MCA II Exam 1

MCA II Exam 1
The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine
for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea.
Which clinical finding is the best indicator that the treatment has been effective?
a. Weight loss of 2 lb in 24 hours
b. Hourly urine output greater than 60 mL
c. Reduction in patient complaints of chest pain
d. Reduced dyspnea with the head of bed at 30 degrees
Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the
presence of fluid in the alveoli), the best indicator that the medications are effective is a
decrease in dyspnea with the head of the bed at 30 degrees. The other assessment
data may also indicate that diuresis or improvement in cardiac output has occurred but
are not as specific to evaluating this patient's response.
The nurse working on the heart failure unit knows that teaching an older female patient
with newly diagnosed heart failure is effective when the patient states that
a. she will take furosemide (Lasix) every day at bedtime.
b. the nitroglycerin patch is to be used when chest pain develops.
c. she will call the clinic if her weight goes up 3 pounds in 1 week.
d. an additional pillow can help her sleep if she is short of breath at night.
Teaching for a patient with heart failure includes information about the need to weigh
daily and notify the health care provider about an increase of 3 lb in 2 days or 3 to 5 lb
in a week. Nitroglycerin patches are used primarily to reduce preload (not to prevent
chest pain) in patients with heart failure and should be used daily, not on an "as
needed" basis. Diuretics should be taken earlier in the day to avoid nocturia and sleep
disturbance. The patient should call the clinic if increased orthopnea develops rather
than just compensating by further elevating the head of the bed.
When teaching the patient with newly diagnosed heart failure about a 2000-mg sodium
diet, the nurse explains that foods to be restricted include:
a. canned and frozen fruits.
b. yogurt and milk products.
c. fresh or frozen vegetables.
d. eggs and other high-protein foods

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