Chapter 40: Infective Endocarditis

Question 1

A nurse is caring for a patient with suspected infective endocarditis (IE). Which assessment finding is most concerning and requires immediate follow-up?

a. A new onset of a loud systolic murmur
b. Splinter hemorrhages in the nail beds
c. Fatigue and low-grade fever
d. Janeway lesions on the palms and soles

Answer 1

a. A new onset of a loud systolic murmur

Rationale: A new or worsening murmur may indicate valve damage or dysfunction, which is a critical complication of IE and requires immediate evaluation. Splinter hemorrhages, fatigue, fever, and Janeway lesions are common findings in IE but are not as urgent.

Question 2

A 35-year-old patient with a history of IV drug use is diagnosed with infective endocarditis. What is the priority nursing intervention?

a. Teach the patient about the importance of a low-sodium diet
b. Prepare the patient for valve replacement surgery
c. Administer prophylactic antibiotics before invasive procedures
d. Monitor for signs of embolic complications

Answer 2

d. Monitor for signs of embolic complications

Rationale: Embolic complications, such as stroke, pulmonary embolism, or organ infarction, are common in IE and can be life-threatening. Monitoring for these complications is the priority. Other interventions may be relevant but are not the immediate priority.

Question 3

Which patient is at the highest risk for developing infective endocarditis (IE)?

a. A 45-year-old with uncontrolled hypertension
b. A 30-year-old IV drug user with a history of hepatitis C
c. A 60-year-old with a history of atrial fibrillation on anticoagulants
d. A 50-year-old with peripheral artery disease

Answer 3

b. A 30-year-old IV drug user with a history of hepatitis C

Rationale: IV drug use introduces bacteria directly into the bloodstream, significantly increasing the risk of IE. The other conditions do not have the same direct association with IE.

Question 4

A nurse is educating a patient with infective endocarditis about antibiotic therapy. Which statement by the patient indicates a need for further teaching?

a. “I will need to take antibiotics for several weeks to clear the infection.”
b. “I should report any symptoms of fever or fatigue to my healthcare provider.”
c. “Once I feel better, I can stop taking the antibiotics.”
d. “It is important to finish all the antibiotics prescribed.”

Answer 4

c. “Once I feel better, I can stop taking the antibiotics.”

Rationale: Patients with IE require prolonged antibiotic therapy to fully eradicate the infection and prevent recurrence. Stopping antibiotics prematurely increases the risk of relapse or antibiotic resistance. The other statements reflect appropriate understanding.

Question 5

Which patient is most likely to develop acute infective endocarditis (IE)?

a. A 55-year-old with a history of rheumatic heart disease
b. A 25-year-old IV drug user with no known valve disease
c. A 70-year-old with a history of prosthetic valve replacement
d. A 45-year-old with mitral valve prolapse and regurgitation.

Answer 5

b. A 25-year-old IV drug user with no known valve disease

Rationale: Acute IE often occurs in individuals with healthy valves, such as IV drug users, due to the rapid introduction of pathogens into the bloodstream. Subacute IE is more common in patients with preexisting valve disease.

Question 6

A nurse is reviewing the diagnostic criteria for infective endocarditis (IE). Which clinical feature is most indicative of subacute IE?

a. Low-grade fever persisting for weeks
b. Rapid onset of heart failure symptoms
c. Sudden onset of septic emboli
d. Acute confusion and neurological changes

Answer 6

a. Low-grade fever persisting for weeks

Rationale: Subacute IE typically presents with nonspecific symptoms like low-grade fever over a prolonged period, often in patients with preexisting valve disease. Rapid onset and severe symptoms are more characteristic of acute IE.

Question 7

A nurse suspects prosthetic valve endocarditis (PVE) in a patient. What is the most important question to ask during the health history?

a. “Have you ever been diagnosed with a heart murmur?”
b. “Do you have a history of IV drug use?”
c. “When was your valve replacement surgery performed?”
d. “Have you been exposed to anyone with an infection recently?”

Answer 7

c. “When was your valve replacement surgery performed?”

Rationale: PVE can occur early (within 60 days of surgery) or late (after 60 days). Knowing the timing helps determine the causative pathogen and guide treatment. Other questions are relevant but less critical for diagnosing PVE.

Question 8

Which clinical manifestation would most likely be seen in a patient with subacute IE?

a. Osler nodes and splenomegaly
b. Acute onset of chest pain and dyspnea
c. High fever and signs of septic shock
d. Sudden neurologic deficits

Answer 8

a. Osler nodes and splenomegaly

Rationale: Subacute IE commonly presents with Osler nodes (painful, raised lesions on fingers/toes) and splenomegaly, reflecting chronic infection. Acute symptoms such as chest pain, septic shock, and neurologic deficits are more consistent with acute IE.

Question 9

A nurse is caring for a patient with fungal infective endocarditis. Which treatment plan is most appropriate?

a. Long-term oral antibiotics
b. Short-term IV antibiotics followed by oral therapy
c. IV antifungal therapy and possible valve surgery
d. Antipyretics and observation for symptom resolution

Answer 9

c. IV antifungal therapy and possible valve surgery

Rationale: Fungal IE is difficult to treat and often requires aggressive antifungal therapy and valve replacement. Antibiotics alone or observation are insufficient for fungal infections.

Question 10

Which patient is at the highest risk of developing infective endocarditis (IE)?

a. A patient with mitral valve prolapse without regurgitation
b. A patient undergoing renal dialysis
c. A patient with a history of hypertension
d. A patient with chronic atrial fibrillation

Answer 10

b. A patient undergoing renal dialysis

Rationale: Renal dialysis is a major risk factor for IE due to repeated vascular access, which increases the likelihood of bloodstream infections. Other options have a lower risk for IE.

Question 11

What is the most common causative organism of infective endocarditis?

a. Staphylococcus aureus
b. Streptococcus viridans
c. Haemophilus influenzae
d. Eikenella corrodens

Answer 11

a. Staphylococcus aureus

Rationale: Staphylococcus aureus is responsible for about 50% of IE cases and is a common cause of both community-acquired and healthcare-associated IE.

Question 12

A nurse suspects embolization in a patient with IE. Which symptom suggests embolization from a left-sided vegetation?

a. Hemoptysis
b. Sudden onset of dyspnea
c. Acute flank pain
d. Pleuritic chest pain

Answer 12

c. Acute flank pain

Rationale: Embolization from left-sided vegetations can cause infarction in organs such as the kidneys, leading to flank pain. The other symptoms are more indicative of right-sided embolization (e.g., pulmonary embolism).

Question 13

n a patient with right-sided infective endocarditis, what is the most likely complication?

a. Cerebral embolism
b. Splenic infarction
c. Pulmonary embolism
d. Myocardial infarction

Answer 13

c. Pulmonary embolism

Rationale: Right-sided IE causes vegetations to embolize to the lungs, leading to pulmonary embolism. Left-sided IE is associated with embolization to systemic organs.

Question 14

Which diagnostic test is most definitive for identifying vegetations in infective endocarditis?

a. Transthoracic echocardiogram (TTE)
b. Transesophageal echocardiogram (TEE)
c. Chest X-ray
d. Blood cultures

Answer 14

b. Transesophageal echocardiogram (TEE)

Rationale: TEE is more sensitive than TTE for detecting vegetations on heart valves, making it the gold standard for diagnosing IE.

Question 15

A patient with IE is found to have heart block on ECG. What does this indicate?

a. Myocardial invasion
b. Pulmonary embolism
c. Acute ischemic stroke
d. Valvular stenosis

Answer 15

a. Myocardial invasion

Rationale: Invasion of the myocardium by the infection can disrupt electrical conduction pathways, resulting in heart block.

Question 16

Which statement by a patient with a prosthetic valve indicates a need for further teaching about preventing infective endocarditis?

a. “I will need antibiotics before dental procedures.”
b. “I should report any symptoms of infection, like fever, to my doctor.”
c. “I don’t need to take antibiotics if I’m feeling healthy.”
d. “Good oral hygiene is important to prevent infections.”

Answer 16

c. “I don’t need to take antibiotics if I’m feeling healthy.”

Rationale: Prophylactic antibiotics are required for high-risk patients undergoing certain procedures, regardless of how they feel, to prevent bacteremia and IE.

Question 17

What is the most appropriate nursing intervention for a patient with IE and signs of systemic embolization?

a. Administer anticoagulants immediately
b. Notify the healthcare provider
c. Prepare the patient for emergency valve replacement surgery
d. Perform a neurological assessment

Answer 17

b. Notify the healthcare provider

Rationale: Systemic embolization is a serious complication requiring immediate medical evaluation. Anticoagulants are not always indicated in IE-related embolization.

Question 18

Which complication is most associated with left-sided IE?

a. Heart failure
b. Pulmonary embolism
c. Deep vein thrombosis
d. Pleural effusion

Answer 18

a. Heart failure

Rationale: Left-sided IE often damages the heart valves and supporting structures, leading to valve dysfunction and heart failure.

Question 19

Why are HACEK organisms significant in infective endocarditis?

a. They are the most common cause of IE.
b. They are resistant to all antibiotics.
c. They are associated with IV drug use.
d. They form biofilms that increase resistance to treatment.

Answer 19

d. They form biofilms that increase resistance to treatment.

Rationale: HACEK organisms produce biofilms that protect them from immune defenses and antibiotics, complicating treatment.

Question 20

*What is the primary reason embolization occurs in infective endocarditis?

a. Increased platelet count
b. Fragility of vegetation
c. Valvular regurgitation
d. High blood pressure

Answer 20

b. Fragility of vegetation

Rationale: Embolization occurs when fragile vegetations made of fibrin, platelets, leukocytes, and microbes dislodge and travel through the bloodstream.

Question 21

What nursing intervention is most critical for a patient with suspected infective endocarditis?

a. Obtain blood cultures before initiating antibiotics

b. Monitor for signs of venous thrombosis

c. Administer antipyretics for fever

d. Schedule an echocardiogram for diagnosis

Answer 21

a. Obtain blood cultures before initiating antibiotics

Rationale: Blood cultures must be obtained before starting antibiotics to identify the causative organism and guide treatment.

Question 22

Which patient scenario represents a healthcare-associated infection leading to IE?

a. A patient undergoing chemotherapy develops IE from an infected IV catheter.
b. A patient develops IE 3 months after valve surgery.
c. A patient with poor dental hygiene develops IE.
d. A patient with a history of rheumatic fever develops IE.

Answer 22

a. A patient undergoing chemotherapy develops IE from an infected IV catheter.

Rationale: Healthcare-associated IE commonly results from infections linked to invasive devices like IV catheters.

Question 23

Which symptom is most indicative of embolization to the brain in IE?

a. Hematuria
b. Shortness of breath
c. Petechiae
d. Confusion

Answer 23

d. Confusion

Rationale: Confusion or other neurological deficits suggest embolization to the brain, leading to an ischemic stroke.

Question 24

What is the primary purpose of prolonged antibiotic therapy in infective endocarditis?

a. To prevent embolization of vegetation
b. To improve valve function
c. To eradicate organisms protected by biofilms
d. To reduce fever and inflammation

Answer 24

c. To eradicate organisms protected by biofilms

Rationale: Prolonged antibiotic therapy is necessary to penetrate biofilms and completely eliminate the infecting organisms.

Question 25

Which clinical finding is most specific to infective endocarditis (IE)?

a. Generalized fatigue and malaise
b. Petechiae on the buccal mucosa
c. Osler’s nodes on fingertips
d. Low-grade fever

Answer 25

c. Osler’s nodes on fingertips

Rationale: Osler’s nodes are a hallmark sign of IE, caused by immune complex deposition. Petechiae and fever are common but not specific to IE.

Question 26

What is the most likely explanation for a new systolic murmur in a patient with IE?

a. Development of mitral valve prolapse
b. Valve damage due to vegetation
c. Increased cardiac output
d. Myocardial infarction

Answer 26

b. Valve damage due to vegetation

Rationale: Vegetations in IE can damage heart valves, leading to new or worsening murmurs, particularly with left-sided valve involvement.

Question 27

A nurse assesses splinter hemorrhages in a patient with suspected IE. Where should the nurse examine for this finding?

a. Palms of the hands
b. Nail beds
c. Conjunctivae
d. Buccal mucosa

Answer 27

b. Nail beds

Rationale: Splinter hemorrhages appear as black longitudinal streaks under the nail beds, resulting from microemboli.

Question 28

What is the primary reason older adults with IE may not present with a fever?

a. Their immune system produces fewer cytokines.
b. Vegetations primarily form in the right heart.
c. They have fewer systemic embolizations.
d. Their valves are less likely to be damaged.

Answer 28

a. Their immune system produces fewer cytokines.

Rationale: Older adults or immunocompromised patients may have a diminished febrile response due to reduced immune system activity.

Question 29

Which finding is consistent with Janeway’s lesions in IE?

a. Painful red spots on the palms
b. Painless flat red spots on the soles
c. Tender purple lesions on the toes
d. Hemorrhagic streaks on the nail beds

Answer 29

b. Painless flat red spots on the soles

Rationale: Janeway’s lesions are painless, flat, red spots typically seen on the palms or soles. They are caused by septic microemboli.

Question 30

In a patient with IE, which symptom would suggest heart failure as a complication?

a. Bilateral crackles on lung auscultation
b. Petechiae on the conjunctivae
c. Splinter hemorrhages in nail beds
d. Roth’s spots on retinal exam

Answer 30

a. Bilateral crackles on lung auscultation

Rationale: Heart failure, a common complication of IE, often manifests with pulmonary congestion, leading to crackles on auscultation.

Question 31

Why are murmurs typically absent in tricuspid valve infective endocarditis?

a. Right-sided vegetations rarely cause valve dysfunction.

b. Pulmonary embolism masks the murmur.

c. The tricuspid valve is not commonly affected in IE.

d. Right-sided heart sounds are too faint to detect.

Answer 31

d. Right-sided heart sounds are too faint to detect.

Rationale: Murmurs in tricuspid valve IE are often absent because right-sided heart sounds are less audible compared to left-sided murmurs.

Question 32

Which combination of criteria confirms a diagnosis of IE according to the Duke Criteria?

a. One major and one minor criterion
b. Two major criteria and one minor criterion
c. Five minor criteria
d. Either b or c

Answer 32

d. Either b or c

Rationale: A diagnosis of IE is made with 2 major criteria and 1 minor criterion, or 5 minor criteria, per the Duke Criteria.

Question 33

Which laboratory finding supports the diagnosis of acute IE?

a. Normal ESR and CRP levels
b. Mild leukocytosis
c. Negative blood cultures
d. Decreased platelet count

Answer 33

b. Mild leukocytosis

Rationale: Mild leukocytosis is a common finding in acute IE due to the systemic inflammatory response.

Question 34

Why is echocardiography crucial in the diagnosis of IE?

a. It identifies the microorganism causing the infection.

b. It rules out culture-negative IE.

c. It confirms the presence of vegetations on the valves.

d. It detects changes in C-reactive protein levels.

Answer 34

c. It confirms the presence of vegetations on the valves.

Rationale: Echocardiography (especially transesophageal) is essential for visualizing vegetations, which is a key diagnostic feature of IE.

Question 35

Which minor criterion in the Duke Criteria is most likely to be documented in a patient with a history of IV drug use?

a. Vascular phenomena
b. Immunologic phenomena
c. Predisposing heart condition or IV drug use
d. Echocardiographic findings

Answer 35

c. Predisposing heart condition or IV drug use

Rationale: A history of IV drug use is a recognized minor criterion for IE, as it increases the risk of infection.

Question 36

When collecting blood cultures for suspected IE, what is the best approach?

a. Collect three blood cultures over 1 hour from different sites.
b. Draw all cultures from a single venipuncture site.
c. Obtain blood cultures only after starting antibiotics.
d. Collect blood samples every 12 hours.

Answer 36

a. Collect three blood cultures over 1 hour from different sites.

Rationale: This approach ensures adequate detection of bacteremia while reducing the risk of contamination.

Question 37

A patient with suspected IE has received antibiotics for a skin infection in the past 2 weeks. What diagnostic challenge might this pose?

a. False-positive echocardiographic findings
b. Negative blood cultures despite active infection
c. Decreased C-reactive protein (CRP) levels
d. Absence of leukocytosis

Answer 37

b. Negative blood cultures despite active infection

Rationale: Recent antibiotic use can lead to culture-negative IE, as it may suppress bacterial growth in blood cultures.

Question 38

Which diagnostic finding is considered a major criterion for infective endocarditis (IE) according to the Duke Criteria?

a. Mild leukocytosis
b. Presence of Janeway’s lesions
c. Positive blood cultures from two separate sites
d. Increased erythrocyte sedimentation rate (ESR)

Answer 38

c. Positive blood cultures from two separate sites

Rationale: Positive blood cultures for a typical microorganism are a major Duke Criterion for diagnosing IE. The other findings are minor criteria or nonspecific.

Question 39

When should blood cultures be repeated after initiating antibiotic therapy for IE?

a. Every 24 to 48 hours until negative cultures are obtained
b. Every 12 hours until infection clears
c. Weekly during the course of therapy
d. After completion of therapy

Answer 39

a. Every 24 to 48 hours until negative cultures are obtained

Question 40

What condition makes IE with HF particularly life-threatening?

a. Resistance to antifungal therapy
b. Limited access to follow-up care
c. Poor response to both drug therapy and valve replacement
d. Inability to control embolization

Answer 40

c. Poor response to both drug therapy and valve replacement

Rationale: HF complicates IE, and it often responds poorly to medical and surgical treatments, leading to high mortality.

Question 41

What is the typical duration of antibiotic therapy for IE caused by bacterial organisms?

a. 2 weeks or longer
b. 3 to 4 weeks
c. 6 weeks or longer
d. 12 weeks or longer

Answer 41

c. 6 weeks or longer

Rationale: Prolonged therapy is necessary to eradicate bacteria protected within valvular vegetations.

Question 42

A patient with IE has persistent fever despite antibiotic therapy. What is the most appropriate initial action?

a. Increase the antibiotic dose
b. Manage with aspirin, fluids, and rest
c. Perform an immediate valve replacement
d. Stop antibiotics and reassess

Answer 42

b. Manage with aspirin, fluids, and rest

Rationale: Persistent fever may be managed symptomatically unless it indicates a complication like abscess or embolization.

Question 43

What is the most common indication for valve replacement surgery in IE?

a. Persistent fever
b. Uncontrolled infection
c. Positive blood cultures after 48 hours of treatment
d. New-onset hypertension

Answer 43

b. Uncontrolled infection

Rationale: Surgery is often required for uncontrolled infection, valve dysfunction causing HF, or to prevent embolization.

Question 44

Which complication is most likely in fungal infective endocarditis (IE)?

a. Rapid resolution with antibiotics
b. Prolonged low-grade fever
c. Poor response to antibiotics alone
d. Reduced risk of valve replacement

Answer 44

c. Poor response to antibiotics alone

Rationale: Fungal IE often requires early valve replacement and prolonged antibiotic therapy due to poor response to antibiotics alone.

Question 45

What is the recommended follow-up care after completing antibiotic therapy for IE?

a. Annual echocardiogram only
b. Blood cultures every 2 weeks
c. Echocardiogram and inflammatory marker assessments at 1, 3, 6, and 12 months
d. Prophylactic antibiotics every 6 months

Answer 45

c. Echocardiogram and inflammatory marker assessments at 1, 3, 6, and 12 months

Rationale: Monitoring with echocardiography and inflammatory markers helps evaluate for recurrence or complications.

Question 46

Why is identifying the causative organism critical in the treatment of IE?

a. It allows for targeted antibiotic therapy.
b. It determines the need for surgery.
c. It predicts the duration of illness.
d. It ensures prevention of HF.

Answer 46

a. It allows for targeted antibiotic therapy.

Rationale: Accurate identification of the pathogen is necessary to select effective antibiotics for treating IE.

Question 47

Which is the primary reason for antibiotic prophylaxis in patients at risk for IE?

a. To eliminate dormant bacteria
b. To prevent embolization
c. To treat persistent fever
d. To avoid initial bacterial colonization on heart valves

Answer 47

d. To avoid initial bacterial colonization on heart valves

Rationale: Antibiotic prophylaxis prevents colonization of bacteria on damaged or prosthetic heart valves during high-risk procedures.

Question 48

Which assessment finding is most indicative of embolic complications in a patient with IE?

a. New onset of S3 heart sound
b. Petechiae on the buccal mucosa
c. Splinter hemorrhages in the nail beds
d. Decreased range of motion (ROM) in joints

Answer 48

b. Petechiae on the buccal mucosa

Rationale: Petechiae can indicate embolization from vegetative lesions, a common complication in IE.

Question 49

What is the priority nursing assessment for a patient with suspected IE?

a. Evaluate for joint tenderness
b. Assess for muscle weakness
c. Inspect for Osler’s nodes
d. Listen for a new or changing heart murmur

Answer 49

d. Listen for a new or changing heart murmur

Rationale: Heart murmurs are a key clinical finding in IE and may indicate valvular involvement.

Question 50

Which symptom is most commonly associated with IE?

a. Arthralgia
b. Myalgia
c. New heart murmur
d. Decreased ROM

Answer 50

c. New heart murmur

Rationale: A new or worsening systolic murmur is a hallmark symptom of IE due to valve dysfunction.

Question 51

What should the nurse include when assessing for vascular complications in IE?

a. Presence of arthralgia and myalgia
b. Auscultation of S3 heart sounds
c. Inspection for splinter hemorrhages and Osler’s nodes
d. Palpation for joint swelling and tenderness

Answer 51

c. Inspection for splinter hemorrhages and Osler’s nodes

Rationale: These vascular phenomena are common signs of IE-related embolic complications.

Question 52

Which finding suggests possible hemodynamic complications in a patient with IE?

a. S3 heart sound
b. Joint pain with decreased ROM
c. Myalgia in the lower extremities
d. Presence of Roth’s spots

Answer 52

a. S3 heart sound

Rationale: An S3 heart sound may indicate heart failure, a potential hemodynamic complication of IE.

Question 53

Which subjective finding is most concerning in a patient with IE?

a. Night sweats
b. Weight gain
c. Bloody urine
d. Muscle tenderness

Answer 53

c. Bloody urine

Rationale: Bloody urine suggests hematuria, which may indicate embolization or kidney involvement, a serious complication of IE.

Question 54

What objective finding is most indicative of valvular involvement in IE?

a. Splinter hemorrhages
b. Tachycardia
c. Peripheral edema
d. New murmur

Answer 54

d. New murmur

Rationale: A new or changing murmur is a hallmark sign of valvular involvement in IE.

Question 55

Which skin manifestation is painful and associated with IE?

a. Petechiae
b. Janeway’s lesions
c. Osler’s nodes
d. Purpura

Answer 55

c. Osler’s nodes

Rationale: Osler’s nodes are painful, tender, red or purple lesions commonly found on the fingers or toes in IE.

Question 56

Which diagnostic finding is most specific for diagnosing IE?

a. Increased ESR
b. Positive blood cultures
c. Anemia
d. Cardiomegaly on chest x-ray

Answer 56

b. Positive blood cultures

Rationale: Positive blood cultures confirm the presence of the causative organism and are essential for diagnosing IE.

Question 57

Which cardiovascular finding may indicate progression of IE to heart failure?

a. S3 heart sound
b. Retinal hemorrhages
c. Dysrhythmias
d. Tachycardia

Answer 57

a. S3 heart sound

Rationale: An S3 heart sound suggests left ventricular dysfunction, commonly associated with heart failure due to IE.

Question 58

What is a classic respiratory finding in IE associated with embolization?

a. Crackles
b. Tachypnea
c. Orthopnea
d. Dyspnea on exertion

Answer 58

a. Crackles

Rationale: Crackles may indicate pulmonary embolization from right-sided heart lesions.

Question 59

What condition is indicated by Janeway’s lesions in a patient with IE?

a. Immune-mediated response
b. Microembolization
c. Congenital valve disease
d. Cardiac arrhythmias

Answer 59

b. Microembolization

Rationale: aneway’s lesions are flat, painless spots caused by septic microembolization to the skin.

Question 60

Which functional health pattern most directly suggests systemic embolization in IE?

a. Headaches
b. Night sweats
c. Exercise intolerance
d. Palpitations

Answer 60

a. Headache

Rationale: Headache may indicate embolization to the brain, a potential systemic complication of IE.

Question 61

What laboratory finding most strongly supports the diagnosis of IE?

a. Leukocytosis
b. Hematuria
c. Increased CRP
d. Positive blood cultures

Answer 61

d. Positive blood cultures

Rationale: Positive blood cultures are a definitive diagnostic criterion for IE. Other findings may support but are not diagnostic.

Question 62

Which outcome indicates successful management of a patient with IE?

a. Reduced C-reactive protein levels and tolerance of ADLs without fatigue

b. Normal cardiac function and tolerance of ADLs without fatigue

c. Negative echocardiogram findings and tolerance of ADLs without fatigue

d. Absence of splinter hemorrhages and tolerance of ADLs without fatigue

Answer 62

b. Normal cardiac function and tolerance of ADLs without fatigue

Rationale: The overall goals include maintaining normal or baseline cardiac function and the ability to perform ADLs without fatigue, reflecting effective treatment and recovery.

Question 63

What should the nurse prioritize in patient teaching to prevent recurrence of IE?

a. Early recognition of fatigue
b. Avoiding strenuous physical activity
c. Monitoring for skin changes
d. Adherence to antibiotic therapy and prophylaxis guidelines

Answer 63

d. Adherence to antibiotic therapy and prophylaxis guidelines

Rationale: Understanding and following the treatment plan, including appropriate antibiotic use, is crucial for preventing IE recurrence.

Question 64

Which nursing intervention supports the goal of improving a patient’s tolerance to ADLs?

a. Gradual increase in activity as tolerated
b. Encouraging complete bed rest
c. Limiting fluid intake
d. Monitoring for new heart murmurs

Answer 64

a. Gradual increase in activity as tolerated

Rationale: Gradually increasing activity helps build tolerance and prevents fatigue while ensuring cardiac function remains stable.

Question 65

Which instruction is most important for a patient at high risk for IE?

a. Avoid strenuous exercise
b. Limit dental visits to once a year
c. Increase physical activity gradually
d. Report cold or flu symptoms immediately

Answer 65

d. Report cold or flu symptoms immediately

Rationale: Early reporting of symptoms such as cold or flu can help prevent potential complications from infections that could lead to IE.

Question 66

What is a priority intervention for a patient with a history of IV drug use and IE?

a. Educating on proper handwashing techniques
b. Referring the patient for drug rehabilitation
c. Advising on avoiding public places
d. Teaching stress management techniques

Answer 66

b. Referring the patient for drug rehabilitation

Rationale: IV drug use is a significant risk factor for IE, and addressing the underlying cause is critical for prevention of recurrence.

Question 67

What should the nurse emphasize regarding oral health in patients at risk for IE?

a. Regular use of mouthwash
b. Flossing once a week to avoid bleeding
c. Good oral hygiene and routine dental visits
d. Avoiding dental care unless absolutely necessary

Answer 67

c. Good oral hygiene and routine dental visits

Rationale: Proper oral care and regular dental visits are crucial to preventing bacteremia, a common cause of IE.

Question 68

When should a high-risk patient inform their healthcare provider about their history of IE?

a. When they experience fatigue
b. After dental cleanings
c. When they develop a fever
d. Before any invasive procedure

Answer 68

d. Before any invasive procedure

Rationale: Patients with a history of IE should inform their HCP before invasive procedures, as prophylactic antibiotics may be needed to prevent recurrence.

Question 69

What is a key health promotion strategy for patients at risk for IE?

a. Avoiding people with infections
b. Limiting rest periods to stay active
c. Increasing fluid intake daily
d. Wearing a mask at all times

Answer 69

a. Avoiding people with infections

Rationale: Avoiding exposure to infectious individuals reduces the risk of acquiring infections that could lead to IE.

Question 70

What is the nurse’s priority when assessing IV lines for a patient with IE?

a. Monitoring temperature daily
b. Checking for signs of phlebitis or complications
c. Ensuring the patient adheres to bed rest
d. Teaching the patient about deep breathing exercises

Answer 70

b. Checking for signs of phlebitis or complications

Rationale: Assessing IV lines for patency and complications like phlebitis ensures effective antibiotic therapy and prevents additional infections.

Question 71

Which teaching point reduces the risk of IE recurrence?

a. Take prophylactic antibiotics before invasive procedures
b. Perform daily ROM exercises
c. Increase protein intake in the diet
d. Monitor for palpitations

Answer 71

a. Take prophylactic antibiotics before invasive procedures

Rationale: Prophylactic antibiotics are essential for high-risk patients to prevent bacteremia and subsequent IE recurrence.

Question 72

Why is patient education on elastic compression stockings important for a patient with IE?

a. To reduce the risk of systemic embolization
b. To prevent heart murmurs
c. To avoid antibiotic side effects
d. To manage fever effectively

Answer 72

a. To reduce the risk of systemic embolization

Rationale: Compression stockings improve circulation and help prevent complications like venous thromboembolism.

Question 73

Which symptom should a patient with IE report immediately?

a. Persistent fatigue

b. Weight loss of 1–2 pounds

c. Intermittent headaches

d. Sudden onset of dyspnea

Answer 73

d. Sudden onset of dyspnea

Rationale: Dyspnea may indicate life-threatening complications such as pulmonary edema or HF and warrants immediate medical attention.

Question 74

What is the most important aspect of follow-up care for a patient with IE?

a. Routine ECG monitoring

b. Regular dental visits and good oral hygiene

c. Avoiding all physical activity

d. Consuming a low-calorie diet

Answer 74

b. Regular dental visits and good oral hygiene

Rationale: Dental care prevents oral infections, a common source of bacteremia that can lead to IE recurrence.

Question 75

What action should the nurse take to manage anxiety in a patient with IE?

a. Encourage complete bed rest
b. Advise the patient to avoid social interactions
c. Provide education about the disease and its treatment
d. Focus solely on physical symptoms

Answer 75

c. Provide education about the disease and its treatment

Rationale: Education helps reduce uncertainty and empowers patients, decreasing anxiety about the illness and its management.

Question 76

Which laboratory result indicates that antibiotics are effective in treating IE?

a. Decreased ESR and CRP levels
b. Increased hemoglobin levels
c. Persistent positive blood cultures
d. Elevated white blood cell count

Answer 76

a. Decreased ESR and CRP levels

Rationale: ESR and CRP are markers of inflammation, and their decline suggests effective treatment of the infection.

Question 77

What intervention helps prevent complications related to decreased mobility in patients with IE?

a. Frequent bed rest and performing ROM exercises

b. Applying heating pads to the legs and performing ROM exercises

c. Wearing elastic compression stockings and performing ROM exercises

d. Restricting physical activity and performing ROM exercises

Answer 77

c. Wearing elastic compression stockings and performing ROM exercises

Rationale: These interventions promote circulation, reduce the risk of venous thromboembolism, and minimize complications of immobility.

Question 78

Which complication should the nurse teach the patient with IE to recognize?

a. Increased appetite
b. Sudden weight loss
c. Change in mental status
d. Generalized itching

Answer 78

c. Change in mental status

Rationale: Mental status changes may indicate a life-threatening complication such as a stroke or embolism and require immediate attention.

Question 79

What is the most critical teaching point for a patient receiving outpatient IV antibiotics for IE?

a. Monitor body temperature regularly
b. Perform deep breathing exercises daily
c. Avoid moderate physical activity
d. Use elastic compression stockings

Answer 79

a. Monitor body temperature regularly

Rationale: Persistent temperature elevations can indicate ineffective antibiotic therapy or complications, making this a priority teaching point.

Question 80

Which outcome indicates successful treatment of infective endocarditis (IE)?

a. Persistent fever with mild fatigue
b. Adequate tissue and organ perfusion
c. Decreased appetite and weight loss
d. Increased ESR and CRP levels

Answer 80

b. Adequate tissue and organ perfusion

Rationale: Maintaining adequate tissue and organ perfusion indicates effective management of IE and prevention of complications like embolization.

Question 81

What nursing goal is essential for a patient with IE?

a. Prevent weight gain during treatment
b. Avoid reporting mild fatigue
c. Maintain normal body temperature
d. Perform vigorous physical activity

Answer 81

c. Maintain normal body temperature

Rationale: A normal body temperature signifies that the infection is under control and the antibiotics are effective.

Question 82

Which intervention promotes emotional comfort in a patient with IE?

a. Limiting patient education to avoid stress

b. Restricting physical activity entirely

c. Focusing only on physical symptoms

d. Encouraging rest periods and coping strategies

Answer 82

d. Encouraging rest periods and coping strategies

Rationale: Providing rest and helping the patient develop coping mechanisms enhances emotional comfort during recovery.

Question 83

What patient report suggests improvement in IE treatment?

a. Persistent joint pain and muscle tenderness
b. Ability to perform ADLs without fatigue
c. Frequent night sweats and chills
d. Increased CRP and ESR levels

Answer 83

b. Ability to perform ADLs without fatigue

Rationale: Improved physical tolerance and reduced fatigue reflect successful treatment outcomes and recovery.

Question 84

Which findings would the nurse expect when assessing a patient with infective endocarditis? (SATA)

a. retinal hemorrhages
b. splinter hemorrhages
c. presence of Osler’s nodes
d. painless nodules over bony prominences
e. erythematous macules on the palms and soles

Answer 84

a. retinal hemorrhages
b. splinter hemorrhages
c. presence of Osler’s nodes
e. erythematous macules on the palms and soles

Question 85

The nurse obtains a health history from an older adult with a prosthetic mitral valve who has symptoms of infective endocarditis (IE). Which question by the nurse helps identify a risk factor for IE?

a. “Do you have a history of a heart attack?”

b. “Have you had dental work done recently?”

c. “Have you had any recent immunizations?”

d. “Do you have a family history of endocarditis?”

Answer 85

b. “Have you had dental work done recently?”

Rationale: Dental procedures place the patient with a prosthetic mitral valve at risk for IE. Myocardial infarction, immunizations, and a family history of endocarditis are not risk factors for IE.

Question 86

Which finding would the nurse expect when assessing a young adult with infective endocarditis (IE)?

a. Substernal chest pressure

b. A new regurgitant murmur

c. A pruritic rash on the chest

d. Involuntary muscle movement

Answer 86

b. A new regurgitant murmur

Rationale: 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.

Question 87

Which assessment finding indicates to the nurse that a patient with infective endocarditis has impaired cardiac function?

a. Prolonged fever with chills

b. Increase in heart rate of 15 beats/min with walking

c. Urine production of 25 mL/hr

d. Petechiae on the inside of the mouth and conjunctiva

Answer 87

c. Urine production of 25 mL/hr

Rationale: 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/min is normal with exercise.

Question 88

Which intervention would the nurse include when planning care for a patient hospitalized with a streptococcal infective endocarditis (IE)?

a. Arrange for placement of a long-term IV catheter.

b. Monitor labs for levels of streptococcal antibodies.

c. Teach the importance of completing all oral antibiotics.

d. Encourage the patient to begin regular aerobic exercise.

Answer 88

a. Arrange for placement of a long-term IV catheter.

Rationale: Treatment for IE involves 4 to 6 weeks of IV antibiotic therapy 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.

Question 89

Which assessment finding for a patient with infective endocarditis is consistent with embolized vegetations from the tricuspid valve?

a. Flank pain

b. Splenomegaly

c. Shortness of breath

d. Mental status changes

Answer 89

c. Shortness of breath

Rationale: Embolization from the tricuspid valve would cause symptoms of pulmonary embolus. Flank pain, changes in mental status, and splenomegaly would be associated with embolization from the left-sided valves.

Question 90

Which patient will need the nurse to plan discharge teaching about prophylactic antibiotics before dental procedures?

a. Patient admitted with a large acute myocardial infarction

b. Patient being discharged after an exacerbation of heart failure

c. Patient who had a mitral valve replacement with a mechanical valve

d. Patient being treated for rheumatic fever after a streptococcal infection

Answer 90

c. Patient who had a mitral valve replacement with a mechanical valve

Rationale: Current American Heart Association guidelines recommend the use of prophylactic antibiotics before dental procedures for patients with prosthetic valves to prevent infective endocarditis (IE). The other patients are not at high risk for IE.

Question 91

Which admission prescription written by the health care provider for a patient admitted with infective endocarditis (IE) and a fever would be a priority for the nurse to implement?

a. Administer an IV antibiotic.

b. Draw blood cultures from two sites.

c. Schedule a transesophageal echocardiogram.

d. Give acetaminophen (Tylenol) PRN for fever.

Answer 91

b. Draw blood cultures from two sites.

Rationale: Treatment of the IE with antibiotics should be started as quickly as possible, but it is essential to obtain blood cultures before starting antibiotic therapy to obtain accurate sensitivity results. The echocardiogram and acetaminophen administration also should be implemented rapidly, but the blood cultures (and then administration of the antibiotic) have the highest priority.

Question 92

Which assessment finding in a patient who is admitted with infective endocarditis (IE) is most important to communicate to the health care provider?

a. Muscle aching

b. Right flank pain

c. Janeway‘s lesions on the palms

d. Temperature 100.7F (38.1C)

Answer 92

b. Right flank pain

Rationale: Flank pain indicates possible embolization to the kidney and may require diagnostic testing such as a renal arteriogram and interventions to improve renal perfusion. The other findings are typically found in IE but do not require any new interventions.

Question 93

The nurse is providing education to a client with a history of rheumatic heart. Information includes risk factors for bacterial endocarditis. The nurse asks through teach-back if the client knows the importance of taking which of the following drugs prior to scheduled invasive procedures?

a. Amoxicillin
b. Solumedrol
c. Warfarin
d. Metoprolol

Answer 93

a. Amoxicillin

Rationale: This answer is correct because to help reduce the risk of bacterial endocarditis, the client should take prophylactic antibiotics, such as amoxicillin, prior to any invasive procedure, including dental procedures. Rheumatic heart disease clients are at a higher risk of having bacterial (infective) endocarditis and should be taught to take these measures to prevent a very serious infection in the heart.