosis of decreased cardiac output relat-
ed 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: 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.
4. When planning care for a patient hospitalized with a streptococcal infective
endocarditis (IE), which intervention is a priority for the nurse to include?
, Lewis: Medical-Surgical Nursing
Study online at https://quizlet.com/_av7kly
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.: 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.
5. 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.: 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.
6. 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.: 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.
, Lewis: Medical-Surgical Nursing
Study online at https://quizlet.com/_av7kly
7. The nurse suspects cardiac tamponade in a patient who has acute pericardi-
tis. 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 respira-
tory cycle.
d. listen for a pericardial friction rub that persists when the patient is instructed
to stop breathing.: 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.
8. The nurse has identified a nursing diagnosis of acute pain related to inflam-
matory 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.-
: 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).
9. The nurse is admitting a patient with possible rheumatic fever. Which ques-
tion 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?": ANS: B
Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal infection. Although illicit IV drug
