The nurse is caring for a client with infectious endocarditis. Which information obtained from the health history could have contributed to the development of the disease progress?

Hypertension treated with medications

Prostate surgery six months prior

Use of intravenous substances

Stroke diagnosed one year ago

Answer and Explanation

The Correct Answer is C

A) Hypertension treated with medications
Hypertension (high blood pressure) itself is not a direct cause of infectious endocarditis. While untreated or poorly managed hypertension can contribute to cardiovascular complications, it is not typically a risk factor for developing infectious endocarditis. Infectious endocarditis is more commonly associated with conditions that directly involve the heart valves or blood stream, such as intravenous drug use, prior heart valve disease, or certain invasive procedures.

B) Prostate surgery six months prior
While certain surgeries, such as dental or urinary tract procedures, can increase the risk of infectious endocarditis due to transient bacteremia, prostate surgery by itself is not a major risk factor for this condition. Unless there was a complication during the surgery that resulted in bacteremia (e.g., infection), B is not the most likely contributor to the development of infectious endocarditis.

C) Use of intravenous substances
The use of intravenous (IV) substances, especially illicit drugs, is a major risk factor for the development of infectious endocarditis. Intravenous drug use, particularly when non-sterile needles or contaminated substances are used, can introduce bacteria directly into the bloodstream, leading to bacteremia.

D) Stroke diagnosed one year ago
While a history of stroke may indicate underlying cardiovascular disease or embolic events, it is not directly related to the development of infectious endocarditis. Stroke can occur as a complication of infectious endocarditis, particularly if emboli from infected valves travel to the brain. However, a prior stroke itself does not directly contribute to the development of endocarditis.

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Correct Answer is D

Explanation

A) Hypoglycemic event often develops:
Phenytoin is an anticonvulsant, and while it can affect glucose metabolism, hypoglycemia is not a typical consequence of abruptly stopping the drug. This is not a primary concern when discontinuing phenytoin therapy. Hypoglycemia is more commonly associated with medications like insulin or sulfonylureas, not anticonvulsants like phenytoin.

B) Physical dependency on the drug develops over time:
Phenytoin does not cause physical dependence in the way that some other substances (e.g., alcohol, opioids) can. While the body can become used to a medication over time, and withdrawal symptoms can occur, the risk of physical dependence is not the main reason why phenytoin should not be stopped suddenly.

C) A heart block is likely to develop:
Phenytoin is known to have effects on cardiac conduction, and it can cause heart rhythm disturbances like bradycardia or a prolonged PR interval, especially with toxicity. However, the risk of a heart block developing due to abrupt discontinuation of phenytoin is not the primary concern.

D) Status epilepticus may develop:
The most serious risk of suddenly stopping phenytoin, or any anticonvulsant, is the potential for status epilepticus. Status epilepticus is a medical emergency where seizures occur continuously without recovery in between, which can be life-threatening. Abruptly discontinuing phenytoin can lead to a rebound increase in seizure activity, which can result in status epilepticus.

A. Take the prescribed anticoagulant specifically as directed B. Stop taking your antihypertensive medications until checking with your surgeon C. Avoid lifting objects ten pounds or greater for two days D. Take your immunosuppressive medications daily in the morning

Correct Answer is A

Explanation

A) Take the prescribed anticoagulant specifically as directed:
Clients with mechanical heart valves are at an increased risk of developing blood clots, and therefore, anticoagulation therapy (often warfarin or another blood thinner) is necessary to prevent thromboembolic events. It is essential for the client to take the prescribed anticoagulant exactly as directed, ensuring therapeutic levels are maintained while minimizing the risk of bleeding.

B) Stop taking your antihypertensive medications until checking:
This instruction is not appropriate after heart surgery. Antihypertensive medications are typically necessary to manage blood pressure and reduce the strain on the heart. Stopping antihypertensive medications without consulting the healthcare provider could result in elevated blood pressure, which can put undue stress on the heart, especially after valve replacement surgery.

C) Avoid lifting objects ten pounds or greater for two days:
This statement is not appropriate for a client who has undergone open heart surgery. After heart surgery, particularly valve replacement, the client may be advised to avoid lifting heavy objects for a period of time (often 4-6 weeks) to prevent strain on the incision site and the heart. Two days of restriction is insufficient; longer periods of activity limitation are usually required to ensure proper healing.

D) Take your immunosuppressive medications daily in the morning:
Immunosuppressive medications are not typically prescribed for clients with mechanical heart valves. Immunosuppressive drugs are usually prescribed for clients who have had organ transplants (e.g., kidney, liver) to prevent organ rejection. Since the client in this scenario had a mitral valve replacement, immunosuppressants are not usually indicated unless there are specific complications, such as endocarditis or other infections.

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The nurse is caring for a client with infectious endocarditis. Which information obtained from the health history could have contributed to the development of the disease progress?

Nursing Test Bank

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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