Study Guide/Review for Final Exam
Practice Questions for Exam 1
Endocarditis/Pericarditis
The pericardium layer consists of a fibrous layer that is made up of two layers
called the parietal and visceral layers.
a.True
b.False
A patient is recovering from a myocardial infarction (MI) and develops chest pain
on day 3 that increases when taking a deep breath and is relieved by leaning
forward. Which action should the nurse take next?
a. Assess the feet for pedal edema.
b. Palpate the radial pulses bilaterally.
c. Auscultate for a pericardial friction rub.
d. Check the heart monitor for dysrhythmias.
True or False: Endocarditis only affects the atrioventricular and semi-lunar valves
in the heart.
False
Rationale: Endocarditis can affect not only the heart valves but the interventricular
septum and chordae tendineae as well.
You're providing discharge teaching to a patient being treated for endocarditis.
Which statement by the patient demonstrated they understood your teaching
about this condition?
A. "I will stop taking the antibiotics once my fever is gone in order to prevent antibiotic
resistance."
B. "I will only wash my hands with soap and water."
C. "I will inform my dentist about my history of endocarditis prior to any invasive
procedures."
D. "I will avoid eating fish and organ meats."
A patient being treated for infective endocarditis is complaining of very sharp
radiating abdominal pain that goes to the left shoulder and back. As the nurse
familiar with complications of infective endocarditis, what do you suspect is the
cause of this patient finding?
A. Renal embolic event
B. Pulmonary embolic event
C. Central nervous system embolic event
D. Splenic embolic event
You are providing care to a patient with pericarditis. Which of the following is NOT
a proper nursing intervention for this patient?
A. Monitor the patient for complications of cardiac tamponade.
B. Administer Ibuprofen as scheduled.
C. Place the patient in supine position to relieve pain.
D. Monitor the patient for pulsus paradoxus and muffled heart sounds.
A patient with severe pericarditis has developed a large pericardial effusion. The
patient is symptomatic. The physician orders what type of procedure to help treat
this condition?
A. Pericardiectomy
B. Heart catheterization
This is an NCLEX review for endocarditis. Patients who have endocarditis are experiencing inflammation of the endocardium layer of the heart. There are two types of endocarditis: infective and non-infective. This NCLEX review will focus on the the infective endocarditis (IE). When taking care of a patient with endocarditis, it is very
important the nurse knows how to recognize the typical signs and symptoms seen in this condition, the types of endocarditis, treatments, nursing interventions, and patient education . Don’t forget to take the endocarditis quiz. In this NCLEX review for endocarditis, you will learn the following: Definition: Inflammation of the endocardium layer of the heart. What is the endocardium layer? The endocardium is a membrane
that lines the inside of the heart chambers and the heart valves. How many heart valves do you have? Four….Atrioventricular (tricuspid and mitral valve) and Semilunar (pulmonic and aortic valves) Endocarditis mainly affects the heart valves but it can affect the: Endocarditis is hard to treat because there is no blood flow to the valves so the body does NOT respond properly to the pathogen present (hence, WBCs can NOT get to the valves to fight the infection) and it is hard for antibiotics to get to it (so the patient will need weeks of IV antibiotics). Patients who have defective heart valves can experience complications of heart failure (valves are leaking or have stenosis, embolic events (strokes), erosion of
valve leaflets, and abscesses of the heart tissue.NCLEX Lecture on Endocarditis
Types of Endocarditis:
Non-infective: sterile platelets and fibrin (thrombus) form on the valve due to trauma or some other issue (hypercoagulated blood) but it isn’t pathogenic. However, it is a site of origin for possible infective endocarditis.
Patho of how a heart valve turns into Infective Endocarditis:
- A defect on the valve allows platelets and fibrin (aka a thrombus…clotting ingredient) to stick to the endothelial cells.
- A pathogen enters into the blood (from invasive procedure….dental work, central line placement, implantable device) and the pathogen sticks to the platelets and fibrin (thrombus).
- The pathogen is able to grow.
- As it grows, parts of the pathogen, platelets, and fibrin can break off. This can cause a stroke.
Type of Infective Endocarditis:
- Acute IE: affects patient who have healthy heart valves (high death rate). The onset is fast and symptoms are very severe.
- Subacute IE: affects people who have a pre-existing condition like rheumatic heart disease, valve problem. The symptoms are subtle and onset slower (several weeks to months to develop).
*IV drug uses are susceptible to both
Signs and Symptoms of Infective Endocarditis:
Remember the mnemonic: Pathogens
Petechiae (tiny purplish red spots on the skin….from emboli)
Anorexia (loss of appetite and enlarged spleen pushing on the stomach)
Tired and weak
High Fever & Heart Failure
Osler’s Nodes: tender, red lesions on the hands and feet
finGernail changes: splinter hemorrhages that are small, dark lines under the nails…like petechiae but found under the nails
Embolic events, Erythematous, non-tender nodular lesions on the palms or soles of feet (Janeway Lesions)…small, septic emboli that form abscesses
Night sweats, New cardiac heart murmur or worsening of one
Splenomegaly (helps fight infection so it becomes enlarged), Roth Spots (burst of blood vessels in the retinas with white centers)
Diagnosed:
TEE (transesophageal echocardiogram): an ultrasound probe is placed down through the patient throat and it looks at the back side of the heart which helps assess the heart valves.
Nursing Interventions for Infective Endocarditis:
Monitor:
- Embolic episodes of the spleen, renal, brain, pulmonary status:
- Spleen embolic: radiating abdominal pain that goes to the left shoulder
- Renal: flank pain in the groin with possible pus or blood in the urine
- Brain (stroke): changes in neuro status…confusion, speech difficulty
- Pulmonary: chest pain, shortness of breath, dyspnea, decreased oxygen saturation
- Signs and symptoms of heart failure
- Monitor vital signs especially temperature, heart rate, blood pressure, oxygen saturation
Interventions:
- Collecting blood cultures to find out what type of microorganism is infecting the patient…antibiotic treatment is based on this
- Administered IV antibiotics…type of antibiotics depends on the pathogen causing the problem
- Example: Vancomycin or Rocephin (strong…usually need a central line because patient will be on long term and go home on them…up to 4 weeks)
Educate the patient about:
- inform other healthcare practitioners about history of endocarditis because they are at risk for it again and will need prophylactic antibiotics prior to invasive procedures (especially dental procedures).
- how to take or administer antibiotics (complete all doses)
- monitor central line site and how to care for it
- good oral care
You may be interested in more NCLEX Reviews.
References:
- “Endocarditis | Infective Endocarditis | IE | Medlineplus”. Medlineplus.gov. Web. 19 Aug. 2016.
- “What Causes Endocarditis? – NHLBI, NIH”. Nhlbi.nih.gov. N.p., 2010. Web. 20 Aug. 2016.
- “What Is Endocarditis? – NHLBI, NIH”. Nhlbi.nih.gov. N.p., 2010. Web. 20 Aug. 2016.