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NURS 401 Heart Disease: Questions & Solutions (A+)
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NURS 401 Heart Disease: Questions & Solutions (A+)
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NURS 401 Heart Disease: Questions & Solutions (A+)The nurse is performing an initial assessment of a client diagnosed with heart
failure (HF) that includes the client's sensorium and level of consciousness
(LOC). Why is the assessment of the client's sensorium and LOC important in
clients with HF?
HF ultimately affects oxygen transportation to the brain.
Clients with HF are susceptible to overstimulation of the sympathetic nervous
system.
Decreased LOC causes an exacerbation of the signs and symptoms of HF.
The most significant adverse effect of medications used for HF treatment is
altered LOC. Right Ans - HF ultimately affects oxygen transportation to the
brain.
A client with acute pericarditis is exhibiting distended jugular veins,
tachycardia, tachypnea, and muffled heart sounds. The nurse recognizes these
as symptoms of what occurrence?
The pericardial space is eliminated with scar tissue and thickened
pericardium.
Excess pericardial fluid compresses the heart and prevents adequate diastolic
filling.
The parietal and visceral pericardial membranes adhere to each other,
preventing normal myocardial contraction.
Fibrin accumulation on the visceral pericardium infiltrates into the
myocardium, creating generalized myocardial dysfunction. Right Ans -
Excess pericardial fluid compresses the heart and prevents adequate diastolic
filling.
Which action will the nurse include in the plan of care for a client admitted
with acute decompensated heart failure (ADHF) who is receiving milrinone?
Monitor blood pressure frequently
Encourage the client to ambulate in room
Titrate milrinone rate slowly before discontinuing
Teach the client about safe home use of the medication Right Ans - Monitor
blood pressure frequently
The client with cardiac failure is taught to report which symptom to the health
care provider or clinic immediately?
Increased appetite
,Persistent cough
Weight loss
Ability to sleep through the night Right Ans - Persistent cough
A client has been diagnosed with heart failure. What is the major nursing
outcome for the client?
Reduce the workload on the heart.
Walk 30 minutes three times a week.
Maintain a healthy diet.
Sleep 8 hours per night. Right Ans - Reduce the workload on the heart.
The nurse identifies which symptom as a characteristic of right-sided heart
failure?
Jugular vein distention (JVD)
Dyspnea
Pulmonary crackles
Cough Right Ans - Jugular vein distention (JVD)
The nurse is obtaining data on an older adult client. What finding may indicate
to the nurse the early symptom of heart failure?
Decreased urinary output
Dyspnea on exertion
Hypotension
Tachycardia Right Ans - Dyspnea on exertion
The nurse is admitting a client with frothy pink sputum. What does the nurse
suspect is the primary underlying disorder of pulmonary edema?
decreased left ventricular pumping
decreased right ventricular elasticity
increased left atrial contractility
increased right atrial resistance Right Ans - decreased left ventricular
pumping
The nurse is assigned to care for a patient with heart failure. What
classification of medication does the nurse anticipate administering that will
improve symptoms as well as increase survival?
ACE inhibitor
Calcium channel blocker
Diuretic
, Bile acid sequestrants Right Ans - ACE inhibitor
The nurse is teaching a group of clients with heart failure about how to
decrease leg edema. What dietary advice will the nurse give to clients with
severe heart failure?
Avoid the intake of processed and commercially prepared foods.
Avoid the intake of canned fruit and fruit juices.
Encourage increased intake of vegetables with natural sodium.
Encourage increased intake of red meat. Right Ans - Avoid the intake of
processed and commercially prepared foods.
A client arrives at the ED with an exacerbation of left-sided heart failure and
reports shortness of breath. Which is the priority nursing action?
Administer angiotensin II receptor blockers
Assess oxygen saturation
Administer diuretics
Administer angiotensin-converting enzyme inhibitors Right Ans - Assess
oxygen saturation
The nurse is admitting a client with heart failure. What client statement
indicates that fluid overload was occurring at home?
"I eat six small meals a day when I am hungry."
"I've stopped eating foods with salt, though I miss the taste."
"I'm having trouble going up the steps during the day."
"My best time of the day is the morning." Right Ans - "I'm having trouble
going up the steps during the day."
The nurse is preparing to administer furosemide to a client with severe heart
failure. What lab study should be of most concern for this client while taking
furosemide?
BNP of 100
Sodium level of 135
Hemoglobin of 12
Potassium level of 3.1 Right Ans - Potassium level of 3.1
A client is exhibiting digitalis toxicity. Which of the following medications
would the nurse expect to be ordered for this client?
Digoxin immune FAB
Ibuprofen
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