LEWIS MEDICAL SURGICAL MAIN SET QUESTIONS
AND ANSWERS SET A+
✔✔When developing a community health program to decrease the incidence of
rheumatic fever, which action would be most important for the community health nurse
to include?
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 antibiotics to those with a family history of rheumatic fever.
- ✔✔ANS: B
The incidence of rheumatic fever is decreased by treatment of streptococcal infections
with antibiotics. Family history is not a risk factor for rheumatic fever. There is no
immunization that is effective in decreasing the incidence of rheumatic fever. Teaching
about monitoring temperature will not decrease the incidence of rheumatic fever.
✔✔When caring for a patient with mitral valve stenosis, it is most important that the
nurse assess for:
a. diastolic murmur.
b. peripheral edema.
c. right upper quadrant tenderness.
d. complaints of shortness of breath. - ✔✔ANS: d
The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs,
resulting in hypoxemia and dyspnea. The other findings also may be associated with
mitral valve disease but are not indicators of possible hypoxemia.
✔✔A 21-year-old woman is scheduled for percutaneous transluminal balloon
valvuloplasty to treat mitral stenosis. When explaining the advantage of valvuloplasty
instead of valve replacement to the patient, which information will the nurse include?
a. Biologic replacement valves require the use of immunosuppressive drugs.
b. Mechanical mitral valves require replacement approximately every 5 years.
, c. Lifelong anticoagulant therapy is needed after mechanical valve replacement.
d. Ongoing cardiac care by a health care provider is unnecessary after valvuloplasty. -
✔✔ANS: c
Long-term anticoagulation therapy is needed after mechanical valve replacement, and
this would restrict decisions about career and childbearing in this patient. Mechanical
valves are durable and last longer than biologic valves. All valve repair procedures are
palliative, not curative, and require lifelong health care. Biologic valves do not activate
the immune system, and immunosuppressive therapy is not needed.
✔✔While caring for a 23-year-old patient with mitral valve prolapse (MVP) without
valvular regurgitation, the nurse determines that discharge teaching has been effective
when the patient states that it will be necessary to
a. take antibiotics before any dental appointments.
b. limit physical activity to avoid stressing the heart.
c. take an aspirin a day to prevent clots from forming on the valve.
d. avoid use of over-the-counter (OTC) medications that contain stimulant drugs. -
✔✔ANS: D
Use of stimulant medications should be avoided by patients with MVP because 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.
✔✔While caring for a patient with aortic stenosis, the nurse identifies a nursing
diagnosis of acute pain related to decreased coronary blood flow. A priority nursing
intervention for this patient would be to
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. - ✔✔ANS: A
Rest is recommended to balance myocardial oxygen supply and demand and to
decrease chest pain. The patient with aortic stenosis requires higher preload to maintain
cardiac output, so nitroglycerin and measures to decrease venous return are
contraindicated. Anticoagulation is not recommended unless the patient has atrial
fibrillation.
✔✔During discharge teaching with a 68-year-old patient who had a mitral valve
replacement with a mechanical valve, the nurse instructs the patient on the
a. use of daily aspirin for anticoagulation.
b. correct method for taking the radial pulse.
c. need for frequent laboratory blood testing.
d. need to avoid any physical activity for 1 month. - ✔✔ANS: C
Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves
to prevent clotting on the valve. This will require frequent international normalized ratio
(INR) testing. Daily aspirin use will not be effective in reducing the risk for clots on the
AND ANSWERS SET A+
✔✔When developing a community health program to decrease the incidence of
rheumatic fever, which action would be most important for the community health nurse
to include?
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 antibiotics to those with a family history of rheumatic fever.
- ✔✔ANS: B
The incidence of rheumatic fever is decreased by treatment of streptococcal infections
with antibiotics. Family history is not a risk factor for rheumatic fever. There is no
immunization that is effective in decreasing the incidence of rheumatic fever. Teaching
about monitoring temperature will not decrease the incidence of rheumatic fever.
✔✔When caring for a patient with mitral valve stenosis, it is most important that the
nurse assess for:
a. diastolic murmur.
b. peripheral edema.
c. right upper quadrant tenderness.
d. complaints of shortness of breath. - ✔✔ANS: d
The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs,
resulting in hypoxemia and dyspnea. The other findings also may be associated with
mitral valve disease but are not indicators of possible hypoxemia.
✔✔A 21-year-old woman is scheduled for percutaneous transluminal balloon
valvuloplasty to treat mitral stenosis. When explaining the advantage of valvuloplasty
instead of valve replacement to the patient, which information will the nurse include?
a. Biologic replacement valves require the use of immunosuppressive drugs.
b. Mechanical mitral valves require replacement approximately every 5 years.
, c. Lifelong anticoagulant therapy is needed after mechanical valve replacement.
d. Ongoing cardiac care by a health care provider is unnecessary after valvuloplasty. -
✔✔ANS: c
Long-term anticoagulation therapy is needed after mechanical valve replacement, and
this would restrict decisions about career and childbearing in this patient. Mechanical
valves are durable and last longer than biologic valves. All valve repair procedures are
palliative, not curative, and require lifelong health care. Biologic valves do not activate
the immune system, and immunosuppressive therapy is not needed.
✔✔While caring for a 23-year-old patient with mitral valve prolapse (MVP) without
valvular regurgitation, the nurse determines that discharge teaching has been effective
when the patient states that it will be necessary to
a. take antibiotics before any dental appointments.
b. limit physical activity to avoid stressing the heart.
c. take an aspirin a day to prevent clots from forming on the valve.
d. avoid use of over-the-counter (OTC) medications that contain stimulant drugs. -
✔✔ANS: D
Use of stimulant medications should be avoided by patients with MVP because 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.
✔✔While caring for a patient with aortic stenosis, the nurse identifies a nursing
diagnosis of acute pain related to decreased coronary blood flow. A priority nursing
intervention for this patient would be to
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. - ✔✔ANS: A
Rest is recommended to balance myocardial oxygen supply and demand and to
decrease chest pain. The patient with aortic stenosis requires higher preload to maintain
cardiac output, so nitroglycerin and measures to decrease venous return are
contraindicated. Anticoagulation is not recommended unless the patient has atrial
fibrillation.
✔✔During discharge teaching with a 68-year-old patient who had a mitral valve
replacement with a mechanical valve, the nurse instructs the patient on the
a. use of daily aspirin for anticoagulation.
b. correct method for taking the radial pulse.
c. need for frequent laboratory blood testing.
d. need to avoid any physical activity for 1 month. - ✔✔ANS: C
Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves
to prevent clotting on the valve. This will require frequent international normalized ratio
(INR) testing. Daily aspirin use will not be effective in reducing the risk for clots on the
