A patient who has heart failure recently started taking digoxin in addition to furosemide and captopril. Which finding by the home health nurse is a priority to communicate to the health care provider?.
Weight increase from 120 pounds to 122 pounds over 3 days.
Serum potassium level 3.0 mEq/L after 1 week of therapy.
Palpable liver edge 2 cm below the ribs on the right side.
Presence of 1+ to 2+ edema in the feet and ankles.
The Correct Answer is B
Choice A rationale:
A weight increase from 120 pounds to 122 pounds over 3 days is within the normal fluctuation range.
Choice B rationale:
A serum potassium level of 3.0 mEq/L after 1 week of therapy is concerning because it’s below the normal range (3.5-5.0 mEq/L)171819. This could indicate hypokalemia, which can cause serious complications if left untreated.
Choice C rationale:
A palpable liver edge 2 cm below the ribs on the right side could suggest an abnormality such as an enlarged liver.
Choice D rationale:
The presence of 1+ to 2+ edema in the feet and ankles could indicate conditions like heart failure or venous insufficiency.
So, the correct answer is Choice B, after analyzing all choices.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
This is correct. Standing still for prolonged periods can cause blood to pool in the legs, increasing blood pressure.
Choice B rationale:
This is also correct. Stopping the medication abruptly can cause a rebound increase in blood pressure.
Choice C rationale:
This is incorrect. Furosemide is a diuretic that can cause the body to lose potassium, so it’s important to consume potassium-rich foods.
Choice D rationale:
This is correct. Furosemide can cause orthostatic hypotension, a form of low blood pressure that happens when you stand up from sitting or lying down.
So, the correct answer is Choice C, after analyzing all choices.
Correct Answer is ["A","B","C"]
Explanation
Choice A rationale:
Obtaining blood cultures x 3 is anticipated for the client. This is because the adolescent’s symptoms such as fever, shortness of breath, and petechiae could indicate a bacterial infection, possibly endocarditis, which is a risk for individuals with a history of rheumatic fever and cardiac valve damage. Blood cultures would help identify the causative bacteria.
Choice B rationale:
Administering antibiotic therapy is anticipated for the client. The adolescent’s symptoms suggest a possible bacterial infection, which could have been introduced during the recent dental work. Antibiotics would help eliminate the bacteria and prevent further complications.
Choice C rationale:
Obtaining an echocardiogram is anticipated for the client. Given the adolescent’s history of rheumatic fever and cardiac valve damage, and current symptoms like shortness of breath and chest pain, an echocardiogram would help assess the condition of the heart valves and detect any abnormalities.
Choice D rationale:
Restricting dental hygiene is contraindicated for the client. Good oral hygiene is important, especially for individuals with a history of rheumatic fever and cardiac valve damage, as it helps prevent oral infections that could potentially spread to the heart.
Choice E rationale:
Performing a strenuous exercise regimen twice daily is contraindicated for the client. The adolescent is currently experiencing symptoms like shortness of breath and chest pain, which could be exacerbated by strenuous exercise. It’s important to avoid overexertion until the adolescent’s condition stabilizes.
So, the correct answer is, after analyzing all choices, Choices A, B, and C are anticipated for the client, while Choices D and E are contraindicated. .
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