,1. A client with heart failure has crackles in all lung fields, jugular venous distention, and 3+
pitting edema. Which medication should the nurse expect to administer first to reduce preload
and relieve pulmonary congestion?
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
Correct Answer: Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload by promoting diuresis,
which relieves pulmonary congestion . The client's signs indicate acute fluid overload, making
diuretics the first-line treatment for exacerbation of heart failure . Digoxin improves
contractility, while enalapril and carvedilol are long-term therapies.
2. A client with heart failure is prescribed digoxin. Which finding is most indicative of digoxin
toxicity?
A) Heart rate of 72 beats per minute
B) Anorexia, nausea, and visual disturbances
C) Weight gain of 2 kg in 24 hours
D) Increased urine output
Correct Answer: Anorexia, nausea, and visual disturbances
Rationale: Anorexia, nausea, and visual disturbances (yellow-green halos) are classic signs of
digoxin toxicity . Therapeutic range is 0.8-2.0 ng/mL, and hypokalemia increases toxicity risk .
Bradycardia, not a normal heart rate, is also a sign.
,3. A client with heart failure has an ejection fraction of 25% and is prescribed a beta-blocker.
Which medication is most likely to improve survival in this client?
A) Metoprolol succinate
B) Diltiazem
C) Furosemide
D) Digoxin
Correct Answer: Metoprolol succinate
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce mortality in heart
failure with reduced ejection fraction (HFrEF) by reducing sympathetic overdrive and improving
cardiac function . Calcium channel blockers like diltiazem are not recommended for HFrEF .
4. A client with angina is prescribed sublingual nitroglycerin. Which instruction should the nurse
include in the teaching plan?
A) "Chew the tablet for faster absorption."
B) "Take the tablet every 5 minutes for up to 3 doses."
C) "Expect a headache; this is a normal side effect."
D) "Store the tablets in the refrigerator."
Correct Answer: "Expect a headache; this is a normal side effect."
Rationale: Headache is a common side effect of nitroglycerin due to vasodilation . Sublingual
tablets should be taken every 5 minutes for up to 3 doses, then call 911 if pain persists. Tablets
should be stored in a cool, dark place, not the refrigerator .
5. A client is receiving a heparin infusion for a pulmonary embolism. Which laboratory value
should the nurse monitor to evaluate the effectiveness of therapy?
, A) PT/INR
B) aPTT
C) Platelet count
D) Hemoglobin
Correct Answer: aPTT
Rationale: Heparin is monitored using the activated partial thromboplastin time (aPTT), typically
maintained at 1.5-2.5 times the control value . PT/INR is used for warfarin monitoring. Platelet
count is monitored for heparin-induced thrombocytopenia (HIT) .
6. A client receiving heparin develops a sudden drop in platelet count. The nurse should suspect
which complication?
A) Heparin-induced thrombocytopenia (HIT)
B) Hemolytic anemia
C) Disseminated intravascular coagulation
D) Bone marrow suppression
Correct Answer: Heparin-induced thrombocytopenia (HIT)
Rationale: HIT is a serious immune-mediated reaction to heparin, causing a decrease in platelet
count and potential thrombosis . Heparin should be discontinued if HIT is suspected, and
alternative anticoagulation should be initiated .
7. A client is prescribed warfarin for atrial fibrillation. The nurse should teach the client to avoid
foods high in which vitamin?
A) Vitamin A
B) Vitamin C
pitting edema. Which medication should the nurse expect to administer first to reduce preload
and relieve pulmonary congestion?
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
Correct Answer: Furosemide
Rationale: Furosemide is a loop diuretic that rapidly reduces preload by promoting diuresis,
which relieves pulmonary congestion . The client's signs indicate acute fluid overload, making
diuretics the first-line treatment for exacerbation of heart failure . Digoxin improves
contractility, while enalapril and carvedilol are long-term therapies.
2. A client with heart failure is prescribed digoxin. Which finding is most indicative of digoxin
toxicity?
A) Heart rate of 72 beats per minute
B) Anorexia, nausea, and visual disturbances
C) Weight gain of 2 kg in 24 hours
D) Increased urine output
Correct Answer: Anorexia, nausea, and visual disturbances
Rationale: Anorexia, nausea, and visual disturbances (yellow-green halos) are classic signs of
digoxin toxicity . Therapeutic range is 0.8-2.0 ng/mL, and hypokalemia increases toxicity risk .
Bradycardia, not a normal heart rate, is also a sign.
,3. A client with heart failure has an ejection fraction of 25% and is prescribed a beta-blocker.
Which medication is most likely to improve survival in this client?
A) Metoprolol succinate
B) Diltiazem
C) Furosemide
D) Digoxin
Correct Answer: Metoprolol succinate
Rationale: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce mortality in heart
failure with reduced ejection fraction (HFrEF) by reducing sympathetic overdrive and improving
cardiac function . Calcium channel blockers like diltiazem are not recommended for HFrEF .
4. A client with angina is prescribed sublingual nitroglycerin. Which instruction should the nurse
include in the teaching plan?
A) "Chew the tablet for faster absorption."
B) "Take the tablet every 5 minutes for up to 3 doses."
C) "Expect a headache; this is a normal side effect."
D) "Store the tablets in the refrigerator."
Correct Answer: "Expect a headache; this is a normal side effect."
Rationale: Headache is a common side effect of nitroglycerin due to vasodilation . Sublingual
tablets should be taken every 5 minutes for up to 3 doses, then call 911 if pain persists. Tablets
should be stored in a cool, dark place, not the refrigerator .
5. A client is receiving a heparin infusion for a pulmonary embolism. Which laboratory value
should the nurse monitor to evaluate the effectiveness of therapy?
, A) PT/INR
B) aPTT
C) Platelet count
D) Hemoglobin
Correct Answer: aPTT
Rationale: Heparin is monitored using the activated partial thromboplastin time (aPTT), typically
maintained at 1.5-2.5 times the control value . PT/INR is used for warfarin monitoring. Platelet
count is monitored for heparin-induced thrombocytopenia (HIT) .
6. A client receiving heparin develops a sudden drop in platelet count. The nurse should suspect
which complication?
A) Heparin-induced thrombocytopenia (HIT)
B) Hemolytic anemia
C) Disseminated intravascular coagulation
D) Bone marrow suppression
Correct Answer: Heparin-induced thrombocytopenia (HIT)
Rationale: HIT is a serious immune-mediated reaction to heparin, causing a decrease in platelet
count and potential thrombosis . Heparin should be discontinued if HIT is suspected, and
alternative anticoagulation should be initiated .
7. A client is prescribed warfarin for atrial fibrillation. The nurse should teach the client to avoid
foods high in which vitamin?
A) Vitamin A
B) Vitamin C
