LEWIS’S MEDICAL SURGICAL NURSING FINAL
PAPER 2026 FULL STUDY GUIDE
◉ During the assessment of a 25-year-old patient with infective
endocarditis (IE), the nurse would expect to find
a. substernal chest pressure.
b. a new regurgitant murmur.
c. a pruritic rash on the chest.
d. involuntary muscle movement. Answer: ANS: B
New regurgitant murmurs occur in IE because vegetations on the
valves prevent valve closure. Substernal chest discomfort, rashes,
and involuntary muscle movement are clinical manifestations of
other cardiac disorders such as angina and rheumatic fever.
◉ The nurse identifies the nursing diagnosis of decreased cardiac
output related to valvular insufficiency for the patient with infective
endocarditis (IE) based on which assessment finding(s)?
a. Fever, chills, and diaphoresis
b. Urine output less than 30 mL/hr
c. Petechiae on the inside of the mouth and conjunctiva
d. Increase in heart rate of 15 beats/minute with walking Answer:
ANS: B
,Decreased renal perfusion caused by inadequate cardiac output will
lead to decreased urine output. Petechiae, fever, chills, and
diaphoresis are symptoms of IE, but are not caused by decreased
cardiac output. An increase in pulse rate of 15 beats/minute is
normal with exercise.
◉ When planning care for a patient hospitalized with a streptococcal
infective endocarditis (IE), which intervention is a priority for the
nurse to include?
a. Monitor labs for streptococcal antibodies.
b. Arrange for placement of a long-term IV catheter.
c. Teach the importance of completing all oral antibiotics.
d. Encourage the patient to begin regular aerobic exercise. Answer:
ANS: B
Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy in
order to eradicate the bacteria, which will require a long-term IV
catheter such as a peripherally inserted central catheter (PICC) line.
Rest periods and limiting physical activity to a moderate level are
recommended during the treatment for IE. Oral antibiotics are not
effective in eradicating the infective bacteria that cause IE. Blood
cultures, rather than antibody levels, are used to monitor the
effectiveness of antibiotic therapy.
◉ A patient is admitted to the hospital with possible acute
pericarditis. The nurse should plan to teach the patient about the
purpose of
,a. echocardiography.
b. daily blood cultures.
c. cardiac catheterization.
d. 24-hour Holter monitor. Answer: ANS: A
Echocardiograms are useful in detecting the presence of the
pericardial effusions associated with pericarditis. Blood cultures are
not indicated unless the patient has evidence of sepsis. Cardiac
catheterization and 24-hour Holter monitor is not a diagnostic
procedure for pericarditis.
◉ To assess the patient with pericarditis for evidence of a
pericardial friction rub, the nurse should
a. listen for a rumbling, low-pitched, systolic murmur over the left
anterior chest.
b. auscultate by placing 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 contraction. Answer: ANS: B
Pericardial friction rubs are heard best with the diaphragm at the
lower left sternal border. The nurse should ask the patient to hold
his or her breath during auscultation to distinguish the sounds from
a pleural friction rub. Friction rubs are not typically low pitched or
, rumbling and are not confined to systole. Rubs are not assessed by
palpation.
◉ The nurse suspects cardiac tamponade in a patient who has acute
pericarditis. To assess for the presence of pulsus paradoxus, the
nurse should
a. note when Korotkoff sounds are auscultated during both
inspiration and expiration.
b. subtract the diastolic blood pressure (DBP) from the systolic
blood pressure (SBP).
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: ANS: A
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 has identified a nursing diagnosis of acute pain related
to inflammatory process for a patient with acute pericarditis. The
priority intervention by the nurse for this problem is to
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.
PAPER 2026 FULL STUDY GUIDE
◉ During the assessment of a 25-year-old patient with infective
endocarditis (IE), the nurse would expect to find
a. substernal chest pressure.
b. a new regurgitant murmur.
c. a pruritic rash on the chest.
d. involuntary muscle movement. Answer: ANS: B
New regurgitant murmurs occur in IE because vegetations on the
valves prevent valve closure. Substernal chest discomfort, rashes,
and involuntary muscle movement are clinical manifestations of
other cardiac disorders such as angina and rheumatic fever.
◉ The nurse identifies the nursing diagnosis of decreased cardiac
output related to valvular insufficiency for the patient with infective
endocarditis (IE) based on which assessment finding(s)?
a. Fever, chills, and diaphoresis
b. Urine output less than 30 mL/hr
c. Petechiae on the inside of the mouth and conjunctiva
d. Increase in heart rate of 15 beats/minute with walking Answer:
ANS: B
,Decreased renal perfusion caused by inadequate cardiac output will
lead to decreased urine output. Petechiae, fever, chills, and
diaphoresis are symptoms of IE, but are not caused by decreased
cardiac output. An increase in pulse rate of 15 beats/minute is
normal with exercise.
◉ When planning care for a patient hospitalized with a streptococcal
infective endocarditis (IE), which intervention is a priority for the
nurse to include?
a. Monitor labs for streptococcal antibodies.
b. Arrange for placement of a long-term IV catheter.
c. Teach the importance of completing all oral antibiotics.
d. Encourage the patient to begin regular aerobic exercise. Answer:
ANS: B
Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy in
order to eradicate the bacteria, which will require a long-term IV
catheter such as a peripherally inserted central catheter (PICC) line.
Rest periods and limiting physical activity to a moderate level are
recommended during the treatment for IE. Oral antibiotics are not
effective in eradicating the infective bacteria that cause IE. Blood
cultures, rather than antibody levels, are used to monitor the
effectiveness of antibiotic therapy.
◉ A patient is admitted to the hospital with possible acute
pericarditis. The nurse should plan to teach the patient about the
purpose of
,a. echocardiography.
b. daily blood cultures.
c. cardiac catheterization.
d. 24-hour Holter monitor. Answer: ANS: A
Echocardiograms are useful in detecting the presence of the
pericardial effusions associated with pericarditis. Blood cultures are
not indicated unless the patient has evidence of sepsis. Cardiac
catheterization and 24-hour Holter monitor is not a diagnostic
procedure for pericarditis.
◉ To assess the patient with pericarditis for evidence of a
pericardial friction rub, the nurse should
a. listen for a rumbling, low-pitched, systolic murmur over the left
anterior chest.
b. auscultate by placing 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 contraction. Answer: ANS: B
Pericardial friction rubs are heard best with the diaphragm at the
lower left sternal border. The nurse should ask the patient to hold
his or her breath during auscultation to distinguish the sounds from
a pleural friction rub. Friction rubs are not typically low pitched or
, rumbling and are not confined to systole. Rubs are not assessed by
palpation.
◉ The nurse suspects cardiac tamponade in a patient who has acute
pericarditis. To assess for the presence of pulsus paradoxus, the
nurse should
a. note when Korotkoff sounds are auscultated during both
inspiration and expiration.
b. subtract the diastolic blood pressure (DBP) from the systolic
blood pressure (SBP).
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: ANS: A
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 has identified a nursing diagnosis of acute pain related
to inflammatory process for a patient with acute pericarditis. The
priority intervention by the nurse for this problem is to
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.
