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The nurse is working in a long-term care facility with a group of older adults with cardiac disorders. Why would it be important for the nurse to closely monitor an older adult receiving digitalis preparations for cardiac disorders?
- A. Older adults are at increased risk for toxicity.
- B. Older adults are at increased risk for cardiac arrests.
- C. Older adults are at increased risk for hyperthyroidism.
- D. Older adults are at increased risk for asthma.
Correct Answer: A
Rationale: Older adults receiving digitalis preparations are at increased risk for toxicity because of the decreased ability of the kidneys to excrete the drug due to age-related changes. The margin between a therapeutic and toxic effect of digitalis preparations is narrow. Using digitalis preparations does not increase the risk of cardiac arrests, hyperthyroidism, or asthma.
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The nurse is preparing to administer digoxin to a client with heart failure. The nurse obtains an apical pulse rate for 1 minute and determines a rate of 52 beats/minute. What is the first action by the nurse?
- A. Administer the medication and inform the charge nurse about the rate.
- B. Withhold the medication and notify the health care provider of the heart rate.
- C. Administer atropine to speed the heart rate and then administer the digoxin.
- D. Administer the medications and then notify the health care provider.
Correct Answer: B
Rationale: Digitalis drugs are withheld if the heart rate is less than 60 or more than 120 beats/minute until a health care provider is consulted. The other choices would have the nurse administer the drug, which would not be the standard of practice.
A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion?
- A. Assess for reduced urine output.
- B. Assess for reduced blood sodium levels.
- C. Assess for elevated blood potassium levels.
- D. Assess for elevated blood urea nitrogen levels.
Correct Answer: D
Rationale: Elevated blood urea nitrogen indicates impaired renal perfusion in a client with left-sided heart failure. Serum sodium levels may be elevated. Reduced urine output or elevated blood potassium levels do not indicate impaired renal perfusion in a client with left-sided heart failure.
A client is awaiting the availability of a heart for transplant. What option may be available to the client as a bridge to transplant?
- A. Implanted cardioverter-defibrillator (ICD)
- B. Pacemaker
- C. Intra-aortic balloon pump (IABP)
- D. Ventricular assist device (VAD)
Correct Answer: D
Rationale: VADs may be used for one of three purposes: (1) a bridge to recovery, (2) a bridge to transport, or (3) destination therapy (mechanical circulatory support when there is no option for a heart transplant). An implanted cardioverter-defibrillator or pacemaker is not a bridge to transplant and will only correct the conduction disturbance and not the pumping efficiency. An IABP is a temporary, secondary mechanical circulatory pump to supplement the ineffectual contraction of the left ventricle. The IABP is intended for only a few days.
The nurse instructs the client with heart failure to check weight at the same time each day using the same scale. When should the client contact the health care provider?
- A. If the weight gain is more than 3 lb in 1 week.
- B. If the weight gain is more than 4 lb in 1 month.
- C. If the weight gain is more than 2 lb in 24 hours.
- D. If the weight gain is more than 1 lb in 48 hours.
Correct Answer: C
Rationale: Clients should check weight at the same time each day using the same scale and should consult a health care provider if the weight gain is more than 2 pounds in 24 hours. The other options are not correct since there is a variance with weight on a daily basis.
A client with heart failure is having a decrease in cardiac output. What indication does the nurse have that this is occurring?
- A. Heart rate of 72 beats/minute
- B. Respiratory rate of 20 breaths/minute
- C. Blood pressure 80/46 mm Hg
- D. Oxygen saturation 94%
Correct Answer: C
Rationale: The body can compensate for changes in heart function that occur over time. When cardiac output falls, the body uses certain compensatory mechanisms designed to increase stroke volume and maintain blood pressure. These compensatory mechanisms can temporarily improve the client's cardiac output but ultimately fail when contractility is further compromised. A heart rate of 72 beats/minute is within normal range as well as the respiratory rate and oxygen saturation.