Nokea
Which of the following findings in a patient with infective endocarditis (IE) is most important for the nurse to communicate to the health care provider?
- A. Generalized muscle aching
- B. Sudden onset left flank pain
- C. Janeway's lesions on the palms
- D. Temperature 38.1°C
Correct Answer: B
Rationale: 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.
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Which of the following prescriptions written by the health care provider for a patient admitted with infective endocarditis (IE) and a fever should the nurse implement first?
- A. Order blood cultures drawn from two sites.
- B. Give acetaminophen (Tylenol) PRN for fever.
- C. Administer ceftriaxone 1 g IV
- D. Obtain a transesophageal echocardiogram.
Correct Answer: A
Rationale: 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.
The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient with acute pericarditis. Which of the following actions is best for the nurse to implement?
- A. Force fluids to 3000 ml to decrease fever and inflammation.
- B. Teach about deep, slow respirations to control the pain.
- C. Remind the patient to ask for the opioid pain medication every 4 hours.
- D. Position the patient in Fowler's position, leaning forward on the overbed table.
Correct Answer: D
Rationale: Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep respirations tends 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 anti-inflammatory drug (NSAID).
The nurse is obtaining a health history from a patient with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which of the following questions by the nurse is best?
- A. Have you been to the dentist lately?
- B. Do you have a history of a heart attack?
- C. Is there a family history of endocarditis?
- D. Have you had any recent immunizations?
Correct Answer: A
Rationale: 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.
The nurse is conducting discharge teaching about the need for prophylactic antibiotics when having dental procedures. This teaching would be provided to a patient with which of the following diagnoses?
- A. Acute myocardial infarction
- B. Exacerbation of heart failure
- C. Mechanical mitral valve replacement
- D. Rheumatic fever after a streptococcal infection
Correct Answer: C
Rationale: Current guidelines recommend the use of prophylactic antibiotics before dental procedures for patients with prosthetic valves to prevent infective endocarditis (IE). The other patients are not at risk for IE.
The nurse is caring for a patient with rheumatic fever who has subcutaneous nodules, erythema marginatum, and polyarthritis. Which of the following nursing diagnoses best reflects these findings?
- A. Activity intolerance related to physical deconditioning (arthralgia)
- B. Risk for infection as evidenced by immunosuppression
- C. Chronic pain related to injury agent (permanent joint fixation)
- D. Risk for impaired skin integrity evidenced by pressure over bony prominence
Correct Answer: A
Rationale: The patient's joint pain will lead to difficulty with activity. The skin lesions seen in rheumatic fever are not open or pruritic and thus do not pose a high risk for infection. Although acute joint pain will be a problem for this patient, joint inflammation is a temporary clinical manifestation of rheumatic fever and is not associated with permanent joint changes.