A 21-year-old man known to paramedics as an IV heroin user is found unconscious in the park. Paramedics are unable to revive him using naloxone or flumazenil. An autopsy determines that the man had infective endocarditis (IE). What is the pathophysiology associated with this disease?
A history of rheumatic fever as a child
Right-sided heart valves infected with S. aureus through repeated intravenous drug use
HIV as a result of IV drug use, which made him susceptible to IE
IV drug use has nothing to do with the development of IE
The Correct Answer is B
Choice A reason: Rheumatic fever can lead to valvular heart disease, particularly affecting the left-sided valves, but it is not the primary pathophysiology in IV drug users with infective endocarditis. It is unrelated to the acute presentation in this case.
Choice B reason: IV drug use introduces pathogens directly into the bloodstream, often leading to infection of the right-sided heart valves, particularly the tricuspid valve. Staphylococcus aureus is the most common causative organism. This pathophysiology is well-documented and explains the development of IE in IV drug users.
Choice C reason: While HIV may increase susceptibility to infections due to immunosuppression, it is not the direct cause of infective endocarditis. The primary mechanism in this case is bacterial seeding of the heart valves via IV drug use.
Choice D reason: This statement is incorrect. IV drug use is a major risk factor for infective endocarditis due to repeated introduction of bacteria into the bloodstream and damage to cardiac valves.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Generalized anxiety disorder is a risk factor for suicide, but it is less predictive than depression. Anxiety may contribute to distress, but without comorbid depression or other high-risk behaviors, the risk is moderate.
Choice B reason: Breakups can be emotionally distressing, especially in adolescence, but without signs of depression or suicidal ideation, the risk remains lower. Emotional resilience and support systems play a role in mitigating risk.
Choice C reason: LGBTQ+ youth face elevated suicide risk due to stigma, discrimination, and potential rejection. However, without additional risk factors like depression, suicidal ideation, or previous attempts, the risk is not as high as in someone with active depressive symptoms.
Choice D reason: Depression is the most significant predictor of suicide in adolescents. A recent diagnosis suggests active symptoms, and the presence of mood disorder increases the likelihood of suicidal ideation and behavior, making this individual the highest risk.
Correct Answer is A
Explanation
Choice A reason: These questions align with validated alcohol screening tools such as the AUDIT and NIAAA guidelines. They quantify drinking patterns and help identify risky behaviors, making them appropriate for the SBIRT framework.
Choice B reason: While these questions may provide insight into drinking habits, they are not part of standardized screening tools and lack the specificity needed for clinical assessment under SBIRT.
Choice C reason: These questions are more appropriate for assessing readiness to change or dependence severity but are not primary screening questions in SBIRT.
Choice D reason: These questions explore social consequences and polysubstance use but are not standard initial screening items in SBIRT. They may be useful in follow-up assessments.
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