The client hospitalized with infective endocarditis develops sharp flank pain and hematuria. The nurse notifies the physician, recognizing that these clinical manifestations may indicate:

vegetative embolization to the kidneys.

hemolysis of red blood cells by hemolytic microorganisms.

septicemia resulting in decreased glomerular blood flow.

bacterial infection in the kidneys.

Answer and Explanation

The Correct Answer is A

A. vegetative embolization to the kidneys: Infective endocarditis is an infection of the heart valves or the endocardium. Vegetations (clumps of bacteria, fibrin, and platelets) can form on the damaged heart structures. These vegetations are fragile and can break off, forming emboli that travel through the bloodstream to various organs. Embolization to the kidneys can cause renal infarction, leading to sharp flank pain due to ischemia or infarction of kidney tissue and hematuria.

B. hemolysis of red blood cells by hemolytic microorganisms: While some bacteria can cause hemolysis, it is not typically associated with localized flank pain. Hemolysis would present with systemic signs such as jaundice, fatigue, and anemia, not acute flank pain and visible hematuria.

C. septicemia resulting in decreased glomerular blood flow: Septicemia may impair renal perfusion over time but would more likely lead to generalized signs of acute kidney injury, such as oliguria and rising creatinine levels, rather than acute flank pain and hematuria.

D. bacterial infection in the kidneys: Acute pyelonephritis can cause flank pain and hematuria, but in the context of infective endocarditis, embolic events are a more likely and urgent explanation for new-onset symptoms, particularly sharp localized pain.

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Correct Answer is C

Explanation

A. Administer an antidiarrheal medication: Atropine is an anticholinergic agent that reduces gastrointestinal motility, often leading to constipation rather than diarrhea. Administering an antidiarrheal would not be appropriate and could cause harmful effects if unnecessary.

B. Assess the pupils for constriction: Atropine causes pupil dilation (mydriasis), not constriction. Checking for constriction would not align with the expected pharmacologic effects of the drug and is not a priority assessment after administration.

C. Provide frequent oral care: Atropine inhibits secretions as part of its anticholinergic effects, often leading to dry mouth (xerostomia). Frequent oral care helps maintain mucous membrane integrity and client comfort, making this an appropriate nursing action following administration.

D. Insert an indwelling catheter: Although atropine can cause urinary retention, especially in older adults, catheter insertion is not routinely required after administration; a single 0.5 mg IV dose is less likely to cause significant urinary retention requiring catheterization. It should only be considered if the client shows clinical signs of acute urinary retention.

A. Review daily the necessity of the central venous catheter. B. Maintain a pressure of 300 mm Hg on the flush bag. C. Cleanse the insertion site daily with isopropyl alcohol. D. Change the pressurized tubing system and flush bag daily.

Correct Answer is A

Explanation

A. Review daily the necessity of the central venous catheter: One of the most effective strategies to reduce the risk of catheter-related bloodstream infections is to remove the central line as soon as it is no longer needed. Daily evaluation of necessity prevents prolonged catheter use, which significantly increases infection risk. Removing the source of potential infection is the ultimate preventative action.

B. Maintain a pressure of 300 mm Hg on the flush bag: While maintaining appropriate flush pressure is important for catheter patency and preventing blood clots, it does not play a direct role in preventing bloodstream infections. This action is more related to ensuring adequate line function rather than infection control.

C. Cleanse the insertion site daily with isopropyl alcohol: Current guidelines recommend using chlorhexidine-based solutions rather than isopropyl alcohol for skin antisepsis due to better antimicrobial efficacy. Daily site care is important, but the choice of antiseptic is critical in reducing infection risk.

D. Change the pressurized tubing system and flush bag daily: Tubing and flush systems should be changed typically every 72–96 hours unless contamination is suspected. Changing them daily is not recommended and does not provide added protection against infection it may even increase risk with unnecessary manipulation.

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The client hospitalized with infective endocarditis develops sharp flank pain and hematuria. The nurse notifies the physician, recognizing that these clinical manifestations may indicate:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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