MSN 377 ACTUAL 2026 TEST PAPER QUESTIONS AND
SOLUTIONS RATED A+
✔✔Infective Endocarditis: Risk Factors - ✔✔Prior endocarditis
Prosthetic heart valves - antibiotics prophylactically before any type of procedure
Acquired valve disease
Cardiac lesions
Rheumatic heart disease
Congenital heart disease
Pacemakers
Marfan's syndrome
Cardiomyopathy
Noncardiac
-hospital acquired bacteremia
-IV drug use
-intravascular devices
-oral, respiratory, or surgical procedures
Infection erodes leaflets of valves
✔✔Infective Endocarditis: Clinical Manifestations - ✔✔Splinter hemorrhages - black
lines in nailed from microemobolization of vegetation
Petechia
Osler's nodes - red and purplish lesions on fingers and toes
Janeway's lesions - painless flat red spots
Roth's spots - retinal hemorrhages
New cardiac murmur - most commonly with aortic and pulmonic valves
Clinical signs of embolization
Low grade fever, chills, weakness, malaise, fatigue, anorexia
Arthralgia, myalgia, back pain, abdominal discomfort - joints and muscle pain
Weight loss
Headache
Clubbing of fingers may occur in subacute forms
,Ruptured cordae tendineae can occur
AV blocks may be seen on 12 lead ECG
The more infectious the organism, the more severe the symptoms
✔✔Signs of Embolization - ✔✔Spleen - sharp left upper quadrant pain and
splenomegaly
Kidneys - flank pain, hematuria, and renal failure
Brain - hemiplegia, ataxia, aphasia, visual changes, and changes in LOC
Pulmonary emboli - dyspnea, chest pain, hemoptysis, and respiratory arrest
Small peripheral blood vessels of arms and legs - ischemia and gangrene
✔✔Infective Endocarditis: Diagnosis - ✔✔Recent health history
Blood cultures - 3 drawn over a period of 1hr from 3 different sites - don't give antibiotics
before cultures
Lab - WBC and inflammatory markers (elevated CRP, sed. red increased, increased
fibrinogen which causes the RBCs to stick together and settle faster than they should
Physical exam
Echocardiogram 2D or 3D
TEE (trans esophageal echocardiogram) - through esophagus, pt is sedated, better see
valves and their function
CXR
ECG
Cardiac catheterization
✔✔Infective Endocarditis: Major Diagnostic Criteria - ✔✔Requires two of the following
Two positive blood cultures 12hrs apart
Nonvalvular regurgitation
Intracardiac mass or vegetation noted on echocardiography
✔✔Infective Endocarditis: Interprofessional Care - ✔✔Prophylactic Treatment for the
following conditions:
,-prosthetic heart valve or prosthetic material use to repair heart valve
-previous history of infectious endocarditis
-congenital heart disease (CHD)
-cardiac transplantation recipients who develop heart valve disease
Prophylactic Treatments for the following procedures:
-oral/dental manipulation
-respiratory procedures and surgery
-surgical procedures that involve infected skin, skin suture, or musculoskeletal tissues
✔✔Infective Endocarditis: Interprofessional Care: Cont. - ✔✔Hospitalization and IV
antibiotics, may be required long-term
May go home on antibiotics - need PICC line
ASA, acetaminophen
Fluids (if tolerated)
Rest
Valve replacement, excision, debridement of valves
✔✔Infective Endocarditis: Nursing Management: Assessment - ✔✔Cardiac - especially
listen for new murmurs
Musculoskeletal - arthralgia and myalgia, joint or muscle pain
Classic S/S
Hemodynamic complications
Embolic complications
✔✔Infective Endocarditis: Nursing Management: Identification of Risk Factors -
✔✔Diabetes
IV drug abuse
Known congenital heart disease
Valve replacement
Etc.
✔✔Infective Endocarditis: Nursing Management: Patient Education - ✔✔Good oral
hygiene
Stop using IV drugs
Don't share needles
, ✔✔Infective Endocarditis: Nursing Diagnoses - ✔✔Decreased cardiac output related to
altered heart rhythm, valvular insufficiency, and fluid overload
Activity intolerance related to generalized weakness, arthralgia, and alteration in O2
transport secondary to valvular dysfunction
✔✔Myocarditis: Pathophysiology - ✔✔Focal or diffuse inflammation of the myocardium,
causing cellular damage and necrosis
Results in myocardial dysfunction and one of the most common causes of dilated
cardiomyopathy
✔✔Myocarditis: Etiologies - ✔✔Coxsackie viruses A and B - most common cause
Viral, bacterial , or fungal infections
Radiation therapy
Pharmacologic and chemical factors
Autoimmune
Idiopathic
(New txs are aimed at decreasing inflammation with monoclonal antibodies)
✔✔Myocarditis: Clinical Manifestations - ✔✔Range from no overt signs to severe heart
involvement or SCD
Viral S/S: fever, fatigue, N/V, dyspnea, malaise, myalgia, pharyngitis, lymphadenopathy
Cardiac S/S:
-early signs appear 7-10 days after viral infection: pleuritic chest pain, pericardial friction
rub and effusion (pericarditis), tamponade
-late signs: heart failure s/s, S3, crackles, JVD, syncope, peripheral edema, angina
✔✔Myocarditis: Diagnosis - ✔✔ECG - nonspecific, diffuse ST changes, dysrhythmias,
conduction disturbances
Labs - elevated inflammatory markers, cardiac biomarkers, and viral titers
Nuclear scans, echocardiogram, MRI
Endomyocardial biopsy - gold standard
SOLUTIONS RATED A+
✔✔Infective Endocarditis: Risk Factors - ✔✔Prior endocarditis
Prosthetic heart valves - antibiotics prophylactically before any type of procedure
Acquired valve disease
Cardiac lesions
Rheumatic heart disease
Congenital heart disease
Pacemakers
Marfan's syndrome
Cardiomyopathy
Noncardiac
-hospital acquired bacteremia
-IV drug use
-intravascular devices
-oral, respiratory, or surgical procedures
Infection erodes leaflets of valves
✔✔Infective Endocarditis: Clinical Manifestations - ✔✔Splinter hemorrhages - black
lines in nailed from microemobolization of vegetation
Petechia
Osler's nodes - red and purplish lesions on fingers and toes
Janeway's lesions - painless flat red spots
Roth's spots - retinal hemorrhages
New cardiac murmur - most commonly with aortic and pulmonic valves
Clinical signs of embolization
Low grade fever, chills, weakness, malaise, fatigue, anorexia
Arthralgia, myalgia, back pain, abdominal discomfort - joints and muscle pain
Weight loss
Headache
Clubbing of fingers may occur in subacute forms
,Ruptured cordae tendineae can occur
AV blocks may be seen on 12 lead ECG
The more infectious the organism, the more severe the symptoms
✔✔Signs of Embolization - ✔✔Spleen - sharp left upper quadrant pain and
splenomegaly
Kidneys - flank pain, hematuria, and renal failure
Brain - hemiplegia, ataxia, aphasia, visual changes, and changes in LOC
Pulmonary emboli - dyspnea, chest pain, hemoptysis, and respiratory arrest
Small peripheral blood vessels of arms and legs - ischemia and gangrene
✔✔Infective Endocarditis: Diagnosis - ✔✔Recent health history
Blood cultures - 3 drawn over a period of 1hr from 3 different sites - don't give antibiotics
before cultures
Lab - WBC and inflammatory markers (elevated CRP, sed. red increased, increased
fibrinogen which causes the RBCs to stick together and settle faster than they should
Physical exam
Echocardiogram 2D or 3D
TEE (trans esophageal echocardiogram) - through esophagus, pt is sedated, better see
valves and their function
CXR
ECG
Cardiac catheterization
✔✔Infective Endocarditis: Major Diagnostic Criteria - ✔✔Requires two of the following
Two positive blood cultures 12hrs apart
Nonvalvular regurgitation
Intracardiac mass or vegetation noted on echocardiography
✔✔Infective Endocarditis: Interprofessional Care - ✔✔Prophylactic Treatment for the
following conditions:
,-prosthetic heart valve or prosthetic material use to repair heart valve
-previous history of infectious endocarditis
-congenital heart disease (CHD)
-cardiac transplantation recipients who develop heart valve disease
Prophylactic Treatments for the following procedures:
-oral/dental manipulation
-respiratory procedures and surgery
-surgical procedures that involve infected skin, skin suture, or musculoskeletal tissues
✔✔Infective Endocarditis: Interprofessional Care: Cont. - ✔✔Hospitalization and IV
antibiotics, may be required long-term
May go home on antibiotics - need PICC line
ASA, acetaminophen
Fluids (if tolerated)
Rest
Valve replacement, excision, debridement of valves
✔✔Infective Endocarditis: Nursing Management: Assessment - ✔✔Cardiac - especially
listen for new murmurs
Musculoskeletal - arthralgia and myalgia, joint or muscle pain
Classic S/S
Hemodynamic complications
Embolic complications
✔✔Infective Endocarditis: Nursing Management: Identification of Risk Factors -
✔✔Diabetes
IV drug abuse
Known congenital heart disease
Valve replacement
Etc.
✔✔Infective Endocarditis: Nursing Management: Patient Education - ✔✔Good oral
hygiene
Stop using IV drugs
Don't share needles
, ✔✔Infective Endocarditis: Nursing Diagnoses - ✔✔Decreased cardiac output related to
altered heart rhythm, valvular insufficiency, and fluid overload
Activity intolerance related to generalized weakness, arthralgia, and alteration in O2
transport secondary to valvular dysfunction
✔✔Myocarditis: Pathophysiology - ✔✔Focal or diffuse inflammation of the myocardium,
causing cellular damage and necrosis
Results in myocardial dysfunction and one of the most common causes of dilated
cardiomyopathy
✔✔Myocarditis: Etiologies - ✔✔Coxsackie viruses A and B - most common cause
Viral, bacterial , or fungal infections
Radiation therapy
Pharmacologic and chemical factors
Autoimmune
Idiopathic
(New txs are aimed at decreasing inflammation with monoclonal antibodies)
✔✔Myocarditis: Clinical Manifestations - ✔✔Range from no overt signs to severe heart
involvement or SCD
Viral S/S: fever, fatigue, N/V, dyspnea, malaise, myalgia, pharyngitis, lymphadenopathy
Cardiac S/S:
-early signs appear 7-10 days after viral infection: pleuritic chest pain, pericardial friction
rub and effusion (pericarditis), tamponade
-late signs: heart failure s/s, S3, crackles, JVD, syncope, peripheral edema, angina
✔✔Myocarditis: Diagnosis - ✔✔ECG - nonspecific, diffuse ST changes, dysrhythmias,
conduction disturbances
Labs - elevated inflammatory markers, cardiac biomarkers, and viral titers
Nuclear scans, echocardiogram, MRI
Endomyocardial biopsy - gold standard
