The nurse is caring for a client who has heart failure with an EF of 40%. The client has a BP of 170/67 with an HR of 60. He currently is in normal sinus rhythm and has an amber urine output of 45ml in the last 3 hours. Which medication would the nurse expect to give first?
Isosorbide PO
Nitroglycerin Drip
Dopamine drip
Normal Saline Bolus
The Correct Answer is D
D Normal saline bolus administration is indicated for hypovolemia or inadequate intravascular volume, which can lead to decreased cardiac output and hypotension. In this scenario, the client has an amber urine output of 45ml in the last 3 hours, indicating decreased urine output and potential hypovolemia. The elevated blood pressure (170/67 mmHg) suggests possible volume overload or fluid retention, but the decreased urine output raises concerns for inadequate intravascular volume. Therefore, administering a normal saline bolus may be the first priority to optimize intravascular volume and improve cardiac output.
A Isosorbide mononitrate is a vasodilator commonly used in the treatment of heart failure and angina. It helps reduce preload and afterload, thereby decreasing the workload on the heart. However, in this scenario, the client's blood pressure is elevated (170/67 mmHg), and there is no indication of acute decompensation or pulmonary congestion. Therefore, isosorbide PO may not be the first priority medication at this time.
B Nitroglycerin is a potent vasodilator commonly used to manage acute heart failure exacerbations and acute coronary syndromes. It helps reduce preload and afterload, improving cardiac output and relieving symptoms of heart failure. In this scenario, the client's blood pressure is elevated, but the heart rate is normal, and there are no signs of acute decompensation. Therefore, initiating a nitroglycerin drip may not be the first priority unless the client develops symptoms of acute decompensation or pulmonary congestion.
C Dopamine is a vasopressor medication that can be used to increase blood pressure and cardiac output in patients with hypotension or shock. However, in this scenario, the client's blood pressure is elevated (170/67 mmHg), and there is no evidence of hypotension. Therefore, initiating a dopamine drip may not be appropriate at this time and could potentially exacerbate hypertension.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
B. A client who is postoperative with shallow respirations at a rate of 9/min is likely not adequately eliminating carbon dioxide from their body due to hypoventilation. This retention of carbon dioxide can lead to an increase in the partial pressure of CO2 in the blood, causing an acidotic state.
A. Metabolic acidosis results from an accumulation of acids in the body or a loss of bicarbonate. Hypoventilation leading to respiratory acidosis does not directly cause metabolic acidosis.
C. Respiratory alkalosis occurs when there is excessive elimination of CO2 from the body, leading to decreased arterial carbon dioxide levels (hypocapnia) and an increase in pH. Shallow respirations and decreased respiratory rate are more consistent with hypoventilation and respiratory acidosis rather than hyperventilation and respiratory alkalosis.
D. Metabolic alkalosis results from excessive loss of acids or increased bicarbonate levels in the body. Hypoventilation leading to respiratory acidosis does not directly cause metabolic alkalosis.
Correct Answer is C
Explanation
C Dyspnea, or difficulty breathing, is a classic symptom of circulatory overload. When the circulatory system is overloaded with excess fluid, it can lead to pulmonary congestion and impaired gas exchange, resulting in dyspnea. Patients experiencing circulatory overload may exhibit signs such as shortness of breath, increased respiratory rate, and crackles on lung auscultation.
A Flushing, or the sudden reddening of the skin, is not typically associated with circulatory overload. Instead, it can be a symptom of various conditions such as fever, allergic reactions, or hormonal changes. While circulatory overload may lead to fluid retention and increased blood volume, flushing is not a characteristic symptom.
B Vomiting is also not a typical symptom of circulatory overload. Vomiting can be caused by various factors such as anesthesia, pain medications, or postoperative ileus. While fluid overload can result in gastrointestinal symptoms like nausea and abdominal discomfort, vomiting is not a specific indicator of circulatory overload.
D Bradycardia, or a slow heart rate, is not typically associated with circulatory overload. Instead, it can be caused by factors such as medications (e.g., opioids, beta-blockers), vagal stimulation, or underlying cardiac conditions. In circulatory overload, the body's compensatory response is often tachycardia (increased heart rate) rather than bradycardia.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today