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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%.
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A client with heart failure has been digitalized. The client requires long-term digoxin therapy. Which of the following instructions should the nurse provide the client on discharge?
- A. Take the drug with high-fiber meals.
- B. Report to the center if the pulse is less than 70 \mathrm{bpm}.
- C. Take antacids promptly to avoid gastric problems.
- D. Take the drug regularly without skipping a dose.
Correct Answer: D
Rationale: The nurse should instruct the client to take the drug regularly without skipping a dose. The client should consult the provider before discontinuing the drug. Taking the drug with high-fiber meals will decrease the absorption of the drug. The client should be advised to report to the center if the pulse is less than 60 \mathrm{bpm}. Antacids should not be taken as they alter the plasma digoxin levels.
Before administering a cardiotonic drug, the nurse would expect which of the following laboratory tests to be completed? Select all that apply.
- A. Liver function tests
- B. Renal function tests
- C. Complete blood count
- D. Electrolyte levels
- E. Blood glucose
Correct Answer: A,B,C,D
Rationale: Liver function tests, renal function tests, complete blood count with the addition of serum electrolytes, and an electrocardiogram complete the lab workup prior to initiating therapy with a cardiotonic drug. It is not necessary to obtain serum blood glucose, but it might appear with other lab work that has been gathered.
When caring for a client who has been digitalized for his heart failure, the nurse observes that the client is experiencing bradycardia. Which of the following would the nurse expect the primary health care provider to prescribe for the client's bradycardia?
- A. Atropine
- B. Cholestyramine
- C. Furosemide
- D. Milrinone
Correct Answer: A
Rationale: Atropine should be administered to clients who develop bradycardia. Bradycardia may be seen in digitalis toxicity. Milrinone is a miscellaneous inotropic used in heart failure. Furosemide is a loop diuretic that can be used as part of the drug therapy regimen for heart failure. Cholestyramine is used to lower blood cholesterol levels. Milrinone, furosemide, and cholestyramine are not used in the treatment of bradycardia.
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.
A client is receiving maintenance therapy with digoxin. The nurse understands that which form would be used? Select all that apply.
- A. Capsule
- B. Injection
- C. Ointment
- D. Patch
- E. Tablet
Correct Answer: A,E
Rationale: Capsules and tablets are used for maintenance therapy, injections are used for rapid digitalization, and digoxin patches and ointment do not exist.