Nokea
The nurse is caring for a client with an exacerbation of congestive heart failure (CHF). The client has generalized edema, dyspnea, and jugular venous distention. The nurse should anticipate a prescription for which medication?
- A. Mannitol
- B. Furosemide
- C. Diltiazem
- D. Verapamil
Correct Answer: B
Rationale: Furosemide, a loop diuretic, is used to treat fluid overload in CHF, addressing edema, dyspnea, and jugular venous distention. Mannitol, diltiazem, and verapamil are not appropriate.
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The nurse is caring for a client who is receiving prescribed cilostazol. Which of the following client findings would indicate a therapeutic response?
- A. Absence of pain while ambulating
- B. Decreased total cholesterol
- C. Increased visual acuity
- D. Improved focus and attention
Correct Answer: A
Rationale: Cilostazol is used to treat intermittent claudication, so the absence of pain while ambulating indicates a therapeutic response. It does not directly affect cholesterol, visual acuity, or focus.
The following scenario applies to the next 1 items
The nurse in the emergency department (ED) is caring for a client with septic shock
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Nurses' Notes
1400: Follow-up assessment after the infusion of 30 mL/kg of 0.9% saline bolus (1850 mL total) was infused. Vital signs: T 103.4° F (39.7° C), P 104, RR 22, BP 90/61, pulse oximetry reading 95% on room air.
1410: The physician was notified of the vital signs, and a verbal order for a dopamine drip was received for 5 mcg/kg/minute to titrate to a MAP of 65 mm Hg. The order was read back and verified.
1415: Dopamine infusion started in the client's right antecubital peripheral vascular access device.
1445: The client reports 'stinging' pain at the vascular access site. The site had erythema, swelling, and tenderness when touched. The infusion was stopped.
The nurse reviewed all nursing note entries and notified the physician of the vascular access device assessment findings. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client's progress
- A. Obtain a prescription for phentolamine, Flush the vascular access device, Aspirate any residual medication, Restart the infusion at a lower rate.
- B. Extravasation, Hematoma, Infiltration, Phlebitis.
- C. Urinary output, Neurovascular status of affected extremity, Drainage at vascular access site, Pain level.
Correct Answer: B, A, C
Rationale: The client is experiencing extravasation (B) due to dopamine causing stinging, erythema, and swelling. Actions include obtaining phentolamine (A, an antidote for vasopressor extravasation) and aspirating residual medication (A). Monitor neurovascular status (C) and pain level (C) to assess progress.
The nurse is caring for a three-year-old who is receiving digoxin for congestive heart failure. Which of the following manifestations is an early sign of digoxin toxicity?
- A. dizziness
- B. tachycardia
- C. vomiting
- D. failure to thrive
Correct Answer: C
Rationale: Vomiting is an early sign of digoxin toxicity in children. Dizziness is less common in young children, tachycardia is not typical, and failure to thrive is a chronic issue, not an early sign.
The nurse is caring for a client with heart failure. Which medication should the nurse clarify with the primary healthcare provider (PHCP)?
- A. lisinopril
- B. prednisone
- C. hydralazine
- D. carvedilol
Correct Answer: B
Rationale: Prednisone, a corticosteroid, can cause fluid retention and worsen heart failure, so it should be clarified. Lisinopril, hydralazine, and carvedilol are commonly used in heart failure management.
The emergency department nurse is caring for a client with an abdominal aortic aneurysm at risk of rupturing. The nurse will anticipate the primary healthcare provider (PHCP) to prescribe
- A. esmolol
- B. dexamethasone
- C. heparin
- D. pantoprazole
Correct Answer: A
Rationale: Esmolol, a short-acting beta-blocker, is used to control blood pressure and reduce aortic wall stress in an abdominal aortic aneurysm. Dexamethasone, heparin, and pantoprazole are not indicated.