Lewis: Medical-
Surgical Nursing
,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?" - CORRECT ANSWERS-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. - CORRECT ANSWERS-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 - 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.
Surgical Nursing
,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?" - CORRECT ANSWERS-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. - CORRECT ANSWERS-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 - 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.
