Nokea
A client with severe mitral valve insufficiency has been admitted to the unit. The client has heart failure and has developed pulmonary edema. What would be the best course of treatment for this client?
- A. Cardiac glycosides
- B. Beta-blockers
- C. Surgery
- D. Palliative care
Correct Answer: C
Rationale: If the cause of heart failure and pulmonary edema can be corrected surgically (e.g., a mitral valve disorder), the client is supported medically while being prepared for surgery. The other options do not have the potential to reverse or stabilize this client's disease process, so they would not be the best treatment option.
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A client is scheduled for a multiple gated acquisition (MUGA) scan the following day. What medication is contraindicated for the nurse to administer the morning of the procedure?
- A. Furosemide
- B. Acetaminophen
- C. Morphine sulfate
- D. Guaifenesin
Correct Answer: A
Rationale: Diuretics are contraindicated the morning of a test to avoid any interruptions for urination. Clients are also medicated to relieve a cough that may cause movement during the test so administration of guaifenesin is not contraindicated. Acetaminophen and morphine sulfate are not contraindicated the morning of the test.
A client with heart failure reports not having had a bowel movement in 2 days. Why would it be important for the nurse to obtain a prescription for a stool softener?
- A. Straining engages the Valsalva maneuver, which can cause dangerous effects.
- B. The client should not develop hemorrhoids.
- C. The client can develop a rectal fissure, which will increase pain levels.
- D. The client should have a bowel movement every day to avoid development of an intestinal obstruction.
Correct Answer: A
Rationale: Avoid activities that engage the Valsalva maneuver, such as straining with bowel elimination or using the arms to pull and reposition oneself. The Valsalva maneuver increases intrathoracic pressure, reduces right atrial filling, triggers tachycardia, and increases blood pressure. The client's discomfort would be increased if hemorrhoids or a rectal fissure developed but would not engage the Valsalva maneuver. It is not necessary for the client to have a bowel movement on a daily basis.
A client develops cardiogenic pulmonary edema and is extremely apprehensive. What medication can the nurse administer with a health care provider's prescription that will relieve anxiety and slow respiratory rate?
- A. Furosemide
- B. Nitroglycerin
- C. Dopamine
- D. Morphine sulfate
Correct Answer: D
Rationale: Morphine seems to help relieve respiratory symptoms by depressing higher cerebral centers, thus relieving anxiety and slowing respiratory rate. Morphine also promotes muscle relaxation and reduces the work of breathing. Furosemide is a loop diuretic and will decrease fluid accumulation but will not reduce anxiety. Nitroglycerin will promote smooth muscle relaxation in the vessel walls and will relieve pain but not reduce anxiety. Dopamine is an inotrope that will increase the force of ventricular contraction but will not alleviate anxiety.
A client is brought to the emergency department via rescue squad with suspicion of cardiogenic pulmonary edema. What complication(s) should the nurse monitor for? Select all that apply.
- A. Nausea and vomiting
- B. Pulmonary embolism
- C. Cardiac arrhythmias
- D. Respiratory arrest
- E. Cardiac arrest
Correct Answer: C,D,E
Rationale: Pulmonary edema is fluid accumulation in the lungs, which interferes with gas exchange in the alveoli. It represents an acute emergency and is a frequent complication of left-sided heart failure. Cardiac arrhythmias and cardiac or respiratory arrest are associated complications. Nausea and vomiting are not complications but are symptoms of many disorders. The client is not at increased risk for the development of pulmonary embolism with pulmonary edema.
The nurse is preparing a client for a multiple gated acquisition (MUGA) scan. What would be an important instruction for the nurse to give a client who is to undergo a MUGA scan?
- A. Avoid any activity at least 2 hours before the test.
- B. Drink plenty of fluids during the test.
- C. Avoid dairy products a day before and a day after the test.
- D. Lie very still at intermittent times during the test.
Correct Answer: D
Rationale: The nurse should instruct the client, who is to undergo a MUGA scan, to lie very still at intermittent times during the 45-minute test. The client need not drink plenty of fluids, avoid activities before/after the test, or avoid dairy products during the test.