A nurse is admitting a client who has acute heart failure. Which of the following prescriptions from the provider should the nurse anticipate?
Provide the client with a 4g sodium diet.
Ambulate the client every 4 hr while awake.
Infuse 0.9% sodium chloride 500 mL IV bolus over 1 hr.
Administer enalapril 2.5 mg PO twice daily.
The Correct Answer is D
A) Provide the client with a 4g sodium diet: This is incorrect. Clients with acute heart failure typically require a low-sodium diet (often less than 2g per day) to help manage fluid retention and reduce workload on the heart.
B) Ambulate the client every 4 hr while awake: While mobility is important, the frequency and timing of ambulation in clients with acute heart failure should be carefully considered based on their stability and fatigue level. It may not be appropriate to ambulate every 4 hours.
C) Infuse 0.9% sodium chloride 500 mL IV bolus over 1 hr: This is generally not appropriate for clients with acute heart failure due to the risk of fluid overload. Instead, fluid management often involves restricting IV fluids and closely monitoring fluid balance.
D) Administer enalapril 2.5 mg PO twice daily: This prescription is appropriate. Enalapril, an ACE inhibitor, is commonly used to manage heart failure by reducing afterload and improving cardiac output. It helps alleviate symptoms and improve quality of life in heart failure patients.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A) Tinnitus: This is not typically associated with pneumonia. Tinnitus refers to ringing in the ears and is more related to auditory issues rather than respiratory infections.
B) Drooling: While drooling may occur in some cases of severe throat infections or in children with difficulty swallowing, it is not a classic sign of pneumonia.
C) Fever: This is the correct answer. Fever is a common manifestation of bacterial pneumonia in children, indicating an immune response to infection. It often accompanies other symptoms like cough and difficulty breathing.
D) Steatorrhea: This refers to fatty stools, which are more associated with malabsorption syndromes or pancreatic issues, not pneumonia. It is not an expected manifestation of bacterial pneumonia.
Correct Answer is D
Explanation
A. Face: While jaundice can sometimes be observed on the face, it is not the most reliable area for assessment in clients with dark skin, as changes may be less visible due to pigmentation.
B. Palms of the hands: The palms can show signs of jaundice, but they may not be the best area to assess for this condition in clients with darker skin tones. Jaundice is typically more detectable in areas with less pigmentation.
C. Shoulders: The shoulders do not provide a reliable assessment area for jaundice, as skin tone can vary widely and may obscure subtle changes in color.
D. Sclera: The sclera (the white part of the eye) is the most appropriate area to assess for jaundice, regardless of skin color. Yellowing of the sclera is a classic sign of jaundice and can be easily observed in clients with dark skin.
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