LEWIS MEDICAL SURGICAL CORRECT TEST PAPER
QUESTIONS AND ANSWERS SET A+
✔✔A patient admitted with acute dyspnea is newly diagnosed with dilated
cardiomyopathy. Which information will the nurse plan to teach the patient about
managing this disorder?
a. A heart transplant should be scheduled as soon as possible.
b. Elevating the legs above the heart will help relieve dyspnea.
c. Careful compliance with diet and medications will prevent heart failure.
d. Notify the doctor about any symptoms of heart failure such as shortness of breath. -
✔✔ANS: D
The patient should be instructed to notify the health care provider about any worsening
of heart failure symptoms. Because dilated cardiomyopathy does not respond well to
therapy, even patients with good compliance with therapy may have recurrent episodes
of heart failure. Elevation of the legs above the heart will worsen symptoms (although
this approach is appropriate for a patient with hypertrophic cardiomyopathy). The patient
with terminal or end-stage cardiomyopathy may consider heart transplantation.
✔✔The nurse is obtaining a health history from a 24-year-old patient with hypertrophic
cardiomyopathy (HC). Which information obtained by the nurse is most important?
a. The patient has a history of a recent upper respiratory infection.
b. The patient has a family history of coronary artery disease (CAD).
c. The patient reports using cocaine a "couple of times" as a teenager.
d. The patient's 29-year-old brother died from a sudden cardiac arrest. - ✔✔ANS: D
About half of all cases of HC have a genetic basis, and it is the most common cause of
sudden cardiac death in otherwise healthy young people. The information about the
patient's brother will be helpful in planning care (such as an automatic implantable
cardioverter-defibrillator [AICD
✔✔for the patient and in counseling other family members. The patient should be
counseled against the use of stimulant drugs, but the limited past history indicates that
the patient is not at current risk for cocaine use. Viral infections and CAD are risk factors
for dilated cardiomyopathy, but not for HC. - ✔✔...
, ✔✔The nurse will plan discharge teaching about the need for prophylactic antibiotics
when having dental procedures for which patient?
a. Patient admitted with a large acute myocardial infarction.
b. Patient being discharged after an exacerbation of heart failure.
c. Patient who had a mitral valve replacement with a mechanical valve.
d. Patient being treated for rheumatic fever after a streptococcal infection. - ✔✔ANS: C
Current American Heart Association 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.
✔✔Which admission order written by the health care provider for a patient admitted with
infective endocarditis (IE) and a fever would be a priority for the nurse to implement?
a. Administer ceftriaxone (Rocephin) 1 g IV.
b. Order blood cultures drawn from two sites.
c. Give acetaminophen (Tylenol) PRN for fever.
d. Arrange for a transesophageal echocardiogram. - ✔✔ANS: B
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 acetaminophen administration also should
be implemented rapidly, but the blood cultures (and then administration of the antibiotic)
have the highest priority.
✔✔Which assessment finding in a patient who is admitted with infective endocarditis
(IE) is most important to communicate to the health care provider?
a. Generalized muscle aching
b. Sudden onset right flank pain
c. Janeway's lesions on the palms
d. Temperature 100.7° F (38.1° C) - ✔✔ANS: B
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.
✔✔Which assessment finding obtained by the nurse when assessing a patient with
acute pericarditis should be reported immediately to the health care provider?
a. Pulsus paradoxus 8 mm Hg
b. Blood pressure (BP) of 168/94
c. Jugular venous distention (JVD) to jaw level
d. Level 6 (0 to 10 scale) chest pain with a deep breath - ✔✔ANS: C
The JVD indicates that the patient may have developed cardiac tamponade and may
need rapid intervention to maintain adequate cardiac output. Hypertension would not be
associated with complications of pericarditis, and the BP is not high enough to indicate
that there is any immediate need to call the health care provider. A pulsus paradoxus of
QUESTIONS AND ANSWERS SET A+
✔✔A patient admitted with acute dyspnea is newly diagnosed with dilated
cardiomyopathy. Which information will the nurse plan to teach the patient about
managing this disorder?
a. A heart transplant should be scheduled as soon as possible.
b. Elevating the legs above the heart will help relieve dyspnea.
c. Careful compliance with diet and medications will prevent heart failure.
d. Notify the doctor about any symptoms of heart failure such as shortness of breath. -
✔✔ANS: D
The patient should be instructed to notify the health care provider about any worsening
of heart failure symptoms. Because dilated cardiomyopathy does not respond well to
therapy, even patients with good compliance with therapy may have recurrent episodes
of heart failure. Elevation of the legs above the heart will worsen symptoms (although
this approach is appropriate for a patient with hypertrophic cardiomyopathy). The patient
with terminal or end-stage cardiomyopathy may consider heart transplantation.
✔✔The nurse is obtaining a health history from a 24-year-old patient with hypertrophic
cardiomyopathy (HC). Which information obtained by the nurse is most important?
a. The patient has a history of a recent upper respiratory infection.
b. The patient has a family history of coronary artery disease (CAD).
c. The patient reports using cocaine a "couple of times" as a teenager.
d. The patient's 29-year-old brother died from a sudden cardiac arrest. - ✔✔ANS: D
About half of all cases of HC have a genetic basis, and it is the most common cause of
sudden cardiac death in otherwise healthy young people. The information about the
patient's brother will be helpful in planning care (such as an automatic implantable
cardioverter-defibrillator [AICD
✔✔for the patient and in counseling other family members. The patient should be
counseled against the use of stimulant drugs, but the limited past history indicates that
the patient is not at current risk for cocaine use. Viral infections and CAD are risk factors
for dilated cardiomyopathy, but not for HC. - ✔✔...
, ✔✔The nurse will plan discharge teaching about the need for prophylactic antibiotics
when having dental procedures for which patient?
a. Patient admitted with a large acute myocardial infarction.
b. Patient being discharged after an exacerbation of heart failure.
c. Patient who had a mitral valve replacement with a mechanical valve.
d. Patient being treated for rheumatic fever after a streptococcal infection. - ✔✔ANS: C
Current American Heart Association 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.
✔✔Which admission order written by the health care provider for a patient admitted with
infective endocarditis (IE) and a fever would be a priority for the nurse to implement?
a. Administer ceftriaxone (Rocephin) 1 g IV.
b. Order blood cultures drawn from two sites.
c. Give acetaminophen (Tylenol) PRN for fever.
d. Arrange for a transesophageal echocardiogram. - ✔✔ANS: B
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 acetaminophen administration also should
be implemented rapidly, but the blood cultures (and then administration of the antibiotic)
have the highest priority.
✔✔Which assessment finding in a patient who is admitted with infective endocarditis
(IE) is most important to communicate to the health care provider?
a. Generalized muscle aching
b. Sudden onset right flank pain
c. Janeway's lesions on the palms
d. Temperature 100.7° F (38.1° C) - ✔✔ANS: B
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.
✔✔Which assessment finding obtained by the nurse when assessing a patient with
acute pericarditis should be reported immediately to the health care provider?
a. Pulsus paradoxus 8 mm Hg
b. Blood pressure (BP) of 168/94
c. Jugular venous distention (JVD) to jaw level
d. Level 6 (0 to 10 scale) chest pain with a deep breath - ✔✔ANS: C
The JVD indicates that the patient may have developed cardiac tamponade and may
need rapid intervention to maintain adequate cardiac output. Hypertension would not be
associated with complications of pericarditis, and the BP is not high enough to indicate
that there is any immediate need to call the health care provider. A pulsus paradoxus of
