LEWIS MEDICAL SURGICAL EVALUATION TEST
QUESTIONS AND ANSWERS SET A+
✔✔The nurse provides discharge instructions for a 40-year-old woman who is newly
diagnosed with cardiomyopathy. Which statement, if made by the patient, indicates that
further teaching is necessary?
A."I will avoid lifting heavy objects."
B. "I can drink alcohol in moderation."
C."My family will need to take a CPR course."
D. "I will reduce stress by learning guided imagery." - ✔✔B. "I can drink alcohol in
moderation."
Patients with cardiomyopathy should avoid alcohol consumption, especially in patients
with alcohol-related dilated cardiomyopathy. Avoiding heavy lifting and stress, as well as
family members learning CPR, are recommended teaching points.
✔✔ The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral
valve who has symptoms of infective endocarditis (IE). Which question by the nurse is
most appropriate?
a. "Do you have a history of a heart attack?"
b. "Is there a family history of endocarditis?"
c. "Have you had any recent immunizations?"
d. "Have you had dental work done recently?" - ✔✔ANS: d.
Dental procedures place the patient with a prosthetic mitral valve at risk for infective
endocarditis (IE). Myocardial infarction (MI), immunizations, and a family history of
endocarditis are not risk factors for IE.
✔✔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. - ✔✔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 - ✔✔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. - ✔✔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. - ✔✔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.
QUESTIONS AND ANSWERS SET A+
✔✔The nurse provides discharge instructions for a 40-year-old woman who is newly
diagnosed with cardiomyopathy. Which statement, if made by the patient, indicates that
further teaching is necessary?
A."I will avoid lifting heavy objects."
B. "I can drink alcohol in moderation."
C."My family will need to take a CPR course."
D. "I will reduce stress by learning guided imagery." - ✔✔B. "I can drink alcohol in
moderation."
Patients with cardiomyopathy should avoid alcohol consumption, especially in patients
with alcohol-related dilated cardiomyopathy. Avoiding heavy lifting and stress, as well as
family members learning CPR, are recommended teaching points.
✔✔ The nurse obtains a health history from a 65-year-old patient with a prosthetic mitral
valve who has symptoms of infective endocarditis (IE). Which question by the nurse is
most appropriate?
a. "Do you have a history of a heart attack?"
b. "Is there a family history of endocarditis?"
c. "Have you had any recent immunizations?"
d. "Have you had dental work done recently?" - ✔✔ANS: d.
Dental procedures place the patient with a prosthetic mitral valve at risk for infective
endocarditis (IE). Myocardial infarction (MI), immunizations, and a family history of
endocarditis are not risk factors for IE.
✔✔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. - ✔✔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 - ✔✔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. - ✔✔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. - ✔✔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.
