Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

What is the most likely diagnosis for a patient with fever, splinter hemorrhages, and a heart murmur?

1. Congestive heart failure

2. Myocardial infarction

3. Raynaud's phenomenon

4. Bacterial endocarditis

The correct answer is: Bacterial endocarditis

This diagnosis is supported by the presence of fever, splinter hemorrhages, and a heart murmur, which are classic signs associated with bacterial endocarditis. Fever indicates an infectious process, while splinter hemorrhages—small, linear, reddish-brown streaks found in the nail beds—can occur as a result of embolic phenomena often seen in endocarditis, where infected heart valves can release bacteria into the bloodstream. The heart murmur is clinically significant because it may suggest valve dysfunction or damage due to the infection, typical in patients with endocarditis as vegetations form on heart valves. The combination of these symptoms forms a clinical picture strongly indicative of bacterial endocarditis. This condition is frequently caused by bacterial infection of the heart valves, and the presence of these symptoms should prompt immediate investigation and management.