Question 1

Which of the following prescriptions written by the health care provider for a client admitted with infective endocarditis (IE) and a fever should the nurse implement first?

Accepted Answer

Treatment of the IE with antibiotics should be started as quickly as possible, but it is essential to obtain blood cultures before initiating antibiotic therapy to obtain accurate sensitivity results. The echocardiogram and Tylenol administration also should be implemented rapidly, but the blood cultures (and then administration of the antibiotic) have the highest priority.

Question 2

The nurse is assessing a client who has mitral valve regurgitation. Which of the following findings should be communicated to the health care provider immediately?

Accepted Answer

Crackles that are audible throughout the lungs indicate that the client is experiencing severe left ventricular failure with pulmonary congestion and needs immediate interventions such as diuretics. A systolic murmur and palpable thrill would be expected in a client with mitral regurgitation. Although 4+ peripheral edema indicates a need for a change in therapy, it does not need to be addressed urgently.

Question 3

Which of the following assessment data obtained by the nurse when assessing a client with acute pericarditis should be reported immediately to the health care provider?

Accepted Answer

The JVD indicates that the client may have developed cardiac tamponade and may need rapid intervention to maintain adequate cardiac output. Hypertension would not be associated with complications of pericarditis, and the BP is not high enough to indicate that there is any immediate need to call the health care provider. A pulsus paradoxus of 8 mm Hg is normal. Level 6/10 chest pain should be treated but is not unusual with pericarditis.

Question 4

The nurse is conducting discharge teaching about the need for prophylactic antibiotics when having dental procedures. This teaching would be provided to a client with which of the following diagnoses?

Accepted Answer

Current guidelines recommend the use of prophylactic antibiotics before dental procedures for clients with prosthetic valves to prevent infective endocarditis (IE). The other clients are not at risk for IE.

Question 5

The nurse is taking a health history from a 24-year-old client with hypertrophic cardiomyopathy (HC). Which of the following information obtained by the nurse is most relevant?

Accepted Answer

About half of all cases of HC have a genetic basis, and it is the most common cause of sudden cardiac death in otherwise healthy young people; the information about the client's brother will be helpful in planning care (such as an automatic implantable
cardioverter-defibrillator [AICD]) for the client and in counselling other family members. The client should be counselled against use of stimulant drugs, but the one-time use indicates that the client is not at current risk for cocaine use. Viral infections and CAD are risk factors for dilated cardiomyopathy, but not for HC.

Question 6

Which of the following findings in a client with infective endocarditis (IE) is most important for the nurse to communicate to the health care provider?

Accepted Answer

Sudden onset of flank pain indicates possible embolization to the kidney and may require diagnostic testing such as a renal arteriogram and interventions to improve renal perfusion. The other findings are typically found in IE but do not require any new interventions.

Question 7

Which of the following assessment information obtained by the nurse for a client with aortic stenosis is most important to report to the health care provider?

Accepted Answer

Chest pain occurring with aortic stenosis is caused by cardiac ischemia, and reporting this information would be a priority. A systolic murmur and thrill are expected in a client with aortic stenosis. A PMI at the left midclavicular line is normal.

Question 8

The nurse is caring for a client who had an acute myocardial infarction (MI) 3 days prior and has symptoms of stabbing chest pain that increases with deep breathing. Which of the following actions should the nurse take first?

Accepted Answer

The client's clinical manifestations and history are consistent with pericarditis, and the first action by the nurse should be to listen for a pericardial friction rub. Checking the temperature, giving acetaminophen, and notifying the health care provider also are appropriate actions but would not be done before listening for a rub.

Quiz 39: Nursing Management Inflammatory and Structural Heart Disorders