Question

Formulate an NCLEX question about infective endocarditis. Provide the correct answer with rationales and their resources

Answer 1

Formulate an NCLEX question about infective endocarditis. Provide the correct answer with rationales and their resources?

1. True or False: Endocarditis only affects the atrioventricular and semi-lunar valves in the heart.?

a)*false ,Endocarditis can affect not only the heart valves but the interventricular septum and chordae tendineae as well.

*The tricuspid valve is most commonly affected (50%), whereas involvement of the mitral and aortic valves is less common (20% each). The involvement of multiple valves is common. Pulmonary valve endocarditis is rare.

2)What is the most common cause of endocarditis?

a)Endocarditis begins when germs enter the bloodstream and then travel to the heart. Bacterial infection is the most common cause of endocarditis. Endocarditis can also be caused by fungi, such as Candida. In some cases, no cause can be found.

3). A patient is receiving treatment for infective endocarditis. The patient has a history of intravenous drug use and underwent mitral valve replacement a year ago. The patient is scheduled for a transesophageal echocardiogram tomorrow. On assessment, you find tender, red lesions on the patient's hands and feet. You know that this is a common finding in patients with infective endocarditis and is known as?

• A. Janeway Lesions
• B. Roth Spots
• C. Osler's Nodes
• D. Trousseau’s Sign

a)option c,Oslers node

*Osler nodes and Janeway lesions are cutaneous manifestations of endocarditis, a disease most commonly arising from a bacterial or fungal infection of the cardiac endocardium. Osler’s nodes are tender, purple-pink nodules with a pale center, and an average diameter of 1 to 1.5 mm. They are generally found on the distal fingers and toes, though they can also present on the lateral digits, hypothenar and thenar muscles. The pain usually proceeds nodule development, and they disappear in hours to days

4)How is infective endocarditis treated?

a)Initial empiric therapy in patients with suspected endocarditis should include vancomycin or ampicillin/sulbactam (Unasyn) plus an aminoglycoside (plus rifampin in patients with prosthetic valves). Valve replacement should be considered in selected patients with infectious endocarditis

5)How long does it take to get rid of endocarditis?

a)Depending on the severity of your condition, you'll usually have to take antibiotics for 2 to 6 weeks. Your doctor will usually take a blood sample before prescribing antibiotics to make sure you're given the most effective treatment.

6) Select-all-that-apply: What are the typical signs and symptoms of infective endocarditis?

• A. Hyperthermia
• B. S4 gallop
• C. Enlarged Spleen
• D. Hyperkalemia
• E. Substernal pain that radiates to the back
• F. Heart failure
• G. Cardiac Murmur

a)A,C,F,G

*The symptoms of acute IE usually begin with fever (102°–104°), chills, fast heart rate, fatigue, night sweats, aching joints and muscles, persistent cough, or swelling in the feet, legs or abdomen.*

7)How is endocarditis prevented?

a)Good oral health is generally more effective in reducing your risk of bacterial endocarditis than is taking preventive antibiotics before certain procedures. Take good care of your teeth and gums by: Seeking professional dental care every six months. Regularly brushing and flossing your teeth.

8). A 30 year old female is being treated for infective endocarditis with IV antibiotics. At the beginning of the hospitalization, the patient’s symptoms were severe and sudden with a high fever but are now controlled. She has no significant health history other than 2 cesarean sections in the past. She is being prepped for a central line placement so she can be discharged home with home health to continue the 4 week antibiotic regime. What is type of infective endocarditis this classified as based on the information listed?

• A. Acute Infective Endocarditis
• B. Subacute Infective Endocarditis
• C. Non-infective Endocarditis
• D. Pericarditis

a)A. Acute Infective Endocarditis

*Infective endocarditis occurs when bacteria enter the bloodstream and travel to and attach to previously injured heart valves. Acute bacterial endocarditis usually begins suddenly with a high fever, fast heart rate, fatigue, and rapid and extensive heart valve damage.

9)What is the most common complication of infective endocarditis?

a)Congestive heart failure due to aortic valve insufficiency is the most common intracardiac complication of subacute endocarditis. It develops after months of untreated disease but may occur a full year following microbiological cure

10). A patient is admitted with sepsis. The patient has a temperature of 104.2 'F and is experiencing chills. On assessment, you note a mitral murmur which the patient states they've never had before, and dark, small lines on the patient’s fingernails. The patient has a history of IV drug use in the past. However, the patient states they are no longer using drugs. The physician suspects possible infective endocarditis. What diagnostic test do you expect the physician to order in order to confirm the presence of infective endocarditis?

• A. Abdominal ultrasound
• B. Heart catheterization
• C. Transesophageal echocardiogram
• D. White blood cell count

a)C. Transesophageal echocardiogram

*A transesophageal echocardiogram (TEE) is a special type of echocardiogram. It is usually done when your doctor wants to look more closely at your heart to see if it could be producing blood clots. Like an echocardiogram, the TEE uses high-frequency sound waves (ultrasound) to examine the structures of the heart.

11). A patient with endocarditis has listed in their medical history “Roth Spots”. You know that this is a complication of infective endocarditis and presents as?*

• A. Non-tender spots found on the feet and hands
• B. Red and tender lesions found in the eyes
• C. Retinal hemorrhages with white centers
• D. Purplish spots found on the forearms and groin

a)C. Retinal hemorrhages with white centers

*Roth Spots are defined as a white centered retinal hemorrhage and are associated with multiple systemic illnesses, most commonly bacterial infections

12). 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

a)D. Splenic embolic event

*Splenic infarction occurs when the splenic artery or one of its branches are occluded, for example by a blood clot. Although it can occur asymptomatically, the typical symptom is severe pain in the left upper quadrant of the abdomen, sometimes radiating to the left shoulder. Fever and chills develop in some cases.