Adult Health 2 Final Exam
The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of
infective endocarditis. Which question by the nurse is most appropriate?
a. "Do you have a history of a heart attack?"
b. "Have you any recent immunizations?"
c. "Have you been to the dentist lately?"
d. "Is there a family history of endocarditis?" - ANS C
Rationale: Dental procedures place the patient with a prosthetic mitral valve at risk for infectious
endocarditis (IE). Myocardial infarction (MI), immunizations, and a family history of endocarditis are not
risk factors for IE.
The health care provider writes the following admitting orders for a patient with suspected IE who has
fever and chills: ceftriaxone (Rocephin) 1.0 g intravenous piggyback (IVPB) q12hr, acetylsalicylic acid
(ASA) for temperature above 102° F (38.9° C), and blood cultures 2, complete blood cell count (CBC), and
electrocardiogram (ECG). When admitting the patient, the nurse gives the highest priority to
a. obtaining the blood cultures.
b. initiating the IV antibiotic.
c. scheduling the ECG.
d. administering the ASA. - ANS A
Rationale: 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
ECG and ASA should also be accomplished rapidly, but the blood cultures (and then administration of
the antibiotic) have highest priority.
During the assessment of a patient with IE, the nurse would expect to find
a. substernal chest pain and pressure.
b. splinter hemorrhages of the lips.
c. dyspnea and a dry, hacking cough.
,d. a new regurgitant murmur. - ANS D
Rationale: New regurgitant murmurs occur in IE because vegetation on the valves prevents valve
closure. Splinter hemorrhages occur on the nailbeds. Chest pain for pressure is not typical for the
patient with IE and would be more consistent with angina or MI. Although dyspnea may occur as a result
of heart failure, a moist cough would be expected rather than a dry, hacking cough.
A patient hospitalized with IE develops sharp left flank pain and hematuria. The nurse notifies the health
care provider, recognizing that these symptoms may indicate
a. septicemia.
b. acute pyelonephritis.
c. vegetative embolization.
d. glomerulonephritis. - ANS C
Rationale: The patient's clinical manifestations and history of IE indicate embolization. Sudden onset
flank pain is not typical of pyelonephritis, septicemia, or glomerulonephritis.
Which of these assessment data obtained by the nurse when assessing a patient with acute pericarditis
should be reported immediately to the health care provider?
a. Blood pressure (BP) of 166/96
b. Jugular vein distension (JVD) to the level of the jaw
c. Pulsus paradoxus 8 mm Hg
d. Level 6/10 chest pain with deep inspiration - ANS B
Rationale: 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 8 mm Hg is normal. Level 6/10 chest pain should
be treated but is not unusual with pericarditis.
The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient
with acute pericarditis. The most appropriate intervention by the nurse for this problem is to
a. force fluids to 3000 ml/day to decrease fever and inflammation.
,b. teach the patient to take deep, slow respirations to control the pain.
c. position the patient in Fowler's position, leaning forward on the overbed table.
d. remind the patient to ask for the opioid pain medication every four hours. - ANS C
Rationale: Sitting upright and leaning forward frequently will decrease the pain associated with
pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep respirations tends 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).
During postoperative teaching with a patient who had a mitral valve replacement with a mechanical
valve, the nurse instructs the patient regarding
a. the need to avoid high-voltage electrical fields.
b. how to monitor anticoagulation therapy.
c. the need for valve replacement in 7 to 10 years.
d. how to check the radial pulse. - ANS B
Rationale: Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to
prevent clotting on the valve. There is no need to avoid high-voltage electrical fields. Mechanical valves
are durable and would last longer than 7 to 10 years. Monitoring of radial pulse is not necessary after
valve replacement.
Which information obtained by the nurse when assessing a patient admitted with mitral valve stenosis
should be communicated to the health care provider immediately?
a. The patient has a loud diastolic murmur all across the precordium.
b. The patient has crackles audible to the lung apices.
c. The patient has a palpable thrill felt over the left anterior chest.
d. The patient has 4+ peripheral edema in both legs. - ANS B
Rationale: Crackles that are audible throughout the lungs indicate that the patient is experiencing severe
left ventricular failure and needs immediate interventions such as diuretics. A diastolic murmur and
palpable thrill would be expected in a patient with mitral stenosis. Although 4+ peripheral edema
indicates a need for a change in therapy, it does not need to be addressed urgently.
, A patient with percarditis reports increasing chest pain. The nurse further assesses the patient's pain
based on the knowledge that:
A. chest pain with pericarditis is expected, but increasing chest pain could indicate other complications,
such as a myocardial infacrtion
B. chest pain with pericarditis in an uncommon finding and needs to be further assessed
C. actually, assessing chest pain is not necessary
D. I can't come up with a third option so please pick one of the above - ANS A. chest pain with
pericarditis is expected, but increasing chest pain could indicate other complications, such as a
myocardial infarction.
It is important to distinguish between these two types of chest pain, since the treatment plans are
different.
A patient with pericarditis reports increasing chest pain. The nurse further assess the patient's pain.
Which on the following manifestations leads the nurse to believe that the patient is experiencing a
myocardial infarction?
A. pain increases with deep breathing and lying flat
B. pain is relieved with sitting up and leaning forward
C. pain is described as crushing pressure, lasting more than 30 minutes
D. pleural fricition rub is heard upon ausculation - ANS C. pain is described as crushing pressure, lasting
more than 30 minutes
The other answer choices are expected findings for a patient with pericarditis.
In planning community education for prevention of spinal cord injuries, the nurse targets
a. elderly men
The nurse obtains a health history from a patient with a prosthetic mitral valve who has symptoms of
infective endocarditis. Which question by the nurse is most appropriate?
a. "Do you have a history of a heart attack?"
b. "Have you any recent immunizations?"
c. "Have you been to the dentist lately?"
d. "Is there a family history of endocarditis?" - ANS C
Rationale: Dental procedures place the patient with a prosthetic mitral valve at risk for infectious
endocarditis (IE). Myocardial infarction (MI), immunizations, and a family history of endocarditis are not
risk factors for IE.
The health care provider writes the following admitting orders for a patient with suspected IE who has
fever and chills: ceftriaxone (Rocephin) 1.0 g intravenous piggyback (IVPB) q12hr, acetylsalicylic acid
(ASA) for temperature above 102° F (38.9° C), and blood cultures 2, complete blood cell count (CBC), and
electrocardiogram (ECG). When admitting the patient, the nurse gives the highest priority to
a. obtaining the blood cultures.
b. initiating the IV antibiotic.
c. scheduling the ECG.
d. administering the ASA. - ANS A
Rationale: 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
ECG and ASA should also be accomplished rapidly, but the blood cultures (and then administration of
the antibiotic) have highest priority.
During the assessment of a patient with IE, the nurse would expect to find
a. substernal chest pain and pressure.
b. splinter hemorrhages of the lips.
c. dyspnea and a dry, hacking cough.
,d. a new regurgitant murmur. - ANS D
Rationale: New regurgitant murmurs occur in IE because vegetation on the valves prevents valve
closure. Splinter hemorrhages occur on the nailbeds. Chest pain for pressure is not typical for the
patient with IE and would be more consistent with angina or MI. Although dyspnea may occur as a result
of heart failure, a moist cough would be expected rather than a dry, hacking cough.
A patient hospitalized with IE develops sharp left flank pain and hematuria. The nurse notifies the health
care provider, recognizing that these symptoms may indicate
a. septicemia.
b. acute pyelonephritis.
c. vegetative embolization.
d. glomerulonephritis. - ANS C
Rationale: The patient's clinical manifestations and history of IE indicate embolization. Sudden onset
flank pain is not typical of pyelonephritis, septicemia, or glomerulonephritis.
Which of these assessment data obtained by the nurse when assessing a patient with acute pericarditis
should be reported immediately to the health care provider?
a. Blood pressure (BP) of 166/96
b. Jugular vein distension (JVD) to the level of the jaw
c. Pulsus paradoxus 8 mm Hg
d. Level 6/10 chest pain with deep inspiration - ANS B
Rationale: 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 8 mm Hg is normal. Level 6/10 chest pain should
be treated but is not unusual with pericarditis.
The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a patient
with acute pericarditis. The most appropriate intervention by the nurse for this problem is to
a. force fluids to 3000 ml/day to decrease fever and inflammation.
,b. teach the patient to take deep, slow respirations to control the pain.
c. position the patient in Fowler's position, leaning forward on the overbed table.
d. remind the patient to ask for the opioid pain medication every four hours. - ANS C
Rationale: Sitting upright and leaning forward frequently will decrease the pain associated with
pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep respirations tends 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).
During postoperative teaching with a patient who had a mitral valve replacement with a mechanical
valve, the nurse instructs the patient regarding
a. the need to avoid high-voltage electrical fields.
b. how to monitor anticoagulation therapy.
c. the need for valve replacement in 7 to 10 years.
d. how to check the radial pulse. - ANS B
Rationale: Anticoagulation with warfarin (Coumadin) is needed for a patient with mechanical valves to
prevent clotting on the valve. There is no need to avoid high-voltage electrical fields. Mechanical valves
are durable and would last longer than 7 to 10 years. Monitoring of radial pulse is not necessary after
valve replacement.
Which information obtained by the nurse when assessing a patient admitted with mitral valve stenosis
should be communicated to the health care provider immediately?
a. The patient has a loud diastolic murmur all across the precordium.
b. The patient has crackles audible to the lung apices.
c. The patient has a palpable thrill felt over the left anterior chest.
d. The patient has 4+ peripheral edema in both legs. - ANS B
Rationale: Crackles that are audible throughout the lungs indicate that the patient is experiencing severe
left ventricular failure and needs immediate interventions such as diuretics. A diastolic murmur and
palpable thrill would be expected in a patient with mitral stenosis. Although 4+ peripheral edema
indicates a need for a change in therapy, it does not need to be addressed urgently.
, A patient with percarditis reports increasing chest pain. The nurse further assesses the patient's pain
based on the knowledge that:
A. chest pain with pericarditis is expected, but increasing chest pain could indicate other complications,
such as a myocardial infacrtion
B. chest pain with pericarditis in an uncommon finding and needs to be further assessed
C. actually, assessing chest pain is not necessary
D. I can't come up with a third option so please pick one of the above - ANS A. chest pain with
pericarditis is expected, but increasing chest pain could indicate other complications, such as a
myocardial infarction.
It is important to distinguish between these two types of chest pain, since the treatment plans are
different.
A patient with pericarditis reports increasing chest pain. The nurse further assess the patient's pain.
Which on the following manifestations leads the nurse to believe that the patient is experiencing a
myocardial infarction?
A. pain increases with deep breathing and lying flat
B. pain is relieved with sitting up and leaning forward
C. pain is described as crushing pressure, lasting more than 30 minutes
D. pleural fricition rub is heard upon ausculation - ANS C. pain is described as crushing pressure, lasting
more than 30 minutes
The other answer choices are expected findings for a patient with pericarditis.
In planning community education for prevention of spinal cord injuries, the nurse targets
a. elderly men
