The nursing students are preparing a care plan for a patient with heart failure. The patient will be prescribed diuretic therapy after discharge. What evidence-based instructions will the nurse include in this plan?

Potassium supplements can cause irregular heart rhythm and must be avoided.

Instruct the patient to take diuretics at bedtime to promote diuresis during the night.

Notify the physician if weight increases by three pounds in one week.

Administer diuretics in the morning and notify physician of decreased urine output.

Answer and Explanation

The Correct Answer is C

Choice A reason: Potassium supplements can actually be important for patients on diuretic therapy, especially if they are taking loop diuretics like furosemide, which can cause potassium loss. However, it is important to monitor potassium levels and follow the physician's guidance on supplement use.

Choice B reason: Instructing the patient to take diuretics at bedtime is not recommended. Diuretics should be taken in the morning to avoid frequent urination during the night, which can disrupt sleep.

Choice C reason: Notifying the physician if weight increases by three pounds in one week is a key instruction for patients with heart failure. Rapid weight gain can indicate fluid retention and worsening heart failure, requiring prompt medical evaluation and adjustment of treatment.

Choice D reason: Administering diuretics in the morning and notifying the physician of decreased urine output is important, but the focus on notifying the physician about significant weight gain provides a more specific and actionable guideline for managing heart failure.

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Correct Answer is C

Explanation

Choice A reason: Administering lipid injectable emulsion with TPN every day based on albumin results is not the priority intervention. While lipid emulsions may be part of TPN, the focus should be on maintaining aseptic technique to prevent infection.

Choice B reason: Disconnecting IV tubing and adding regular insulin to the TPN bag based on sliding scale results is not appropriate. Insulin should be administered separately, and aseptic technique must be maintained to prevent contamination.

Choice C reason: Maintaining aseptic technique when changing tubing or the parenteral nutrition bag is crucial for preventing infection. Patients receiving TPN through a central venous access device are at high risk for infections, and strict aseptic technique is essential.

Choice D reason: Administering dextrose infusion through separate tubing three hours before discontinuing TPN is not a standard practice. The focus should be on proper administration and infection control practices.

A. pH 7.26, PaCO2 59, HCO3 30 B. pH 7.46, PaCO2 30, HCO3 24 C. pH 7.48, PaCO2 42, HCO3 29 D. pH 7.31, PaCO2 34, HCO3 18

Correct Answer is C

Explanation

Choice A reason: The lab results pH 7.26, PaCO2 59, HCO3 30 indicate respiratory acidosis with partial compensation. This finding is inconsistent with the expected results for a patient with small bowel obstruction and nasogastric suction, which typically leads to metabolic alkalosis due to loss of gastric acid.

Choice B reason: The lab results pH 7.46, PaCO2 30, HCO3 24 suggest a slightly alkaline state with normal bicarbonate levels, which could indicate respiratory alkalosis with compensation. However, for a patient with a small bowel obstruction and nasogastric suction, this is less likely.

Choice C reason: The lab results pH 7.48, PaCO2 42, HCO3 29 indicate metabolic alkalosis. This is a common finding in patients with small bowel obstruction who have been on nasogastric suction, which removes stomach acids and leads to an increase in bicarbonate levels. The elevated pH and bicarbonate levels are consistent with this condition.

Choice D reason: The lab results pH 7.31, PaCO2 34, HCO3 18 indicate metabolic acidosis. This finding is inconsistent with the expected results for a patient with small bowel obstruction and nasogastric suction, which typically leads to

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The nursing students are preparing a care plan for a patient with heart failure. The patient will be prescribed diuretic therapy after discharge. What evidence-based instructions will the nurse include in this plan?

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