Nokea
The nurse is counseling a client with congestive heart failure (CHF) about newly prescribed torsemide. The nurse determines that the teaching has been effective when the client plans to
- A. decreases their dietary potassium.
- B. record their daily urinary output.
- C. measure their weight daily.
- D. take their blood pressure and pulse daily.
Correct Answer: C
Rationale: Torsemide, a loop diuretic, requires daily weight monitoring to assess fluid status in CHF. Decreasing potassium is incorrect (risk of hypokalemia), and urinary output or vital signs monitoring is less critical.
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The clinic nurse is caring for a 38-year-old male
Item 3 of 6
Diagnostic Results
Basic Metabolic Panel (fasting)
• Serum calcium 9.6 mg/dL (2.39 mmol/l) [9.0-10.5 mg/dL (2.24 - 2.61 mmol/l)
• Serum chloride 94 mEq/l (94 mmol/l) 90 to 110 mEq/L (90 -110 mmol/l)
• Serum glucose 126 mg/dL (6.99 mmol/l) 70-110 mg/dL (3.88 - 6.10 mmol/l)
• Serum potassium 4.2 mEq/l (4.2 mmol/l) 3.5 to 5.0 mEq/l (3.5 to 5.0 mmol/l)
• Serum sodium 136 mEq/l (136 mmol/l) 135 to 145 mEq/l (135 to 145 mmol/l)
• Serum creatinine 0.9 mg/dl (79.5 mcmol/l) 0.6 to 1.1 mg/dl (53 to 106 mcmol/l)
• Blood urea nitrogen 19 mg/dl (6.78 mmol/l) 10 to 20 mg/dl (3.57 to 7.14 mmol/l)
Lipid Panel (fasting)
• Total cholesterol 235 mg/dl (6.07 mmol/l) [less than 200 mg/dl (<5.18 mmol/l)]
• High-density lipoprotein (HDL) 35 mg/dl (0.91 mmol/l) [more than 45 mg/dL (>0.75 mmol/L) for men; more than 55 mg/dL (>0.91 mmol/L) for women]
• Low-density lipoprotein (LDL) 135 mg/dl (3.49 mmol/l) [less than 130 mg/dL (< 3.36 mmo/l)]
• Triglycerides 299 mg/dL [Females: 35-135 mg/dL or 0.40-1.52 mmol/L; Males: 40-160 mg/dL or 0.45-1.81 mmol/L]
Thyroid Panel
• Triiodothyronine (T3) 87 ng/dL (1.3 nmol/L) [80-200 ng/dL (1.2-3 nmol/L)]
• Thyroxine (T4) 5.4 µg/dL (69 nmol/L) [5.4-11.5 (69-148 nmol/L)]
• Thyroid-stimulating hormone (TSH) 4.0 µIU/mL (4.0 mIU/L) [0.45-4.5 µIU/mL (0.45-4.5 mIU/L)]
Follow-up Nurses' Notes
1345 - Client presents for a one-week follow-up appointment to review his laboratory results. The client reports no acute complaints, denies pain, and states he has been checking his blood pressure while at the grocery store "with the top number being in the 150s". Oral temperature 98.6°F (37° C) Pulse 88 Respiratory Rate 16 Blood Pressure 143/91 mm Hg Pulse oximetry 95% on room air. Current weight 270 pounds (122.72 kilograms); Body Mass Index 29. 41 inches (102 cm) waist size.
The nurse completes and reviews the follow-up nurses' notes and the laboratory results.Complete the following sentence below from the list of options. Based on the clinical data, this client is at the highest risk of developing.............
- A. hypothyroidism
- B. metabolic syndrome
- C. renal insufficiency
- D. secondary hypertension
Correct Answer: B
Rationale: The client has elevated blood pressure (143/91 mm Hg), high fasting glucose (126 mg/dL), hyperlipidemia (high cholesterol, LDL, triglycerides, low HDL), and obesity (BMI 29, waist 41 inches), which are diagnostic criteria for metabolic syndrome.
While reviewing a client's medication list, the nurse understands which prescribed medication(s) is/are classified as calcium channel blockers. Select all that apply.
- A. Nifedipine
- B. Propranolol
- C. Verapamil
- D. Hydralazine
- E. Digoxin
Correct Answer: A,C
Rationale: Nifedipine and verapamil are calcium channel blockers used to treat hypertension and angina. Propranolol is a beta-blocker, hydralazine is a vasodilator, and digoxin is a cardiac glycoside.
The nurse is preparing to administer a prescribed dose of digoxin to an infant. The nurse should assess the apical heart rate to ensure it is at least
- A. 70 beats-per-minute
- B. 60 beats-per-minute
- C. 90 beats-per-minute
- D. 50 beats-per-minute
Correct Answer: C
Rationale: For infants, digoxin should be withheld if the apical heart rate is below 90-100 beats per minute to prevent toxicity, so 90 beats per minute is the minimum threshold.
The nurse is presenting at a staff development conference about medications used to treat heart failure. The nurse recognizes which medications are used to treat heart failure. Select all that apply.
- A. furosemide
- B. metformin
- C. lisinopril
- D. digoxin
- E. warfarin
- F. metoprolol
Correct Answer: A,C,D,F
Rationale: Furosemide (diuretic), lisinopril (ACE inhibitor), digoxin (cardiac glycoside), and metoprolol (beta-blocker) are used in heart failure. Metformin and warfarin are not standard treatments.
The nurse is assessing a client with systolic heart failure receiving prescribed carvedilol. Which of the following findings would indicate a therapeutic response?
- A. Increased urinary output
- B. Increased left-ventricular ejection fraction (EF)
- C. Increased left-ventricular remodeling
- D. Increased brain natriuretic peptide (BNP)
Correct Answer: B
Rationale: Carvedilol, a beta-blocker, improves left-ventricular ejection fraction in systolic heart failure, indicating a therapeutic response. Increased urinary output, remodeling, or BNP are not desired outcomes.