Nokea
A nurse is preparing to administer a prescribed cardiotonic to a client. The nurse understands that the drug is being administered to achieve which of the following? Select all that apply.
- A. Improved myocardial contractility
- B. Increased myocardial efficiency
- C. Increased blood pressure
- D. Increased peripheral edema
- E. Improved profusion to all body tissues
Correct Answer: A,B,E
Rationale: Cardiotonics are drugs used to increase the efficiency and improve the contraction of the heart muscle, which leads to improved blood flow to all tissues of the body.
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A nurse is preparing to administer a cardiotonic drug via IM injection based on the understanding of which of the following about this route? Select all that apply.
- A. Appropriate when IV access is not available
- B. Site massage necessary after injection
- C. Not the recommended parenteral route
- D. Amount given no more than 2 \mathrm{~mL}
- E. Injection deep into the muscle
Correct Answer: A,B,D,E
Rationale: IM injection is not recommended for cardiotonic drugs yet, but they may be given as an IM injection when needed urgently and no IV access is available. When administering a cardiotonic drug IM, the nurse should give the injection deep in the muscle and follow with massage to the site. No more than 2 \mathrm{~mL} should be injected IM.
A client comes to the clinic complaining of weakness and drowsiness. He states, 'I just get so tired sometimes that Lean't do what I want to do.' The client is receiving digoxin as part of the treatment for heart failure. Which nursing diagnosis would the nurse most likely identify?
- A. Risk for Injury
- B. Activity Intolerance
- C. Decreased Cardiac Output
- D. Imbalanced Nutrition: Less Than Body Requirements
Correct Answer: B
Rationale: Based on the client's statement and complaints, the nurse would most likely identify a nursing diagnosis of Activity Intolerance. Risk for Injury might be appropriate if the client complained of dizziness or if his complaints affected his ambulation. There is no evidence to support a nursing diagnosis of Decreased Cardiac Output or Imbalanced Nutrition.
When educating a group of nursing students on the signs of heart failure, the nurse mentions that the ejection fraction is altered in heart failure. The students demonstrate understanding of the information when they identify which ejection fraction as suggesting heart failure?
- A. 38%
- B. 48%
- C. 58%
- D. 68%
Correct Answer: A
Rationale: The ejection fraction is the amount of blood that is ejected from the ventricles per beat in relation to the amount of blood available to eject. An ejection fraction of less than 40% indicates heart failure. Normally the ejection fraction should be greater than 60%.
A nurse caring for a client with atrial fibrillation who is started on digoxin therapy is required to monitor plasma drug levels. The nurse would report which level to the primary health care provider?
- A. 1.6 ng/ml
- B. 1.8 ng/ml
- C. 2.0 ng/ml
- D. 2.2 ng/ml
Correct Answer: D
Rationale: A plasma digoxin level of more than 2 ng/mL would require the nurse to report to the primary health care provider; therefore, plasma digitalis levels of 2.2 ng/mL indicate digoxin toxicity. The therapeutic levels range from 0.5 to 2 ng/mL.
The nurse is assessing a client diagnosed with left ventricular dysfunction. Which of the following would the nurse most likely assess? Select all that apply.
- A. Dyspnea
- B. Moist cough
- C. Restlessness
- D. Peripheral edema
- E. Neck vein distention
Correct Answer: A,B,C
Rationale: The symptoms of left ventricular dysfunction include dyspnea; moist cough; production of frothy, pink sputum; orthopnea; restlessness; and anxiety. Right-sided failure (right ventricular dysfunction) can be seen with fluid backup in the body such as distended neck veins, peripheral edema, and hepatic engorgement.