A nurse manager is discussing social services for older adults during a staff meeting in a long- term acute care (LTAC) facility. Which statement about Medicare made by one of the employees requires correction by the nurse manager?

Medicare covers people under 65-years who have end-stage renal disease.

Low-income people who have Medicare can also qualify for Medicaid.

People who qualify for Medicare will have no out-of-pocket medical expenses.

Medicare is federally-funded health insurance for people 65-years or older.

Answer and Explanation

The Correct Answer is C

A.   Medicare does cover individuals under 65 years old who have end-stage renal disease (ESRD) and meet certain criteria.
B.   There are programs that allow individuals with both Medicare and low income to qualify for Medicaid, which can help cover additional healthcare costs that Medicare may not fully cover.
C.   While Medicare does provide significant coverage for healthcare services, it is not entirely free of out- of-pocket costs. Medicare Part A typically covers hospital stays, skilled nursing facility care, hospice, and some home health care services with no premiums for most people.
D.   Medicare is indeed federally-funded health insurance primarily for individuals aged 65 and older. It also covers certain younger individuals with disabilities and those with ESRD.

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Correct Answer is B

Explanation

A. Hypernatremia can indicate dehydration or other electrolyte imbalances. Furosemide can further affect electrolyte balance, especially sodium and potassium. However, this sodium level is only slightly elevated and may not necessarily require immediate action regarding furosemide administration.
B. Furosemide is a diuretic that can further decrease blood pressure due to its effects on fluid volume reduction. Administering it to a patient with already low blood pressure could potentially lead to significant hypotension and compromise perfusion to vital organs.
C. While incontinence itself may not directly contraindicate furosemide administration, it could indicate underlying issues such as bladder dysfunction or fluid overload that need further evaluation. This finding alone would not necessarily require holding the medication, but it warrants further assessment and consideration in the clinical context.
D. Normal serum potassium levels typically range from 3.5-5.0 mEq/L. A level of 5.3 mEq/L indicates hyperkalemia (elevated potassium). While this potassium level is mildly elevated, it would not be a reason on its own to hold furosemide. Monitoring potassium levels closely and potentially adjusting potassium

A. "I feel short of breath when I lie down flat." B. "The sputum I have been coughing up is pink." C. "The nurse I had yesterday said she could hear fluid in my lungs." D. "I feel like fluid has been building up in my abdominal area."

Correct Answer is D

Explanation

A. This symptom is consistent with orthopnea, which is common in left-sided heart failure rather than right-sided heart failure. In orthopnea, patients experience shortness of breath when lying flat because fluid accumulates in the lungs due to impaired left ventricular function.
B. Pink-tinged or blood-tinged sputum, known as hemoptysis, can occur in left-sided heart failure due to pulmonary congestion and elevated pressures in the pulmonary circulation. This symptom is not typically associated with right-sided heart failure.
C. This finding suggests pulmonary congestion, which is more indicative of left-sided heart failure. In left- sided heart failure, fluid backs up into the lungs, leading to crackles or rales on auscultation.
D. This statement is consistent with right-sided heart failure. In right-sided heart failure, the right ventricle fails to effectively pump blood into the pulmonary circulation, causing fluid to back up into the venous system. This can lead to peripheral edema (such as in the legs and abdomen) and abdominal distension due to ascites (fluid accumulation in the peritoneal cavity).

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A nurse manager is discussing social services for older adults during a staff meeting in a long- term acute care (LTAC) facility. Which statement about Medicare made by one of the employees requires correction by the nurse manager?

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Correct Answer is B

Explanation

The nurse is performing an admission assessment on a client who is being admitted for right- sided heart failure. Which statement made by the patient would be consistent with right-sided heart failure?

Correct Answer is D

Explanation

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