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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.
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Cardiac tamponade is suspected in a patient who has acute pericarditis. Which of the following actions should the nurse implement to assess for the presence of pulsus paradoxus?
- A. Check the electrocardiogram (ECG) for variations in rate in relation to inspiration and expiration
- B. Note when Korotkoff sounds are audible during both inspiration and expiration.
- C. Auscultate for a pericardial friction rub that increases in volume during inspiration.
- D. Subtract the diastolic blood pressure (DBP) from the systolic blood pressure (SBP).
Correct Answer: B
Rationale: 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 is caring for a patient who has had recent cardiac surgery and develops pericarditis, with symptoms of chest pain at a level 6 (0-10 scale) with deep breathing. Which of the following prescribed PRN medications should the nurse administer?
- A. Fentanyl 2 mg IV
- B. Morphine sulphate 6 mg IV
- C. Ibuprofen 800 mg PO
- D. Acetaminophen 650 mg PO
Correct Answer: C
Rationale: The pain associated with pericarditis is caused by inflammation, so nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis.
The nurse is providing discharge teaching for a patient with mitral valve prolapse (MVP) without valvular regurgitation. Which of the following patient statements indicate that teaching has been effective?
- A. Plan to take antibiotics before any dental appointments.
- B. Limit physical activity to avoid stressing the heart valves.
- C. Take one Aspirin a day to prevent embolization from the valve.
- D. Avoid use of over-the-counter (OTC) medications that contain stimulant drugs.
Correct Answer: D
Rationale: Use of stimulant medications should be avoided by patients with MVP since these may exacerbate symptoms. Daily Aspirin and restricted physical activity are not needed by patients with mild MVP. Antibiotic prophylaxis is needed for patients with MVP with regurgitation but will not be necessary for this patient.
Which of the following techniques should the nurse use to assess the patient with pericarditis for the presence of a pericardial friction rub?
- A. Auscultate with the stethoscope diaphragm at the lower left sternal border.
- B. Listen for a rumbling, low-pitched, systolic sound over the left anterior chest.
- C. Feel the precordial area with the palm of the hand to detect vibration with cardiac contraction.
- D. Ask the patient to stop breathing during auscultation to distinguish the sound from a pleural friction rub.
Correct Answer: A
Rationale: Pericardial friction rubs are heard best with the diaphragm at the lower left sternal border. Because dyspnea is one clinical manifestation of pericarditis, the nurse should time the friction rub with the pulse rather than ask the patient to stop breathing during auscultation. Friction rubs are not typically low pitched or rumbling and are not confined to systole. Rubs are not assessed by palpation.
The nurse is assessing a patient with infective endocarditis (IE). Which of the following findings should the nurse expect to assess?
- A. A new regurgitant murmur
- B. A pruritic rash on the trunk
- C. Involuntary muscle movement
- D. Substernal chest pain and pressure
Correct Answer: A
Rationale: New regurgitant murmurs occur in IE because vegetation on the valves prevents valve closure. Substernal chest discomfort, rashes, and involuntary muscle movement are clinical manifestations of other cardiac disorders such as angina and rheumatic fever.