The nurse is caring for a client with suspected infectious endocarditis. Which information obtained in the health history could contribute to the development of this problem?

A. Edema of ankles: While peripheral edema may be associated with worsening cardiac function or side effects from other medications, it is not a hallmark adverse effect of amiodarone. It warrants evaluation but is not the most urgent symptom related to this drug.

B. Shortness of breath: Amiodarone is a potent antiarrhythmic medication with several potential serious side effects, including pulmonary toxicity. This can manifest as interstitial pneumonitis or pulmonary fibrosis, which may present as new or worsening shortness of breath cough, and chest pain. This is a potentially life-threatening complication and requires immediate medical attention.

C. Fatigue after exercise: Exercise-induced fatigue can result from many conditions, including heart disease or deconditioning, but it is a nonspecific symptom. It does not point directly to a serious adverse reaction from amiodarone.

D. Abdominal fullness: Abdominal fullness is not typically associated with amiodarone. It may relate to gastrointestinal or hepatic issues, but it is not as immediately concerning as respiratory symptoms suggestive of pulmonary toxicity.

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.