A nurse is caring for a client who has left-sided heart failure. Which of the following manifestations should the nurse expect?

Pedal edema

Neck vein distention

Daytime oliguria

Enlarged liver

Answer and Explanation

The Correct Answer is C

C. Oliguria can occur in severe cases of left-sided heart failure. When the heart's ability to pump blood forward is compromised, blood flow to the kidneys decreases, leading to decreased urine production.
A. Pedal edema is more commonly associated with right-sided heart failure.
B. Neck vein distention is typically associated with right-sided heart failure where increased pressure in the right side of the heart leads to jugular venous distention
D. Enlarged liver, or hepatomegaly, can occur in right-sided heart failure due to congestion and backup of blood in the hepatic circulation.

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Correct Answer is C

Explanation

C. Morphine is a central nervous system depressant that can help decrease anxiety and relieve dyspnea in clients with acute heart failure. Therefore, a decrease in anxiety would indicate that the medication has been effective in achieving its intended outcome.
A. Emesis, or vomiting, is not an expected outcome of morphine administration in the context of acute heart failure.
B. While morphine can help alleviate dyspnea, an increased respiratory rate may indicate respiratory distress rather than effective symptom relief.
D. Morphine does not directly affect urinary output, and a decrease in urinary output may indicate other issues such as renal dysfunction or fluid overload.

A. Pursue local protective services. B. Take a nonprescription sleeping medication. C. Contact hospice services for end-of-life care. D. Consider respite care services.

Correct Answer is D

Explanation

D. Respite care services provide temporary relief and support for caregivers by offering short-term care for their loved ones. This allows caregivers to take a break, attend to their own needs, and prevent burnout. Recommending respite care services is a proactive approach to addressing the caregiver's exhaustion and ensuring the well-being of both the caregiver and the client with Alzheimer's disease.
A. The caregiver's exhaustion and irritability may be due to the stress of caregiving rather than intentional neglect or abuse.
B. Relying on medication to manage stress and sleep may not be the best long-term solution and can potentially lead to dependence or other adverse effects.
C. Contacting hospice services for end-of-life care is not appropriate for a client with moderate Alzheimer's disease unless the client's condition has progressed to a terminal stage. Hospice care focuses on providing comfort and support for individuals with a terminal illness who have a life expectancy of six months or less.

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A nurse is caring for a client who has left-sided heart failure. Which of the following manifestations should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has acute heart failure and received morphine IV 30 min ago. Which of the following findings should the nurse identify as an indication that the medication was effective?

Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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