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 ["A","B","D","E"]

Explanation

A. The P-P and R-R distances are equal and regular: Equal and regular spacing between P-P and R-R intervals indicates that both atrial and ventricular rhythms are regular. This is a fundamental aspect of rhythm interpretation, helping to distinguish between regular and irregular rhythms such as atrial fibrillation or sinus arrhythmia.

B. The rhythm rate using a 3-second strip: Assessing the heart rate using a 3-second or 6-second ECG strip helps determine whether the rhythm is bradycardic, tachycardic, or within normal limits, which is crucial for accurate rhythm classification.

C. The duration of the U waves: U waves are typically small and follow the T wave. Although their presence can suggest conditions like hypokalemia, they are not routinely assessed in basic rhythm identification. Evaluating U wave duration is more relevant in electrolyte imbalance analysis than in identifying rhythm type.

D. There is a QRS complex after each P wave: A consistent QRS following every P wave indicates effective conduction from the atria to the ventricles. Each atrial depolarization (P wave) should be followed by a ventricular depolarization (QRS complex) if the signal is being conducted properly through the AV node. This finding supports a diagnosis of sinus rhythm and helps rule out AV blocks, where conduction may be delayed or blocked entirely.

E. P waves are present, upright and rounded: P waves that are upright and rounded in lead II suggest the electrical impulse is originating from the SA node. Their presence and morphology are essential criteria for identifying sinus rhythm and differentiating it from atrial arrhythmias like flutter or fibrillation.

A. Diaphoresis, hypertension B. Palpitations, shortness of breath C. Systolic murmur, severe anxiety D. Visual changes, anorexia

Correct Answer is B

Explanation

A. Diaphoresis, hypertension: While diaphoresis may occur in response to the discomfort or anxiety caused by a rapid heart rate, hypertension is not a typical feature of atrial flutter. The rapid ventricular response can more often lead to hypotension if cardiac output is compromised.

B. Palpitations, shortness of breath: These are hallmark symptoms of rapid atrial flutter. Palpitations result from the fast, irregular atrial contractions, while shortness of breath may occur due to decreased cardiac output and poor ventricular filling during rapid rates.

C. Systolic murmur, severe anxiety: Atrial flutter is not typically associated with a systolic murmur unless there is a pre-existing valvular condition. Anxiety may be present but is a nonspecific response and not as directly linked to atrial flutter as palpitations and dyspnea.

D. Visual changes, anorexia: These symptoms are not characteristic of atrial flutter. Visual changes may occur with severe hypotension or embolic events, and anorexia may be seen in chronic illness, but neither is directly tied to the acute presentation of atrial flutter.

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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

To properly identify a cardiac rhythm, the nurse will determine if the client's rhythm contains the following factors: (Select All that Apply.)

Correct Answer is ["A","B","D","E"]

Explanation

Which physical assessment findings would the nurse anticipate for a client with rapid atrial flutter?

Correct Answer is B

Explanation

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