Med-Surg 1 In class quiz 3
The patient diagnosed with rheumatic fever is receiving education about antibiotics. What teaching is most important? 1 "Antibiotics should be taken with food." 2. "All of the medication should be taken." 3 "The medication may cause nausea or diarrhea." 4 "If a dose is missed, it should be taken with the next scheduled dose."
"All of the medication should be taken."
A patient with heart failure is prescribed enalapril. Which instructions are most important for a safe and effective treatment outcome? Select all that apply. 1 "Avoid sodium intake." 2 "Check your weight daily." 3 "Avoid potassium-rich foods." 4 "Do not worry if a cough develops." 5 "Move slowly while changing positions."
"Avoid potassium-rich foods." "Do not worry if a cough develops." "Move slowly while changing positions."
A patient prescribed ibuprofen 24 hours ago for pericarditis asks the nurse why the pain has not improved. What statement by the nurse is most appropriate? 1 "You may not be taking enough ibuprofen." 2 "It may take another day before you have pain relief." 3"You should make sure you're taking the ibuprofen with food." 4 "The ibuprofen will not help with the pain; it is prescribed to decrease inflammation."
"It may take another day before you have pain relief."
What teaching intervention is the nurse least likely to provide to a stable chronic heart failure patient? 1 "You should avoid overdoing exercise." 2 "You should start exercising only when your edema stabilizes." 3 "You need to avoid salty food and addition of table salt to food." 4 "You cannot claim Medicare reimbursement for cardiac rehabilitation."
"You cannot claim Medicare reimbursement for cardiac rehabilitation."
The nurse is assessing a patient diagnosed with infectious endocarditis for arterial embolization. What symptoms would indicate a splenic infarction? Select all that apply. 1 Chest pain 2 Hematuria 3 Abdominal pain 4 Rebound tenderness 5 Pain in the left shoulder
Abdominal pain Rebound tenderness Pain in the left shoulder
In testing arterial blood gas values, which condition can be a probable cause of metabolic acidosis? 1 Hyperventilation 2 Potassium retention 3 Carbon dioxide retention 4 Accumulation of lactic acid
Accumulation of lactic acid
A patient has a history of acute dyspnea. Which test is used for diagnosing diastolic heart failure in this patient? 1 Chest x-rays 2 Electrocardiogram 3 Multigated angiographic 4 B-type natriuretic peptide
B-type natriuretic peptide
A patient diagnosed with infectious endocarditis is confused and is having difficulty speaking. What action should the nurse perform first? 1 Administer oxygen 2 Contact the health care provider 3 Perform a full mental status exam 4 Place the patient in high-Fowler's position
Contact the health care provider
What are symptoms of aortic stenosis? Select all that apply. 1 Polyuria 2 Debilitation 3 Marked fatigue 4 Nocturnal angina 5 Peripheral cyanosis
Debilitation Marked fatigue Peripheral cyanosis
The nurse is assessing a patient with a cardiac infection. Which symptoms support the diagnosis of infective endocarditis instead of pericarditis or rheumatic carditis? 1 Splinter hemorrhages 2 Thickening of the endocardium 3 Friction rub auscultated at the left lower sternal border 4 Pain aggravated by breathing, coughing, and swallowing
Splinter hemorrhages
Which nursing intervention for a patient admitted today with heart failure will assist the patient to conserve energy? 1 Patient ambulates around the nursing unit with a walker 2 The nurse returns the patient to bed when he becomes tachycardic 3 The nurse monitors the patient's pulse and blood pressure frequently 4 The nurse obtains a bedside commode before administering furosemide
The nurse obtains a bedside commode before administering furosemide
A patient begins lisinopril therapy. What does the nurse consider at the start of therapy with this medication? 1 Liver function tests 2 The risk for hypotension 3 The potential for bradycardia 4 The patient's ability to understand medication teaching
The risk for hypotension
The patient presents to the emergency department with an enlarged heart and a new murmur. The vital signs are blood pressure 108/55, pulse 118, oxygen saturation 94% on room air, and a temperature of 103.4° F. When gathering the health history, what question by the nurse is a priority? 1 "Are you currently taking NSAIDs?" 2 "Have you recently had a sore throat?" 3 "Have you recently had a dental cleaning?" 4 "Did you receive all of your childhood immunizations?"
"Have you recently had a sore throat?"
The emergency department nurse is assessing a patient in which heart failure (HF) is suspected. The nurse knows which diagnostic test result is consistent with a diagnosis of HF? 1 Ejection fraction of 60% 2 Serum potassium level of 3.2 mEq/L 3 B-type natriuretic peptide (BNP) of 760 ng/dL 4 Chest x-ray report showing right middle lobe consolidation
B-type natriuretic peptide (BNP) of 760 ng/dL
The nurse is providing medication instructions to a patient with heart failure who is prescribed beta blockers and digoxin therapy. Which statement made by the patient indicates a need for correction? 1 "I should not take digoxin along with laxatives." 2 "I should take the medication at the same time daily." 3 "I should take two doses at a time if I missed a dose." 4 "I should stop taking the medication only if the primary health care provider advises me to."
"I should take two doses at a time if I missed a dose."
The nurse provided teaching to a patient diagnosed with infective endocarditis. What statement by the patient indicates a need for further teaching? 1 "I will not use dental floss." 2 "I will use antibiotic cream on any cuts." 3 "I will make sure I take antibiotics anytime I go to the dentist." 4 "I will call my health care provider if I have a fever or feel really tired."
"I will make sure I take antibiotics anytime I go to the dentist."
Which teaching will the nurse provide for the patient with valvular heart disease? 1 "Notify only your cardiologist about a defective heart valve." 2 "Tell your dentist about the disease before having invasive dental work." 3 "Take antibiotics after a procedure only when they have been prescribed." 4 "Call you primary health care provider for a fever that lasts for three or more days."
"Tell your dentist about the disease before having invasive dental work."
Which patient has the highest risk for developing infective endocarditis? 1 A 16-year-old girl with a cardiac defect diagnosed with scabies 2 A 24-year-old patient with a recent history of systemic infection who is being seen for preoperative care 3 A 65-year-old patient with a history of a valve replacement diagnosed with chronic renal failure 4 A 45-year-old patient with a history of IV drug use who recently had a dental procedure
A 16-year-old girl with a cardiac defect diagnosed with scabies
After receiving a change-of-shift report about these four patients, which patient should the nurse assess first? 1 68-year-old with pericarditis who is reporting sharp, stabbing chest pain when taking deep breaths 2 55-year-old admitted with pulmonary edema who received furosemide and whose current O 2 saturation is 94% 3 46-year-old with aortic stenosis who takes digoxin and has new-onset frequent premature ventricular contractions 4 79-year-old admitted for possible rejection of a heart transplant who has sinus tachycardia, heart rate 104 beats/min
46-year-old with aortic stenosis who takes digoxin and has new-onset frequent premature ventricular contractions
The nurse is caring for four patients. What patient should the nurse see first? 1 A patient diagnosed with pericarditis with muffled heart sounds 2 A patient admitted with rheumatic endocarditis who has developed peripheral edema 3 A patient with infective endocarditis scheduled for a valve replacement surgery today 4 A patient admitted with a diagnosis of infective endocarditis with a temperature of 100.3° F
A patient diagnosed with pericarditis with muffled heart sounds
An older adult patient with type 2 diabetes mellitus is being treated with rosiglitazone. To which condition is the patient susceptible? 1 Cardiac infection 2 Difficulty in breathing 3 Obstructive sleep apnea 4 Acute myocardial infarction
Acute myocardial infarction
A patient suspected of having cardiac tamponade is scheduled for an echocardiogram. Which intervention should be done first? 1 Repeat vital signs 2 Administer digoxin 3 Administer IV fluids 4 Draw blood for a complete blood count (CBC)
Administer IV fluids
A patient has been diagnosed with acute pericarditis. On continuous electrocardiography, the patient has an irregular heart rate of 110 with no discernible P waves. This is consistent with what common cardiac rhythm found in patients with this diagnosis? 1 Atrial fibrillation 2 Sinus tachycardia 3 Ventricular tachycardia 4 Second-degree heart block
Atrial fibrillation
Which diagnostic reading does the nurse anticipate may be elevated in a patient with heart failure? 1 Sodium 2 Calcium 3 Cardiac output 4 BNP
BNP
Which objective listed by a nursing student about older adults with cardiac disease from the Healthy People 2020 initiative indicates a need for further teaching by the precepting nurse? 1 Ensure that the interdisciplinary team provides follow-up care in the home or nursing home 2 Call the hospitalized patient to check that he or she has no signs or symptoms of impending heart failure 3 Provide a continuing plan of care for the patient and family or other caregivers when the patient is discharged from the hospital 4 Collaborate with the case manager for discharge planning, including adequate support in the community, of patients hospitalized for heart failure
Call the hospitalized patient to check that he or she has no signs or symptoms of impending heart failure
Which are major compensatory mechanisms when cardiac output is insufficient to meet the demands of the body? Select all that apply. 1 Chemical responses 2 Myocardial hypertrophy 3 Pulmonary hypertension 4 Renin-angiotensin system activation 5 Sympathetic nervous system stimulation
Chemical responses Myocardial hypertrophy Renin-angiotensin system activation Sympathetic nervous system stimulation
A patient has refractory end-stage heart failure. In which class of the New York Heart Association (NYHA) functional classification system is the patient categorized? 1 Class I NYHA 2 Class II NYHA 3 Class III NYHA 4 Class IV NYHA
Class IV NYHA
Which medication would the nurse expect to see prescribed to reduce reoccurrence of pericarditis in a patient, following an initial diagnosis? 1 Penicillin 2 Ibuprofen 3 Colchicine 4 Metoprolol
Colchicine
A patient who has been admitted for the third time this year for heart failure says, "This isn't worth it anymore. I just want it all to end." What is the nurse's best response? 1 Tells the patient that things will get better 2 Calls the family to lift the patient's spirits 3 Considers further assessment for depression 4 Sedates the patient to decrease myocardial oxygen demand
Considers further assessment for depression
A patient presents to the emergency department with a fever of 102.3° F after being discharged after an appendectomy. What physical assessment is most important to rule out infective endocarditis? 1 Lung sounds 2 Heart sounds 3 Mental status 4 Peripheral pulses
Heart sounds
The patient has heart failure. Which signs or symptoms would prompt the nurse to suspect pulmonary edema? Select all that apply. 1 Increased urination 2 Decreased heart rate 3 Crackles in the lung bases 4 Difficulty in breathing at rest 5 Disorientation regarding time and place
Crackles in the lung bases Difficulty in breathing at rest Disorientation regarding time and place
A patient diagnosed with infective endocarditis is scheduled to have a valve replacement. What information is most important to report to the surgeon? 1 Petechiae 2 Dental caries 3 An audible murmur 4 Splinter hemorrhages
Dental caries
What are common signs and symptoms of right-sided heart failure? Select all that apply. 1 A hacking cough 2 Dependent edema 3 Increase in weight 4 Nausea and vomiting 5 Oliguria during the day
Dependent edema Increase in weight Nausea and vomiting
When assessing a patient diagnosed with infective endocarditis, the nurse notes petechiae around the clavicles and splinter hemorrhages of the nail beds. What action should the nurse perform first? 1 Document the findings 2 Contact the health care provider 3 Determine if there is a pleural friction rub 4 Check the patient's throat for redness and exudate
Document the findings
The nurse reviews the medical record of a patient who is diagnosed with rheumatic carditis and notes a history of penicillin sensitivity. The nurse anticipates that which medication will be prescribed for this patient? 1 Warfarin 2 Amiodarone 3 Erythromycin 4 Levosimendan
Erythromycin
While assessing for signs of heart failure in a patient, the nurse notes that the patient has poor tissue perfusion. Which other symptoms would have been observed in the patient? Select all that apply. 1 Fatigue 2 Cyanosis 3 Weight gain 4 Cool extremities 5 Jugular venous distention
Fatigue Cyanosis Cool extremities
A patient diagnosed with infective endocarditis has developed left-sided heart failure. What assessment findings are consistent with this complication? Select all that apply. 1 Fatigue 2 Anorexia 3 Peripheral edema 4 Shortness of breath 5 Crackles in the lungs
Fatigue Shortness of breath Crackles in the lungs
For which heart condition is it most important for the home health nurse to discuss an advance directive with the patient and family? 1 Heart failure 2 Rheumatic carditis 3 Infective endocarditis 4 Valvular heart disease
Heart failure
A patient with a history of rheumatic carditis presents to the emergency department with a red sore throat and the following vital signs: blood pressure 130/80, pulse 112, respiratory rate 20, oxygen saturation 95% on room air, and a temperature of 102.3°F. What nursing assessment is priority? 1 Heart sounds 2 Throat culture 3 Echocardiogram 4 Labs for white blood cell count
Heart sounds
The nurse is caring for an 82-year-old patient admitted for exacerbation of heart failure (HF). The nurse questions the patient about the use of which medication because it raises an index of suspicion as to the cause of the worsening of the patient's HF? 1 Ibuprofen 2 NPH insulin 3 Levothyroxine 4 Hydrochlorothiazide
Ibuprofen
The nurse is caring for a patient with pericarditis. Which interventions are appropriate to be included in the patient's plan of care? Select all that apply. 1 Administer aspirin 2 Monitor cardiac output 3 Administer an anti-inflammatory agent 4 Avoid administering anticoagulant agents 5 Instruct the patient to avoid leaning forward
Monitor cardiac output Administer an anti-inflammatory agent Avoid administering anticoagulant agents
Which factor reflects the most common etiology of heart failure? 1 Valvular disorders 2 Ventricular dilation 3 Fluid volume excess 4 Myocardial infarction (MI)
Myocardial infarction (MI)
The nurse notes the patient who recently underwent heart transplant surgery is becoming increasingly fatigued. Which symptoms, in addition to the fatigue, support the nurse's concern that a patient's body has rejected a heart transplant? Select all that apply. 1 Hypertension 2 New bradycardia 3 Decreased weight 4 Abdominal bloating 5 Increased ejection fraction
New bradycardia Abdominal bloating
What patient population has the highest risk of being misdiagnosed when experiencing infective endocarditis? 1 Infants 2 Older adults 3 Young children 4 Pregnant women
Older adults
How does the nurse in the cardiac clinic recognize that the patient with heart failure has demonstrated a positive outcome related to the addition of metoprolol to the medication regimen? 1 Ejection fraction is 25% 2 Patient reports that she experiences palpitations 3 Patient states that she is able to sleep on one pillow 4 Patient was hospitalized five times last year with pulmonary edema
Patient states that she is able to sleep on one pillow
Which patients belong to Category B according to the American College of Cardiology (ACC) and the American Heart Association (AHA)? 1 Patients with refractory end-stage heart failure 2 Patients at high risk for developing heart failure 3 Patients with present or past symptoms of heart failure 4 Patients with cardiac structural abnormalities without symptoms of heart failure
Patients with cardiac structural abnormalities without symptoms of heart failure
One hour after administering enalapril to a patient with heart failure (HF), the patient reports dizziness and the nurse notes a blood pressure of 82/46 mm Hg. Which is the nurse's priority action? 1 Initiate cardiac monitoring 2 Place the patient flat in bed 3 Obtain an order for dopamine 4 Notify the health care provider
Place the patient flat in bed
Which intervention does the nurse perform to decrease dyspnea in a patient with acute heart failure? 1 Avoid waking the patient at night 2 Elevate swollen legs above heart level 3 Place the patient in high Fowler's position 4 Assess for orthostatic hypotension and dizziness
Place the patient in high Fowler's position
The nurse is caring for a patient with heart failure in the coronary care unit (CCU). The patient is now exhibiting signs of air hunger and anxiety. Which nursing intervention does the nurse perform first for this patient? 1 Positions the patient to alleviate dyspnea 2 Determines the patient's physical limitations 3 Encourages alternate rest and activity periods 4 Monitors and documents heart rate, rhythm, and pulses
Positions the patient to alleviate dyspnea
The nurse is caring for a patient with pericarditis. Which assessment findings, if present in the patient, would prompt the nurse to suspect cardiac tamponade? Select all that apply. 1 Tachycardia 2 Atrial fibrillation 3 Pulsus paradoxus 4 Jugular vein distention 5 Decreased cardiac output
Pulsus paradoxus Jugular vein distention Decreased cardiac output
A patient diagnosed with infective endocarditis develops abdominal pain with radiation to the left shoulder. What assessment is priority? 1 Nail beds 2 Lung sounds 3 Mental status 4 Rebound tenderness
Rebound tenderness
What information should the nurse include when providing teaching to a patient diagnosed with endocarditis? Select all that apply. 1 Reporting signs of heart failure 2 Balancing activity with adequate rest 3 Importance of follow-up blood cultures 4 Completing 10 days of antibiotic therapy 5 The need for antibiotic prophylaxis any time the patient goes to the dentist
Reporting signs of heart failure Balancing activity with adequate rest Importance of follow-up blood cultures
For which cardiac conditions is antimicrobial therapy most likely to be used? Select all that apply. 1 Heart failure 2 Cardiomyopathy 3 Rheumatic carditis 4 Infective endocarditis 5 Valvular heart disease
Rheumatic carditis Infective endocarditis Valvular heart disease
A patient diagnosed with endocarditis develops peripheral edema, presents with weight gain, and reports a loss of appetite. What complication should the patient be evaluated for? 1 Stroke 2 Splenic infarction 3 Right-sided heart failure 4 Left-sided arterial embolization
Right-sided heart failure
Which factors are associated with the development of infective endocarditis? Select all that apply. 1 Sepsis 2 Heart failure 3 Pulmonary embolism 4 Myocardial infarction 5 Cystoscopy 2 days ago 6 Intravenous heroin use
Sepsis Cystoscopy 2 days ago Intravenous heroin use
A patient with heart failure is taking furosemide. Which finding concerns the nurse with this new prescription? 1 Serum creatinine of 1.0 mg/dL 2 Serum sodium level of 135 mEq/L 3 Serum potassium level of 2.8 mEq/L 4 Serum magnesium level of 1.9 mEq/L
Serum potassium level of 2.8 mEq/L
While caring for a patient receiving digoxin for heart failure, the nurse becomes concerned when the patient demonstrates which sign/symptom? 1 Weight loss 2 Increased urine output 3 Dry tongue and tented skin 4 Sinus bradycardia, rate of 48 beats/min
Sinus bradycardia, rate of 48 beats/min
What are possible causes of infective endocarditis? Select all that apply. 1 Stroke 2 Renal failure 3 Skin infection 4 IV line placement 5 Urinary tract infection
Skin infection IV line placement Urinary tract infection
The nurse is caring for a patient who is complaining of chest pain. Assessment findings include a scratchy, high-pitched sound over the patient's left side, at the fourth intercostal space. What lab value should the nurse evaluate? 1 Platelet count 2 White blood cell count 3 Hemoglobin and hematocrit 4 Erythrocytes sedimentation rate (ESR)
White blood cell count
A patient diagnosed with pericarditis reports severe substernal chest pain. What position should the patient be placed in? 1 Prone 2 Supine 3 Side-lying 4 upright, leaning forward
upright, leaning forward
