A nurse is caring for an adolescent in an emergency department.

Vital Signs.

2300: Medical History.

Blood pressure 120/78 mm Hg. Apical pulse rate 100/min.

Respiratory rate 20/min.

2400: Temperature 37.9° C (100.2° F). Oxygen saturation 98% on room air.

Nurses' Notes.

Blood pressure 112/64 mm Hg. Apical pulse rate 108/min.

Respiratory rate 28/min.

Temperature 38.9° C (102° F). Oxygen saturation 95% on room air.

Medical History.

History of rheumatic fever with resulting cardiac valve damage.

Nurses' Notes.

2300: Adolescent brought to emergency department by their parent.

Adolescent reports intermittent low-grade fever and anorexia.

Manifestations presented a few days after having dental work performed.

Now they are worse.

Adolescent noticed shortness of breath with exertion today.

Adolescent in semi-reclining position.

Respirations easy and unlabored while at rest.

Mild dyspnea observed when adolescent ambulated to the room.

Lung sounds clear bilaterally.

Oral mucous membranes pink with petechiae noted.

Adolescent reports diffuse joint pain as 2 on a scale of 0 to 10. 2400: Adolescent restless and sweating, sitting in high-Fowler's position.

Dyspnea noted at rest.

Adolescent reports pain in mid-chest as dull, aching, and as 2 on a scale of 0 to 10. Few coarse rales auscultated bilaterally.

The nurse reports the 2400 assessment findings to the provider.

Which of the following should the nurse anticipate the provider will prescribe? For each potential provider's prescription, specify if the potential prescription is anticipated or contraindicated for the client.

Obtain blood cultures x 3.

Administer antibiotic therapy.

Obtain an echocardiogram.

Restrict dental hygiene.

Perform strenuous exercise regimen twice daily.

Answer and Explanation

Correct Answer : A,B,C

Choice A rationale:

Obtaining blood cultures x 3 is anticipated for the client. This is because the adolescent’s symptoms such as fever, shortness of breath, and petechiae could indicate a bacterial infection, possibly endocarditis, which is a risk for individuals with a history of rheumatic fever and cardiac valve damage. Blood cultures would help identify the causative bacteria.

Choice B rationale:

Administering antibiotic therapy is anticipated for the client. The adolescent’s symptoms suggest a possible bacterial infection, which could have been introduced during the recent dental work. Antibiotics would help eliminate the bacteria and prevent further complications.

Choice C rationale:

Obtaining an echocardiogram is anticipated for the client. Given the adolescent’s history of rheumatic fever and cardiac valve damage, and current symptoms like shortness of breath and chest pain, an echocardiogram would help assess the condition of the heart valves and detect any abnormalities.

Choice D rationale:

Restricting dental hygiene is contraindicated for the client. Good oral hygiene is important, especially for individuals with a history of rheumatic fever and cardiac valve damage, as it helps prevent oral infections that could potentially spread to the heart.

Choice E rationale:

Performing a strenuous exercise regimen twice daily is contraindicated for the client. The adolescent is currently experiencing symptoms like shortness of breath and chest pain, which could be exacerbated by strenuous exercise. It’s important to avoid overexertion until the adolescent’s condition stabilizes.

So, the correct answer is, after analyzing all choices, Choices A, B, and C are anticipated for the client, while Choices D and E are contraindicated. .

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Correct Answer is D

Explanation

Choice A rationale:

The pain level of 3 to 5 on a scale of 0 to 10 does not specifically indicate chronic stable angina.

Choice B rationale:

Pain that has worsened over the last week could indicate a number of conditions, not specifically chronic stable angina.

Choice C rationale:

Pain that wakes a patient up at night could be a sign of a number of conditions, not specifically chronic stable angina.

Choice D rationale:

Chronic stable angina is characterized by chest pain that is relieved by rest or nitroglycerin. Therefore, if the patient’s pain goes away with a nitroglycerin tablet, it would help confirm a diagnosis of chronic stable angina.

So, the correct answer is Choice D, after analyzing all choices.

A. "Do you have a history of a heart attack?". B. "Have you had any recent immunizations?". C. "Do you have a family history of endocarditis?". D. "Have you had dental work done recently?".

Correct Answer is D

Explanation

Choice A rationale:

While a history of heart attack indicates a general risk for heart disease, it is not specifically associated with an increased risk for infective endocarditis.

Choice B rationale:

Immunizations do not typically increase the risk for infective endocarditis.

Choice C rationale:

Family history of endocarditis does not necessarily increase the risk for infective endocarditis.

Choice D rationale:

Dental work can introduce bacteria into the bloodstream, which can lead to infective endocarditis, especially in individuals with prosthetic heart valves.

So, the correct answer is D, after analyzing all choices.

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Naxlex Comprehensive Predictor Exams

Which patient statement would help the nurse confirm the previous diagnosis of chronic stable angina?.

Correct Answer is D

Explanation

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?.

Correct Answer is D

Explanation

A patient is admitted to the emergency department and diagnosed as having an ST-segment-elevation myocardial infarction (STEMI). Which question would the nurse ask to determine whether the patient is a candidate for thrombolytic therapy?.

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The nurse is administering a thrombolytic agent to a patient having an acute myocardial infarction. Which patient data indicates that the nurse should stop the drug infusion?.

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