A 74-year-old client with a history of heart failure is admitted to the coronary care unit with acute pulmonary edema. They are intubated and placed on a ventilator. Which of the following parameters should the nurse closely monitor in assessing the client's response to a bolus dose of IV furosemide (Lasix)?

Serum sodium levels

Daily weight

Hourly urine output

24-hour intake and output

Answer and Explanation

The Correct Answer is C

A. Serum sodium levels are important to monitor over time with diuretic therapy but do not provide immediate feedback on the effect of a bolus dose of furosemide.
B. Daily weight helps assess long-term fluid status but is not helpful for evaluating an acute response.
C. Hourly urine output is the most appropriate and immediate measure to assess the effectiveness of a bolus dose of IV furosemide, especially in a critically ill client with acute pulmonary edema.
D. 24-hour intake and output provides a broader picture but does not offer real-time assessment like hourly output does.

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Correct Answer is A

Explanation

A. The view of the electrical current changes in relation to the lead placement – Each ECG lead offers a different angle or view of the heart's electrical activity, so the waveforms in leads I, II, and III naturally look different. This variation helps clinicians assess different parts of the heart.
B. Conduction of the heart differs with lead placement – The heart's electrical conduction system functions independently of lead placement; only the view of the conduction changes.
C. Electrocardiogram (ECG) equipment has malfunctioned – Lead differences are expected and normal; this is not a sign of malfunction.
D. The circadian rhythm has changed – Circadian rhythms affect general physiological patterns but do not cause variation in ECG lead appearance.

A. Take diuretics early in the morning and before bedtime. B. Notify the provider of a weight gain of 0.5 kg (1 lb) in a week. C. Exercise at least three times per week. D. Take naproxen for generalized discomfort.

Correct Answer is C

Explanation

A. Diuretics should be taken early in the morning to avoid nocturia, but not at bedtime.
B. A weight gain of 1 kg (2.2 lb) or more in a day or 1.4–2.3 kg (3–5 lb) in a week should be reported; 0.5 kg (1 lb) in a week is not typically concerning.
C. Regular exercise (e.g., at least three times per week) is encouraged in Class I heart failure to promote cardiovascular health and endurance. This is an appropriate and recommended instruction.
D. Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) and should be avoided in clients with heart failure as it may cause fluid retention and worsen heart function.

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Naxlex Comprehensive Predictor Exams

The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip because:

Correct Answer is A

Explanation

A nurse is providing discharge teaching to a client who has a new diagnosis of Class I heart failure. Which of the following instructions should the nurse include in the teaching?

Correct Answer is C

Explanation

When being discharged home, to assess fluid balance, a client with heart failure should be instructed to:

A client being admitted to the cardiac care unit complains of dyspnea on exertion and fatigue. His ECG demonstrates dysrhythmias associated with left ventricular hypertrophy. Which of the following diagnostic tools would be the most helpful in diagnosing cardiomyopathy?

While admitting an 82-year-old with acute decompensated heart failure to the hospital, the nurse learns that the client lives alone and sometimes confuses the "water pill" with the "heart pill." When planning for the client's discharge the nurse will facilitate a

A nurse is preparing to administer warfarin to a client who has atrial fibrillation. The nurse should explain that the purpose of this medication is which of the following?

After receiving report on the following clients, which client should the nurse assess first?

A nurse is providing discharge instructions for a client who has congestive heart failure. Which of the following client statements indicates to the nurse that the teaching was effective?

The nurse providing discharge teaching to a client admitted with pericarditis. The nurse informs the client that pericarditis can lead to: