Difficulty: Medium
Average Score: 88%
Full-length
Passage / Scenario
History and PhysicalBody System
Findings
General
Client reports a 1-week history of general malaise, fever and chills, night sweats, fatigue, and
poor appetite. Client has poorly controlled hypertension, hypercholesterolemia, and mitral
valve prolapse and regurgitation.
Eye, Ear, Nose, and
Throat (EENT)
Poor dental hygiene. Client reports having 2 teeth extracted 3 weeks ago.
Pulmonary
Vital signs are RR 18 and SpO, 96% on room air. Lungs are clear to auscultation bilaterally.
Cardiovascular
Vital signs are T 100.4 F (38 C), P 105, and BP 140/82. Sinus tachycardia with occasional
premature ventricular contractions on cardiac monitor. S1 and S2 heard on auscultation with
loud systolic murmur at the apex. Peripheral pulses 2+; no edema noted.
Integumentary
Small, erythematous macular lesions on both palms. Thin, brown longitudinal lines on several
nail beds.
For each potential prescription, click to specify whether the prescription is expected or not expected for the care of the client.
Rationale
Expected prescriptions for clients with suspected infective endocarditis (IE) include:
ÔÇó Administering IV antibiotics to kill the infectious pathogen
ÔÇó Preparing the client for echocardiography to identify valvular dysfunction, chamber enlargement, and vegetations
ÔÇó Placing a peripherally inserted central catheter for long-term IV antibiotic therapy
ÔÇó Collecting a blood specimen for culture and sensitivity to identify the infectious pathogen
Initiating low-flow supplemental oxygen is not expected because the client is not exhibiting signs of respiratory distress.
Pericardiocentesis is performed to remove excess fluid from the pericardial cavity and prevent progression to cardiac
tamponade. Pericardial effusions are not commonly expected with IE. Furthermore, this client is not exhibiting signs of
pericardial effusion (eg, muffled heart sounds, substernal pain). Therefore, gathering supplies for pericardiocentesis is not
expected.
ÔÇó Administering IV antibiotics to kill the infectious pathogen
ÔÇó Preparing the client for echocardiography to identify valvular dysfunction, chamber enlargement, and vegetations
ÔÇó Placing a peripherally inserted central catheter for long-term IV antibiotic therapy
ÔÇó Collecting a blood specimen for culture and sensitivity to identify the infectious pathogen
Initiating low-flow supplemental oxygen is not expected because the client is not exhibiting signs of respiratory distress.
Pericardiocentesis is performed to remove excess fluid from the pericardial cavity and prevent progression to cardiac
tamponade. Pericardial effusions are not commonly expected with IE. Furthermore, this client is not exhibiting signs of
pericardial effusion (eg, muffled heart sounds, substernal pain). Therefore, gathering supplies for pericardiocentesis is not
expected.