NCLEX Questions: CHF
Leave the first rating Students also studied Terms in this set (5) Science MedicineNursing Save CHF NCLEX style Questions 12 terms penny_meisenzahl Preview Heart Failure NCLEX Review Questi...16 terms Dominique_Comeaux Preview Med Surg Success Test 1 72 terms dayala123Preview Conges 48 terms LeM The nurse is developing a discharge-teaching plan for the client diagnosed with congestive heart failure. Which interventions should be included in the plan? Select All that Apply.
- Notify health-care provider of a weight gain of more
- Teach client how to count the radial pulse when taking
- Instruct client to remove the saltshaker from the dinner
- Encourage client to monitor urine output for change in
- Discuss the importance of taking the loop diuretic
- The client should not take digoxin if the radial pulse is less than 60.
- The client should be on a low sodium diet to prevent water retention.
than one pound a week.
digoxin, a cardiac glycoside.
table.
color to become dark
furosemide at bedtime
The nurse provides care for a client who is hospitalized for excessive fluid build-up around the heart. The client is
being discharged home on the following medications:
aspirin 81 mg PO, atenolol 50 mg PO, torsemide 10 mg PO twice a day, and lisinopril 20 mg PO. Which potential side effect from the above medications should the nurse teach the client requires priority notification to the healthcare provider (HCP)?
- Achy muscles at night.
- Depression and anxiety.
- Ecchymosis of the arms and hands.
- Heart rate consistently 60 to 68 beats/minute.
- Achy muscles at night.
Rationale: Hypokalemia, which may manifest as muscle aches and cramping, is
associated with loop diuretics (e.g., torsemide). If the hypokalemia worsens, the client is at risk for cardiac dysrhythmia; therefore, this finding requires priority notification to the HCP.he nurse provides education to a client who is newly prescribed digoxin by mouth every other day. Which client statement indicates a need for further instructions?Select all that apply.
- "Before I take this medication, I should check my heart
- "If I have trouble reading road signs, I should call my
- "If I start having nausea and vomiting, I will call my
- "Prior to taking this medication, I need to check my
- If I see a white flashing light when looking around at
rate."
doctor."
doctor."
blood pressure."
object, I need to notify my doctor right away."
Rationale:
Visual disturbances such as color changes or blurred vision is associated with digoxin toxicity; however, flashing lights in the vision are not symptoms related to digoxin usage but related to a potential retinal detachment or tear. While this should be reported to the client's healthcare provider, it is not a finding that is related to the prescribed medication.
- If I see a white flashing light when looking around at object, I need to notify my
doctor right away."
Rationale:
The client should check their heart rate (not their blood pressure) before taking the medication since bradycardia is a side effect.A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time?
- Teach the patient about the medications available for
- Inform the patient how to protect sexual and needle-
- Remind the patient about the need to return for
- Ask the patient to notify individuals who have had risky
- Remind the patient about the need to return for retesting to verify the results.
treatment.
sharing partners.
retesting to verify the results.
contact with the patient.
A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, "I feel obsessed with thoughts about dying. Do you think I am just being morbid?" Which response by the nurse is best?
- "Thinking about dying will not improve the course of
- "It is important to focus on the good things about your
- "Do you think that taking an antidepressant might be
- "Can you tell me more about the kind of thoughts that
- "Can you tell me more about the kind of thoughts that you are having?"
AIDS."
life now."
helpful to you?"
you are having?"