Which clinical manifestations are indicative of right ventricular failure? (Select all that apply.)

Crackles upon auscultation of the lungs

Hepatomegaly

Jugular venous distention

Orthopnea

Peripheral edema

Answer and Explanation

Correct Answer : B,C,E

A. Crackles are more commonly associated with left ventricular failure, which leads to pulmonary congestion.

B. Hepatomegaly, or an enlarged liver, is a sign of right ventricular failure due to blood backing up in the systemic circulation.

C. Jugular venous distention is a classic sign of right ventricular failure as blood accumulates in the venous system.

D. Orthopnea, or difficulty breathing while lying down, is more indicative of left ventricular failure.

E. Peripheral edema is a hallmark of right ventricular failure, resulting from increased venous pressure.

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Correct Answer is B

Explanation

A. Obtaining a stat chest x-ray is important if catheter misplacement is suspected, but in this situation, ensuring the accuracy of the pressure reading through proper leveling and zeroing is the priority.
B. Zero referencing and leveling the catheter at the phlebostatic axis is essential to ensure accurate readings of the pulmonary artery pressure, which is critical for patient assessment and management.
C. Increasing supplemental oxygen is unnecessary given the patient’s stable oxygen saturation and normal respiratory status.
D. While notifying the provider is important, ensuring the accuracy of the pressure reading by leveling and zeroing the catheter should be done first.

A. Spironolactone B. Furosemide C. Metoprolol D. Nitroglycerin

Correct Answer is B

Explanation

A. Spironolactone is a potassium-sparing diuretic, so it would not cause hypokalemia.

B. Furosemide is a loop diuretic that causes the kidneys to excrete potassium, leading to hypokalemia.

C. Metoprolol is a beta-blocker and does not directly affect potassium levels.

D. Nitroglycerin is a vasodilator and does not affect potassium levels.

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Which clinical manifestations are indicative of right ventricular failure? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

A nurse is caring for a client who has heart failure and a potassium level of 2.4 mEq/L. The nurse should identify which of the following medications as the cause of the client's low potassium level?

Correct Answer is B

Explanation

The patient presents to the ED with severe chest discomfort. A cardiac catheterization and angiography shows an 90% occlusion of the left main coronary artery. Which procedure will be most likely performed on this patient?

The nurse is educating a patient's family member about a central venous pressure catheter (CVP). Which statement by the family member best indicates understanding of the purpose of the CVP?

A client who has coronary artery disease tells the nurse he is afraid of dying from a heart attack. Which of the following responses should the nurse make?

The nurse is caring for a patient with a left radial arterial line and a pulmonary artery catheter inserted into the right subclavian vein. Which action by the nurse best ensures the safety of the patient being monitored with invasive hemodynamic monitoring lines?

The nurse is caring for a patient with a left subclavian central venous catheter (CVC) and a left radial arterial line. Which assessment finding by the nurse requires immediate action?

Which of the following describes a situation in which the blood pressure is severely elevated and there is evidence of actual target organ damage?

A nurse is performing cardiopulmonary resuscitation (CPR) for an adult client who is unresponsive. The nurse should evaluate the client's circulation by palpating which of the following pulses?