The client hospitalized with infective endocarditis develops sharp flank pain and hematuria. The nurse notifies the physician, recognizing that these clinical manifestations may indicate:

vegetative embolization to the kidneys.

hemolysis of red blood cells by hemolytic microorganisms.

septicemia resulting in decreased glomerular blood flow.

bacterial infection in the kidneys.

Answer and Explanation

The Correct Answer is A

A. vegetative embolization to the kidneys: Infective endocarditis is an infection of the heart valves or the endocardium. Vegetations (clumps of bacteria, fibrin, and platelets) can form on the damaged heart structures. These vegetations are fragile and can break off, forming emboli that travel through the bloodstream to various organs. Embolization to the kidneys can cause renal infarction, leading to sharp flank pain due to ischemia or infarction of kidney tissue and hematuria.

B. hemolysis of red blood cells by hemolytic microorganisms: While some bacteria can cause hemolysis, it is not typically associated with localized flank pain. Hemolysis would present with systemic signs such as jaundice, fatigue, and anemia, not acute flank pain and visible hematuria.

C. septicemia resulting in decreased glomerular blood flow: Septicemia may impair renal perfusion over time but would more likely lead to generalized signs of acute kidney injury, such as oliguria and rising creatinine levels, rather than acute flank pain and hematuria.

D. bacterial infection in the kidneys: Acute pyelonephritis can cause flank pain and hematuria, but in the context of infective endocarditis, embolic events are a more likely and urgent explanation for new-onset symptoms, particularly sharp localized pain.

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Free Nursing Study Resources

Correct Answer is D

Explanation

A. Maintain the infusion because the client had a cardiac arrest: While epinephrine is essential during cardiac arrest, continuing a high-dose infusion post-resuscitation without reassessment may lead to complications like tachycardia, hypertension, and increased myocardial oxygen demand.

B. Continue to monitor the client's rhythm closely: Ongoing monitoring is important, but it is a passive intervention. The heart rate of 120 bpm may reflect excessive adrenergic stimulation from epinephrine, and further action is needed to prevent deterioration.

C. Suggest that the client's medication be changed to norepinephrine: Norepinephrine is another vasopressor that has less of a beta-1 adrenergic effect compared to epinephrine. It is primarily used for hypotension and septic shock, not as a direct substitute for epinephrine post-cardiac arrest. Changing to another vasopressor without indication is not the best initial step.

D. Ask the physician if the dose can be decreased: A heart rate of 120 bpm may indicate that the epinephrine dose is too high, causing sympathetic overstimulation. Prolonged or excessive tachycardia increases myocardial oxygen demand, which can be detrimental, especially in a post-arrest heart. Decreasing the dose can help prevent arrhythmias or myocardial ischemia, making this the most appropriate and proactive action.

Correct Answer is ["200"]

Explanation

Volume ordered is 1 L.

Convert the total volume to milliliters (mL)

1 L = 1000 mL.

Total volume in mL = 1 L × 1000 mL/L = 1000 mL

Total infusion time = 5 hours

Calculate the infusion rate in milliliters per hour (mL/hr).

Infusion rate (mL/hr) = Total volume (mL) / Total infusion time (hours)

= 1000 mL / 5 hours

= 200

The appropriate setting is 200 mL/hr.

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The client hospitalized with infective endocarditis develops sharp flank pain and hematuria. The nurse notifies the physician, recognizing that these clinical manifestations may indicate:

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who has been successfully resuscitated following a cardiac arrest and is now on an IV infusion of epinephrine. The cardiac monitor shows a heart rate of 120 beats/minute. What should be the nurse's best action?

Correct Answer is D

Explanation

A post-op client is to receive the following: D5%W/0.45% NS 1 L to infuse over 5 hours. What is the appropriate setting on an infusion pump in milliliters per hour? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["200"]

Explanation

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