Med Surg TB Chapter 36 Flashcards


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1

The nurse obtains a health history from an older adult with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse helps identify a risk factor for IE?

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: D

2

What finding should the nurse expect during the assessment of a young adult with infective endocarditis (IE)?

A) Substernal chest procedure

B) A new regurgitant murmur

C) A pruritic rash on the chest

D) Involuntary muscle movement

Answer: B

3

Which assessment finding(s) indicate to the nurse that a patient with infective endocarditis has decreased cardiac output?

A) Fever, chills, diaphoresis

B) Urine production of 25 mL/hr

C) Increase in heart rate of 15 beats/min with walking

D) Petechiae on the inside of the mouth and conjunctiva

Answer: B

4

When planning care for a patient hospitalized with a streptococcal infective endocarditis (IE), which intervention is appropriate for the nurse to include?

A) Arrange for placement of a long-term IV catheter.

B) Monitor labs for levels of streptococcal antibodies.

C) Teach the importance of completing all oral antibiotics.

D) Encourage the patient to begin aerobic exercise.

Answer: A

5

A patient is admitted to the hospital with possible acute pericarditis. What diagnostic test would the nurse expect the patient to undergo?

A) Blood cultures

B) Echocardiography

C) Cardiac catheterization

D) 24-hour Holter monitor

Answer: B

6

How should the nurse assess the patient with pericarditis for evidence of a pericardial friction rub?

A) Listen for a rumbling, low-pitched, systolic murmur over the left anterior chest.

B) Auscultate with 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 contractions.

Answer: B

7

The nurse suspects cardiac tamponade in a patient who has acute pericarditis. How should the nurse assess for the presence of pulsus paradoxus?

A) Subtract the diastolic blood pressure from the systolic blood pressure.

B) Note when Korotkoff sounds are heard during both inspiration and expiration.

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: B

8

A patient has pain due to acute pericarditis. What is an appropriate nursing intervention for this problem?

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) Place the patient in Fowler's position, leaning forward on the table.

D) Provide a fresh ice bag every hour for the patient to place on the chest.

Answer: C

9

The nurse is admitting a patient with possible rheumatic fever. Which question on the admission health history focuses on a pertinent risk factor for rheumatic fever?

A) "Do you use any illegal IV drugs?"

B) "Have you ever injured your chest?"

C) "Have you had a recent sore throat?"

D) "Do you have a family history of heart disease?"

Answer: C

10

A patient with rheumatic fever has subcutaneous nodules, erythema marginatium, and polyarthritis. The patient reports the joint discomfort prevents favorite activities such as taking a daily walk and sewing. What problem should be the focus of nursing interventions?

A) Social isolation

B) General anxiety

C) Activity intolerance

D) Altered body image

Answer: C

11

The home health nurse is visiting a 30-year-old patient recovering from rheumatic fever without carditis. Which statement by the patient indicates a need for further teaching?

A) "I will need prophylactic antibiotic therapy for 5 years."

B) "I can take aspirin or ibuprofen to relieve my joint pain."

C) "I will be immune to future episodes of rheumatic fever after this infection."

D) "I should call the health care provider if I am fatigued or have difficulty breathing."

Answer: C

12

Which action should the nurse include in a community health program to decrease the incidence of rheumatic fever?

A) Vaccinate high-risk groups in the community with streptococcal vaccine.

B) Teach community members to seek treatment for streptococcal pharyngitis.

C) Teach about the importance of monitoring temperature when sore throats occur.

D) Teach about prophylactic antibiotic to those with a family history of rheumatic fever.

Answer: B

13

Which finding for a patient with mitral valve stenosis would be of most concern to the nurse?

A) Diastolic murmur

B) Peripheral edema

C) Shortness of breath on exertion

D) Right upper quadrant tenderness

Answer: C

14

A 21-year-old woman is scheduled for percutaneous transluminal balloon valvuloplasty to treat mitral stenosis. Which information should the nurse include when explaining the advantages of valvuloplasty over valve replacement to the patient?

A) Biologic valves will require immunosuppressive drugs after surgery.

B) Mechanical mitral valves need to be replaced sooner than biologic valves.

C) Lifelong anticoagulant therapy is needed after mechanical valve replacement.

D) Ongoing cardiac care by a health care provider is not necessary after valvuloplasty.

Answer: C

15

Which statement by a 23-year-old patient who has mitral valve prolapse (MVP) without valvular regurgitation indicates that discharge teaching has been effective?

A) "I will take antibiotics before any dental appointments."
B) "I will limit physical activity to avoid stressing the heart."

C) "I should avoid over the counter drugs that contain stimulants."

D) "I should take an aspirin a day to prevent clots from forming on the valve."

Answer: C

16

A patient with aortic stenosis has acute pain due to decreased coronary blood flow. What would be an appropriate nursing intervention for this patient?

A) Promote rest to decrease myocardial oxygen demand.

B) Teach the patient about the need for anticoagulant therapy.

C) Teach the patient to use sublingual nitroglycerin for chest pain.

D) Raise the head of the bed 60 degrees to decrease venous return.

Answer: A

17

An older adult patient who had a mitral valve replacement with a mechanical valve is taking warfarin. What should the nurse include in discharge teaching?

A) Use of daily aspirin for anticoagulation.

B) Correct method for taking the radial pulse.

C) Need for frequent laboratory blood testing.

D) Plan to avoid any physical activity for 1 month.

Answer: C

18

A patient recovering from heart surgery develops pericarditis and reports level 6 (0 to 10 scale) chest pain with deep breathing. Which prescribed PRN medication will be the most appropriate for the nurse to give?

A) Fentanyl 1 mg IV

B) IV morphine sulfate 4 mg

C) Oral ibuprofen (Motrin) 600 mg

D) Oral acetaminophen (Tylenol) 650 mg

Answer: C

19

What nursing assessment finding for a patient with infective endocarditis would be consistent with embolized vegetations from the tricuspid valve?

A) Flank pain

B) Splenomegaly

C) Shortness of breath

D) Mental status changes

Answer: C

20

A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient?

A) A heart transplant should be scheduled as soon as possible.

B) Elevating the legs above the heart will help relieve dyspnea.

C) Careful compliance with diet and medications will prevent heart failure.

D) Notify the health care provider about symptoms such as shortness of breath.

Answer: D

21

The nurse is obtaining a health history from a 24-yr-old patient with hypertrophic cardiomyopathy (CMP). Which information obtained by the nurse is most important in planning care?

A) The patient had a recent upper respiratory infection.

B) The patient has a family history of coronary artery disease.

C) The patient reports using cocaine "a few times" as a teenager.

D) The patient's 29-yr-old brother died fro sudden cardiac arrest.

Answer: D

22

Which patient will need the nurse to plan discharge teaching about prophylactic antibiotics before dental procedures?

A) Patient admitted with a large acute myocardial infarction

B) Patient being discharged after an exacerbation of heart failure

C) Patient who had a mitral valve replacement with a mechanical valve

D) Patient being treated for rheumatic fever after a streptococcal infection

Answer: C

23

Which admission order written by the health care provider for a patient admitted with infective endocarditis (IE) and a fever would be a priority for the nurse to implement?

A) Administer ceftriaxone 1 gram IV.

B) Order blood cultures from two sites.

C) Schedule a transesophageal echocardiogram.

D) Give acetaminophen (Tylenol) PRN for fever.

Answer: B

24

Which assessment finding in a patient who is admitted with infective endocarditis (IE) is most important to communicate to the health care provider?

A) Muscle aching

B) Right flank pain

C) Janeway's lesions on the palms

D) Temperature 100.7 oF (38.1 oC)

Answer: B

25

Which finding by a nurse assessing a patient with acute pericarditis should be reported immediately to the health care provider?

A) Pulsus paradoxus 8 mm Hg

B) Blood pressure (BP) of 168/94 mm Hg

C) Jugular vein distension (JVD) to jaw level

D) Level 6 (0 to 10 scale) chest pain with a deep breath

Answer: C

26

The nurse is caring for a patient with aortic stenosis. Which assessment data would be most important to report to the health care provider?

A) The patient reports chest pressure when ambulating.

B) A loud systolic murmur is heard along the right sternal border.

C) A thrill is palpated at the second intercostal space, right sternal border.

D) The point of maximal impulse (PMI) is at the left midclavicular line.

Answer: A

27

Two days after an acute myocardial infarction (MI), a patient reports stabbing chest pain that increases with a deep breath. Which action will the nurse take first?

A) Auscultate the heart sounds.

B) Check the patient's temperature.

C) Give PRN acetaminophen (Tylenol).

D) Notify the patient's health care provider.

Answer: A

28

The nurse is caring for a patient admitted with mitral valve regurgitation. Which information obtained by the nurse should be reported to the health care provider immediately?

A) The patient has 4+ peripheral edema.

B) The patient has diffuse bilateral crackles.

C) The patient has a loud systolic murmur across the precordium.

D) The patient has a palpable thrill felt over the left anterior chest.

Answer: B

29

Which action by the nurse will determine if therapies ordered for a patient with chronic constrictive pericarditis are effective?

A) Assess for the presence of a paradoxical pulse.

B) Monitor for changes in the patient's sedimentation rate.

C) Assess for the presence of jugular vein distention (JVD).

D) Check the electrocardiogram (ECG) for ST segment changes.

Answer: C

30

Which statement by a patient with restrictive cardiomyopathy indicates that the nurse's discharge teaching about self-management has been effective?

A) "I will avoid taking aspirin or other inflammatory drugs."

B) "I can restart my exercise program that includes hiking and biking."

C) "I will need to limit my intake of salt and fluids even in hot weather."

D) "I will take antibiotics before my teeth are cleaned at the dental office."

Answer: D

31

The nurse is assessing a patient with myocarditis before giving a scheduled dose of digoxin (Lanoxin). Which finding is most important for the nurse to communicate to the health care provider?

A) Fatigue

B) Leukocytosis

C) Irregular pulse

D) Generalized myalgia

Answer: C

32

After receiving change-of-shift report on four patients, which patient should the nurse assess first?

A) Patient with rheumatic fever who has sharp chest pain with a deep breath.

B) Patient with acute aortic regurgitation whose blood pressure is 86/54 mm Hg.

C) Patient with infective endocarditis who has a murmur and splinter hemorrhages.

D) Patient with dilated cardiomyopathy who has bilateral crackles at the lung bases.

Answer: B

33

After receiving information about four patients during change-of-shift report which patient should the nurse assess first?

A) Patient with acute pericarditis who has a pericardial friction rub.

B) Patient who has just returned to the unit after balloon valvuloplasty.

C) Patient who has hypertrophic cardiomyopathy and a heart rate of 116.

D) Patient with a mitral valve replacement who has an anticoagulant scheduled.

Answer: B

34

Which action could the nurse delegate to unlicensed assistive personnel (UAP) trained as electrocardiogram (ECG) technicians working on the cardiac unit?

A) Select the best lead for monitoring a patient with an admission diagnosis of Dressler syndrome.

B) Obtain a list of herbal medications used at home while admitting a new patient with pericarditis.

C) Teach about the need to monitor the weight daily for a patient who has hypertrophic cardiomyopathy.

D) Watch the heart monitor for changes in rhythm while a patient who had a valve replacement ambulates.

Answer: D