A nurse is caring for an adolescent in an emergency department who was brought to the emergency department by their parent. The adolescent reports intermittent low-grade fever and anorexia. Manifestations presented a few days after having dental work performed. Now they are worse. The adolescent noticed shortness of breath with exertion today. The nurse reports the 2400 assessment findings to the provider. Which of the following should the nurse anticipate the provider will prescribe? For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the client.

Administer antibiotic therapy

Obtain an echocardiogram

Obtain blood cultures x3

Restrict dental hygiene

Perform strenuous exercise regimen twice a day

Answer and Explanation

The Correct Answer is A

Choice A reason: Administering antibiotic therapy is an anticipated prescription for the client, as it can treat the possible bacterial infection that is causing the fever, anorexia, and shortness of breath. The client may have developed infective endocarditis, a serious condition that affects the heart valves and can lead to heart failure or stroke. Antibiotic therapy can help prevent further complications and reduce the risk of mortality.

Choice B reason: Obtaining an echocardiogram is an anticipated prescription for the client, as it can help diagnose the presence and severity of infective endocarditis. An echocardiogram is a noninvasive test that uses sound waves to create images of the heart and its structures. It can show if there is any damage to the heart valves, vegetation (clumps of bacteria and cells) on the valves, or signs of heart failure.

Choice C reason: Obtaining blood cultures x3 is an anticipated prescription for the client, as it can help identify the causative organism of the infection and guide the appropriate antibiotic therapy. Blood cultures are samples of blood that are taken from different sites and times and tested for the presence of bacteria or other microorganisms. They can confirm the diagnosis of infective endocarditis and determine the sensitivity and resistance of the bacteria to different antibiotics.

Choice D reason: Restricting dental hygiene is a contraindicated prescription for the client, as it can worsen the oral health and increase the risk of infection. Dental hygiene is important for preventing plaque and tartar buildup, which can harbor bacteria and cause dental caries, gingivitis, or periodontitis. These conditions can increase the risk of bacteremia (bacteria in the blood) and infective endocarditis. The nurse should teach the client to maintain good oral hygiene and use a soft-bristled toothbrush and gentle flossing.

Choice E reason: Performing a strenuous exercise regimen twice a day is a contraindicated prescription for the client, as it can increase the cardiac workload and exacerbate the symptoms of infective endocarditis. Strenuous exercise can cause tachycardia (fast heart rate), dyspnea (difficulty breathing), chest pain, and fatigue, which can worsen the condition of the heart and the valves. The nurse should advise the client to avoid strenuous exercise and limit physical activity to a level that does not cause symptoms.

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Correct Answer is D

Explanation

Choice A reason: Offering the client a reward for agreeing to the treatment is not an appropriate action, as it does not respect the client's autonomy and may be seen as coercive or manipulative.

Choice B reason: Notifying the provider of the client's refusal and documenting it in the chart is a necessary action, but not the first one. The nurse should first attempt to educate the client and the parent and address their concerns and preferences.

Choice C reason: Initiating the treatment as per the parent's request and the provider's order is not an appropriate action, as it violates the client's right to informed consent and may cause harm or resentment.

Choice D reason: Educating the client and the parent about the benefits and risks of the treatment is the best action, as it provides them with the information they need to make an informed decision and shows respect for their values and beliefs.

A. The client has a nonproductive cough and wheezes in the lower lobes. B. The client has dyspnea with a respiratory rate of 30/min and oxygen at 2 L/min via nasal cannula. C. The client has a peripheral saline lock intact to the right forearm with no signs and symptoms of infection. D. The client has lower extremity edema and decreased skin pigmentation noted to bilateral lower extremities.

Correct Answer is D

Explanation

Choice A reason: This statement does not indicate a risk for rheumatic carditis, but rather a possible respiratory infection or asthma. Rheumatic carditis is an inflammatory condition of the heart valves that can result from untreated streptococcal pharyngitis.

Choice B reason: This statement does not indicate a risk for rheumatic carditis, but rather a sign of heart failure. Dyspnea, tachypnea, and hypoxia are common manifestations of heart failure in children with congenital heart defects.

Choice C reason: This statement does not indicate a risk for rheumatic carditis, but rather a normal finding for a client who has an IV access. A peripheral saline lock is used to administer fluids and medications as needed, and it should be monitored for signs of infection, infiltration, or phlebitis.

Choice D reason: This statement indicates a risk for rheumatic carditis, as lower extremity edema and decreased skin pigmentation are signs of erythema marginatum, a characteristic rash that occurs in some cases of rheumatic fever. Erythema marginatum is a pink or red rash that spreads from the trunk to the extremities, and it may fade and reappear with changes in temperature.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a 17-year-old client who is experiencing a relapse of leukemia and is refusing treatment. The client's mother insists that the client receive treatment. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

A nurse on a cardiac care unit is caring for a preschooler who has a history of congenital mitral stenosis. Which of the following statements indicates that the client is at risk for developing rheumatic carditis?

Correct Answer is D

Explanation

A nurse is caring for a 3-year-old child who was admitted with acute diarrhea and dehydration. Which of the following findings indicates that oral rehydration therapy has been effective?

A nurse is planning care for a preschooler who has leukemia. After reviewing the child's information, which of the following potential issues should the nurse identify that the child is at risk for developing? (Select all that apply.)

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A nurse on an oncology unit is assessing a child who has a brain tumor. Which of the following findings should the nurse expect?

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A nurse is admitting a 6-month-old infant who has dehydration. Which of the following amounts of urinary output should indicate to the nurse that the treatment has corrected the fluid imbalance?

A nurse is caring for a child who was admitted with suspected rheumatic fever. The provider prescribes an anti-streptolysin O (ASO) titer. The parent asks the nurse the purpose of the test. Which of the following responses should the nurse make?