Which of the following clients is most at risk for developing endocarditis?
- A. A client who recently had a valve replacement and had dental work recently performed
- B. A client who recently underwent a valve replacement
- C. A client with Marfan's syndrome
- D. A client recently diagnosed with mitral stenosis
Correct Answer: A
Rationale: Endocarditis loves damaged valves and bacteremia recent valve replacement plus dental work (a bacterial gateway) spikes risk, as prosthetic valves are prime targets post-procedure. Valve replacement alone risks less without a trigger. Marfan's or mitral stenosis predispose, but lack acute catalysts like dental work. Nurses flag this combo surgery and oral breach anticipating prophylaxis or monitoring, a top risk in endocarditis's infectious playbook.
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A nurse provides care on a bone marrow transplant unit and is preparing a female patient for a hematopoietic stem cell transplantation (HSCT) the following day. What information should the nurse emphasize to the patient's family and friends?
- A. Your family should likely gather at the bedside in case there's a negative outcome
- B. Make sure she doesn't eat any food in the 24 hours before the procedure
- C. Wear a hospital gown when you go into the patient's room
- D. Do not visit if you've had a recent infection
Correct Answer: D
Rationale: HSCT wipes out immunity, leaving patients prone to sepsis recent infections in visitors could bring pathogens (e.g., flu, strep) into her sterile bubble. Telling family to skip visits if sick is priority, trumping gown-wearing (useful but secondary) or fasting (not typically 24 hours). Gathering for a bad outcome's overly grim HSCT's risky but not a death sentence pre-procedure. Nurses stress this to shield the patient during the 2-4 week engraftment window, when neutropenia peaks, making infection control the linchpin of pre-transplant education in oncology.
An intra-venous drug user with endocarditis has a TOE and multiple blood cultures taken. He is most likely to have:
- A. tricuspid valve involvement and s.aureus on blood culture
- B. tricuspid valve involvement and enterococci on blood culture
- C. mitral valve involvement and mixed growth on blood culture
- D. tricuspid valve involvement and candida on blood culture
Correct Answer: A
Rationale: IVDU endocarditis tricuspid flops, Staph aureus spikes, not enterococci, mixed, candida, or blanks. Nurses hear this chronic junkie beat.
An oncology patient has begun to experience skin reactions to radiation therapy, prompting the nurse to make the diagnosis Impaired Skin Integrity: erythematous reaction to radiation therapy. What intervention best addresses this nursing diagnosis?
- A. Apply an ice pack or heating pad PRN to relieve pain and pruritis
- B. Avoid skin contact with water whenever possible
- C. Apply phototherapy PRN
- D. Avoid rubbing or scratching the affected area
Correct Answer: D
Rationale: Radiation erythema's tender rubbing or scratching tears it open, risking infection. Ice or heat burns it worse; water's fine for gentle cleaning, not avoidance. Phototherapy's for jaundice, not this. Nurses push hands off' to protect radiated skin, a staple in oncology to heal without added damage.
Upon percussion of the midclavicular line from cranial to caudal, you can locate the absolute and relative lung-liver borders. Question: What produces the sound you hear between these two borders?
- A. It is caused by lung tissue
- B. It is caused by liver tissue
- C. It is caused by colon tissue
- D. It is caused by the overlap of lung tissue and liver tissue
Correct Answer: D
Rationale: Lung-liver edge overlap dulls the tap, not pure lung, liver, or colon. Nurses hear this, a chronic border beat.
A 7-year-old child with osteosarcoma is being treated with chemotherapy. Which medication would the nurse expect the physician to order most commonly as a prophylaxis against Pneumocystis jirovecii?
- A. Trimethoprim-sulfamethoxazole
- B. Ketoconazole
- C. Filgastim
- D. Prednisone
Correct Answer: A
Rationale: Osteosarcoma chemotherapy compromises the immune system, increasing susceptibility to opportunistic infections like Pneumocystis jirovecii pneumonia (PCP), a serious risk in immunocompromised children. Trimethoprim-sulfamethoxazole (TMP-SMX) is the most common prophylactic antibiotic for PCP, effectively preventing this lung infection by targeting its causative organism. Ketoconazole treats fungal infections but not PCP, which is caused by a fungus-like organism requiring specific therapy. Filgrastim stimulates neutrophil production to combat neutropenia, not PCP directly. Prednisone, a corticosteroid, suppresses immunity and reduces tumor-related edema but doesn't prevent infections and may increase risk. The nurse anticipates TMP-SMX due to its established role in pediatric oncology protocols, ensuring protection against a preventable, potentially fatal complication during chemotherapy.