LEWIS MEDICAL SURGICAL STUDY GUIDE
QUESTIONS AND ANSWERS SET A+
✔✔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.
c. remind the patient to request opioid pain medication every 4 hours.
d. place the patient in Fowler's position, leaning forward on the overbed table. -
✔✔ANS: D
Sitting upright and leaning forward frequently will decrease the pain associated with
pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep
breaths will tend 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 antiinflammatory drug (NSAID).
✔✔The nurse is admitting a patient with possible rheumatic fever. Which question on
the admission health history will be most pertinent to ask?
a. "Do you use any illegal IV drugs?"
b. "Have you had a recent sore throat?"
c. "Have you injured your chest in the last few weeks?"
d. "Do you have a family history of congenital heart disease?" - ✔✔ANS: B
Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal
infection. Although illicit IV drug use should be discussed with the patient before
discharge, it is not a risk factor for rheumatic fever, and would not be as pertinent when
admitting the patient. Family history is not a risk factor for rheumatic fever. Chest injury
would cause musculoskeletal chest pain rather than rheumatic fever.
✔✔A patient with rheumatic fever has subcutaneous nodules, erythema marginatum,
and polyarthritis. Based on these findings, which nursing diagnosis would be most
appropriate?
a. Pain related to permanent joint fixation
, b. Activity intolerance related to arthralgia
c. Risk for infection related to open skin lesions
d. Risk for impaired skin integrity related to pruritus - ✔✔ANS: B
The patient's joint pain will lead to difficulty with activity. The skin lesions seen in
rheumatic fever are not open or pruritic. 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.
✔✔The nurse establishes the nursing diagnosis of ineffective health maintenance
related to lack of knowledge regarding long-term management of rheumatic fever when
a 30-year-old recovering from rheumatic fever without carditis says which of the
following?
a. "I will need prophylactic antibiotic therapy for 5 years."
b. "I will need to take aspirin or ibuprofen (Motrin) to relieve my joint pain."
c. "I will call the doctor if I develop excessive fatigue or difficulty breathing."
d. "I will be immune to further episodes of rheumatic fever after this infection." -
✔✔ANS: D
Patients with a history of rheumatic fever are more susceptible to a second episode.
Patients with rheumatic fever without carditis require prophylaxis until age 20 and for a
minimum of 5 years. The other patient statements are correct and would not support the
nursing diagnosis of ineffective health maintenance.
✔✔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.
QUESTIONS AND ANSWERS SET A+
✔✔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.
c. remind the patient to request opioid pain medication every 4 hours.
d. place the patient in Fowler's position, leaning forward on the overbed table. -
✔✔ANS: D
Sitting upright and leaning forward frequently will decrease the pain associated with
pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep
breaths will tend 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 antiinflammatory drug (NSAID).
✔✔The nurse is admitting a patient with possible rheumatic fever. Which question on
the admission health history will be most pertinent to ask?
a. "Do you use any illegal IV drugs?"
b. "Have you had a recent sore throat?"
c. "Have you injured your chest in the last few weeks?"
d. "Do you have a family history of congenital heart disease?" - ✔✔ANS: B
Rheumatic fever occurs as a result of an abnormal immune response to a streptococcal
infection. Although illicit IV drug use should be discussed with the patient before
discharge, it is not a risk factor for rheumatic fever, and would not be as pertinent when
admitting the patient. Family history is not a risk factor for rheumatic fever. Chest injury
would cause musculoskeletal chest pain rather than rheumatic fever.
✔✔A patient with rheumatic fever has subcutaneous nodules, erythema marginatum,
and polyarthritis. Based on these findings, which nursing diagnosis would be most
appropriate?
a. Pain related to permanent joint fixation
, b. Activity intolerance related to arthralgia
c. Risk for infection related to open skin lesions
d. Risk for impaired skin integrity related to pruritus - ✔✔ANS: B
The patient's joint pain will lead to difficulty with activity. The skin lesions seen in
rheumatic fever are not open or pruritic. 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.
✔✔The nurse establishes the nursing diagnosis of ineffective health maintenance
related to lack of knowledge regarding long-term management of rheumatic fever when
a 30-year-old recovering from rheumatic fever without carditis says which of the
following?
a. "I will need prophylactic antibiotic therapy for 5 years."
b. "I will need to take aspirin or ibuprofen (Motrin) to relieve my joint pain."
c. "I will call the doctor if I develop excessive fatigue or difficulty breathing."
d. "I will be immune to further episodes of rheumatic fever after this infection." -
✔✔ANS: D
Patients with a history of rheumatic fever are more susceptible to a second episode.
Patients with rheumatic fever without carditis require prophylaxis until age 20 and for a
minimum of 5 years. The other patient statements are correct and would not support the
nursing diagnosis of ineffective health maintenance.
✔✔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.
