Which instruction should a nurse provide a client with a history of rheumatic fever before the client has any dental work done?
To take steroids.
To take aspirin.
To avoid any kind of activity.
To take prophylactic antibiotics.
The Correct Answer is D
Choice A rationale
Glucocorticoids like steroids are primarily utilized to suppress active inflammatory processes during acute rheumatic fever episodes rather than serving as a preventive measure for dental procedures. While they reduce systemic inflammation and carditis severity, they do not provide the necessary antimicrobial coverage required to prevent bacterial seeding of damaged heart valves during invasive oral maneuvers. Administering them before dental work would not address the specific risk of bacteremia-induced endocarditis effectively in this client population.
Choice B rationale
Aspirin is a nonsteroidal anti-inflammatory drug used during the acute phase of rheumatic fever to manage joint pain and reduce fever through prostaglandin inhibition. However, aspirin lacks the antibacterial properties required to prevent subacute bacterial endocarditis. Furthermore, its antiplatelet effect might actually increase the risk of bleeding during dental extractions or deep scaling without offering any protection against the pathogens commonly introduced into the bloodstream from the oral cavity during such procedures.
Choice C rationale
Advising a client to avoid all activity is unnecessary and does not address the physiological risk associated with dental work in a patient with a history of rheumatic fever. Activity restriction is usually reserved for the acute phase of the illness to minimize cardiac demand if carditis is present. For a stable client undergoing dental work, the primary concern is the entry of oral bacteria into the circulation, which physical rest cannot prevent or mitigate.
Choice D rationale
Rheumatic fever often causes permanent damage to heart valves, creating a site where bacteria can easily adhere. Dental procedures can introduce oral flora, such as Streptococcus viridans, into the bloodstream. Prophylactic antibiotics are administered to eliminate these bacteria before they can colonize the endocardium or damaged valves. This prevention strategy is the standard of care for high-risk patients to avoid the development of life-threatening infective endocarditis following invasive dental manipulations.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The normal range for serum creatinine is approximately 0.6 to 1.2 mg/dL for adults. A value of 2.1 mg/dL is significantly elevated, indicating a reduction in the glomerular filtration rate and impaired renal function. In the context of a myocardial infarction, low cardiac output can lead to pre-renal azotemia or acute tubular necrosis. This elevation serves as a primary marker for the development of acute kidney injury, reflecting the kidneys' inability to clear metabolic waste effectively.
Choice B rationale
Serum osmolality represents the concentration of particles dissolved in the blood, with a normal range typically between 275 and 295 mOsm/kg H2O. A value of 290 mOsm/kg H2O is within the normal physiological limits. This indicates a stable balance of electrolytes and water in the plasma. Since the value is normal, it does not suggest an increased risk or current state of acute kidney injury or fluid volume disturbances that would damage renal tissue.
Choice C rationale
The normal range for serum magnesium is approximately 1.3 to 2.1 mEq/L. A magnesium level of 2.0 mEq/L is within the normal therapeutic range. While electrolyte imbalances can occur during renal failure, a normal magnesium level does not indicate an increased risk of acute kidney injury. Magnesium is primarily excreted by the kidneys, so while its level might rise if injury occurs, the current value of 2.0 mEq/L indicates that renal clearance is currently sufficient.
Choice D rationale
The normal range for blood urea nitrogen (BUN) is typically 10 to 20 mg/dL. A BUN of 20 mg/dL is at the upper limit of the normal range but is not considered an elevated finding that signifies acute kidney injury on its own. BUN can be influenced by protein intake, hydration status, and liver function. Without an accompanying elevation in creatinine, this normal BUN level does not suggest that the patient is at high risk for kidney failure.
Correct Answer is D
Explanation
Choice A rationale
Powerlessness refers to the perception that one's own actions will not significantly affect an outcome. While a critical care environment can certainly contribute to a lack of control, the specific physiological and psychological response to constant auditory stimuli like alarms and pumps is more directly related to sensory processing. Powerlessness is a broader psychosocial response to the loss of autonomy in the hospital setting, whereas constant noise specifically targets the patient's neurological and sensory thresholds.
Choice B rationale
Frustration is an emotional response to being hindered or blocked from reaching a goal. While a patient may feel frustrated by the noise and the inability to rest, this is a secondary emotional consequence. The primary clinical phenomenon occurring when the environment is filled with constant, competing auditory stimuli is the saturation of the brain's ability to process information. Frustration describes the feeling, but it does not capture the physiological state of sensory system exhaustion and overstimulation.
Choice C rationale
Physical pain is a localized or generalized unpleasant sensory and emotional experience associated with actual or potential tissue damage. While the stress of a noisy environment can lower a patient's pain tolerance or increase the perception of existing pain due to lack of rest, the noise itself is not the source of physical pain. Pain management requires different interventions, such as analgesics, whereas managing environmental noise requires a reduction in stimuli to prevent the exhaustion of the patient's sensory receptors.
Choice D rationale
Sensory overload occurs when an individual receives more sensory stimuli than their nervous system can navigate or process simultaneously. In an intensive care unit, the repetitive and unpredictable nature of monitor alarms, ventilator hissing, and pump humming keeps the reticular activating system in a state of constant arousal. This prevents the patient from entering deep sleep and leads to cognitive impairment, anxiety, and disorientation. Normal environmental processing becomes impossible as the brain is bombarded by excessive auditory inputs.
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