Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E Chapter 27 Final,100% CORRECT

Type: MCSA The patient has hypertension and asks the nurse how this can lead to heart failure. What is the best response by the nurse? 1. "Hypertension causes resistance in your blood vessels, or afterload; your heart works harder, and weakens." 2. "Hypertension limits the ability of your heart to stretch before emptying, or afterload; your heart works harder, and weakens." 3. "Hypertension causes resistance in your aorta, or afterload; your heart works harder and weakens." 4. "Hypertension limits the amount of blood entering your left ventricle, or afterload; your heart works harder, and weakens." Correct Answer: 1 Rationale 1: The most common cause of increased afterload is an increase in peripheral resistance due to hypertension. Rationale 2: The ability of the heart to stretch before emptying is known as preload, not afterload. Rationale 3: Afterload refers to peripheral resistance, not to resistance in the aorta. Rationale 4: Afterload refers to peripheral resistance, not to the amount of blood entering the left ventricle. Global Rationale: The most common cause of increased afterload is an increase in peripheral resistance due to hypertension. Afterload refers to peripheral resistance, not to the amount of blood entering the left ventricle. The ability of the heart to stretch before emptying is known as preload, not afterload. Afterload refers to peripheral resistance, not to resistance in the aorta. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-2 Relate how the symptoms associated with heart failure may be caused by weakened heart muscle and diminished cardiac output. MNL Learning Outcome: 4.3.1 Examine etiology, pathophysiology, clinical manifestations, and mechanisms to maintain perfusion. Page Number: 396 Question 2 Type: MCMA The patient comes to the emergency department complaining of coughing and difficulty breathing. The patient's diagnosis is heart failure. He asks the nurse how difficulty breathing could be a heart problem. What is the best response by the nurse? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The right side of your heart has weakened and blood has entered your lungs." 2. "The right side of your heart has enlarged and cannot effectively pump blood." 3. "What you have is called congestive heart failure." 4. "The left side of your heart is weak and pumps blood too quickly." 5. "The left side of your heart has weakened and blood has entered your lungs." Correct Answer: 3,5 Rationale 1: Right-sided heart failure results in peripheral edema, not pulmonary congestion. Rationale 2: Right-sided heart failure results in peripheral edema, not pulmonary congestion. Rationale 3: Left heart failure is sometimes called congestive heart failure. Rationale 4: Heart failure results from the inability of the left ventricle to pump blood, not pumping blood too quickly. Rationale 5: When the left ventricle cannot compensate for increased preload, blood backs up into the lungs resulting in cough and shortness of breath. Global Rationale: When the left ventricle cannot compensate for increased preload, blood backs up into the lungs resulting in cough and shortness of breath. Left heart failure is sometimes called congestive heart failure. Left-sided, not right-sided, heart failure is associated with pulmonary congestion. Right-sided heart failure results in peripheral edema, not pulmonary congestion. Heart failure results from the inability of the left ventricle to pump blood, not pumping blood too quickly. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-2 Relate how the symptoms associated with heart failure may be caused by weakened heart muscle and diminished cardiac output. MNL Learning Outcome: 4.3.1 Examine etiology, pathophysiology, clinical manifestations, and mechanisms to maintain perfusion. Page Number: 397 Question 3 Type: MCMA The nurse teaches the patient about digoxin (Lanoxin) toxicity and determines that learning has occurred when the patient makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I should limit my fluids while taking this medication." 2. "It is okay to keep taking my ginseng." 3. "If I have nausea, it means I must stop the medication." 4. "I can drink orange juice every morning." 5. "I must check my pulse and not take the medication if it is less than 60." Correct Answer: 4,5 Rationale 1: Dehydration can increase the risk for digoxin (Lanoxin) toxicity; the patient must not limit fluids. Rationale 2: Ginseng may increase the risk of digoxin (Lanoxin) toxicity. Rationale 3: Nausea, by itself, may be a side effect, but it is not necessarily indicative of digoxin (Lanoxin) toxicity. Rationale 4: Orange juice is a source of potassium, which will minimize the risk for digoxin (Lanoxin) toxicity. Rationale 5: Sixty beats per minute is the generally accepted limit for withholding digoxin (Lanoxin). Global Rationale: Orange juice is a source of potassium, which will minimize the risk for digoxin (Lanoxin) toxicity. Sixty beats per minute is the generally accepted limit for withholding digoxin (Lanoxin). Nausea, by itself, may be a side effect, but it is not necessarily indicative of digoxin (Lanoxin) toxicity. Ginseng may increase the risk of digoxin (Lanoxin) toxicity. Dehydration can increase the risk for digoxin (Lanoxin) toxicity; the patient must not limit fluids. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 27-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 4.3.3 Compare the classes of medication used in pharmacologic management. Page Number: 403 Question 4 Type: MCSA The nurse teaches the patient about lisinopril (Prinivil) and evaluates that additional teaching is required when the patient makes which statement? 1. "I will monitor my blood pressure until my next appointment." 2. "I will avoid using salt substitutes for seasoning." 3. "It takes a while for this medication to take effect." 4. "I don't need to worry about having blood tests done." Correct Answer: 4 Rationale 1: Blood pressure should be monitored to assess effectiveness of the medication. Rationale 2: Potassium should be limited to avoid hyperkalemia. Rationale 3: It takes a while for lisinopril (Prinivil) to become effective. Rationale 4: The use of ACE inhibitors can lead to electrolyte disturbances so levels should be monitored. Global Rationale: The use of ACE inhibitors can lead to electrolyte disturbances so levels should be monitored. Potassium should be limited to avoid hyperkalemia. Blood pressure should be monitored to assess effectiveness of the medication. It takes a while for lisinopril (Prinivil) to become effective. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 27-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 4.3.3 Compare the classes of medication used in pharmacologic management. Page Number: 401 Question 5 Type: MCSA The patient will receive an IV infusion of milrinone (Primacor) as treatment for acute heart failure. What is the priority plan by the nurse? 1. Plan to monitor for atrial fibrillation. 2. Plan to monitor the ECG continuously. 3. Plan to take vital signs every 15 minutes. 4. Plan to monitor for hypertension. Correct Answer: 2 Rationale 1: Atrial fibrillation is not an adverse effect of milrinone (Primacor). Rationale 2: Due to the risk of ventricular dysrhythmia, the patient's ECG is usually monitored continuously during the infusion of milrinone (Primacor). Rationale 3: Vital signs should be assessed continuously, not every 15 minutes, while the patient receives milrinone (Primacor). Rationale 4: Hypotension, not hypertension, is an adverse effect of milrinone (Primacor). Global Rationale: Due to the risk of ventricular dysrhythmia, the patient's ECG is usually monitored continuously during the infusion of milrinone (Primacor). Vital signs should be assessed continuously, not every 15 minutes, while the patient receives milrinone (Primacor). Hypotension, not hypertension, is an adverse effect of milrinone (Primacor). Ventricular dysrhythmias, not atrial fibrillation, are an adverse effect of milrinone (Primacor). Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 27-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 4.3.3 Compare the classes of medication used in pharmacologic management. Page Number: 406 Question 6 Type: MCSA The physician orders metoprolol (Toprol-XL) for several patients. The nurse will most closely monitor the effects of this drug on which patient? 1. The patient with an apical pulse rate of 100 2. The patient with compensated heart failure 3. The patient with chronic bronchitis 4. The patient with a history of migraines Correct Answer: 3 Rationale 1: Beta-blockers may be used for patients with apical pulse rates of 100. Rationale 2: Beta-blockers may be used for patients with compensated heart failure. Rationale 3: Metoprolol (Toprol XL) is selective for blocking beta1 receptors in the heart, so adverse effects on the lungs are not as likely as with other nonselective beta blockers. The nurse should still be aware of and monitor for these effects. Rationale 4: Beta-blockers may be used for patients with migraines. Global Rationale: Metoprolol (Toprol XL) is selective for blocking beta1 receptors in the heart, so adverse effects on the lungs are not as likely as with other nonselective beta blockers. The nurse should still be aware of and monitor for these effects. Beta-blockers may be used for patients with migraines. Beta-blockers may be used for patients with compensated heart failure. Beta-blockers may be used for patients with apical pulse rates of 100. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 27-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 4.3.3 Compare the classes of medication used in pharmacologic management. Page Number: 404 Question 7 Type: MCSA The patient receives digoxin (Lanoxin). Which assessment findings would indicate adverse effects to this medication? 1. Tachycardia and hypotension 2. Blurred vision and tachycardia 3. Anorexia and nausea 4. Anorexia and constipation Correct Answer: 3 Rationale 1: Hypotension can occur, but bradycardia occurs, not tachycardia. Rationale 2: Blurred vision can occur, but bradycardia occurs, not tachycardia. Rationale 3: Anorexia and nausea are common adverse effects of digoxin (Lanoxin). Rationale 4: Anorexia can occur, but diarrhea is more likely than constipation. Global Rationale: Anorexia and nausea are common adverse effects of digoxin (Lanoxin). Hypotension can occur, but bradycardia occurs, not tachycardia. Blurred vision can occur, but bradycardia occurs, not tachycardia. Anorexia can occur, but diarrhea is more likely than constipation. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 27-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 4.3.3 Compare the classes of medication used in pharmacologic management. Page Number: 403 Question 8 Type: MCSA The nurse volunteers at a senior citizen center. The nurse assesses which senior citizen as having the greatest risk of developing heart failure? 1. A 50-year-old African American female who smokes 2. A 75-year-old Caucasian male who is overweight 3. A 69-year-old African American male with hypertension 4. A 52-year-old Caucasian female with asthma Correct Answer: 3 Rationale 1: Race and smoking are risk factors, but being female and younger decreases the overall risk. Rationale 2: Age and obesity are risk factors but not as much other risk factors. Rationale 3: Age, race, and hypertension lead to an increased risk for developing heart failure. Rationale 4: Asthma, by itself, is not considered a significant risk factor in the development of heart failure. Global Rationale: Age, race, and hypertension lead to an increased risk for developing heart failure. Race and smoking are risk factors, but being female and younger decreases the overall risk. Age and obesity are risk factors, but not as much as age, Black race, and hypertension. Asthma, by itself, is not considered a significant risk factor in the development of heart failure. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-1 Identify major diseases that accelerate the progression of heart failure. MNL Learning Outcome: 4.3.1 Examine etiology, pathophysiology, clinical manifestations, and mechanisms to maintain perfusion. Page Number: 396 Question 9 Type: MCSA The patient who is prescribed furosemide (Lasix) and digoxin (Lanoxin) reports using an over-the-counter antacid for recurrent heartburn. The nurse would assess for which result?1. Hyponatremia 2. Hypermagnesemia 3. Increased effectiveness of furosemide (Lanoxin) 4. Decreased effectiveness of digoxin (Lanoxin) Correct Answer: 4 Rationale 1: Hyponatremia does not result from an interaction with furosemide (Lasix).digoxin (Lanoxin), and antacids. Rationale 2: Hypermagnesemia does not result from an interaction with furosemide (Lasix), digoxin (Lanoxin), and antacids. Rationale 3: Use of furosemide (Lasix), digoxin (Lanoxin) and antacid does not increase the effectiveness of furosemide. Rationale 4: Use of antacids may decrease the effectiveness of digoxin (Lanoxin). Global Rationale: Use of antacids may decrease the effectiveness of digoxin (Lanoxin). Use of furosemide (Lasix), digoxin (Lanoxin) and antacid does not increase the effectiveness of furosemide. Hyponatremia and hypermagnesemia do not result from an interaction with furosemide (Lasix).digoxin (Lanoxin), and antacids. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-4 Describe the nurse’s role in the pharmacologic management of heart failure. MNL Learning Outcome: 4.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 403 Question 10 Type: MCSA The patient receives captopril (Capoten) as treatment for heart failure. Which adverse effect will the nurse plan to report to the physician? 1. The patient develops a cough. 2. The patient develops diarrhea. 3. The patient develops dehydration. 4. The patient develops facial flushing. Correct Answer: 1 Rationale 1: A cough is an adverse effect of captopril (Capoten) and should be reported to the physician. Rationale 2: Diarrhea is not an adverse effect of captopril (Capoten). Rationale 3: Dehydration is not an adverse effect of captopril (Capoten). Rationale 4: Facial flushing is not an adverse effect of captopril (Capoten). Global Rationale: A cough is an adverse effect of captopril (Capoten) and should be reported to the physician. Diarrhea is not an adverse effect of captopril (Capoten). Facial flushing is not an adverse effect of captopril (Capoten). Dehydration is not an adverse effect of captopril (Capoten). Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 27-4 Describe the nurse’s role in the pharmacologic management of heart failure. MNL Learning Outcome: 4.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 400 Question 11 Type: MCSA The patient receives enalapril (Vasotec) as treatment for heart failure. What is the best nursing assessment following the initial administration of this drug? 1. Assess the patient for ototoxicity. 2. Assess the patient's blood pressure. 3. Assess the patient for an irregular pulse. 4. Assess the patient for a serious rash. Correct Answer: 2 Rationale 1: Ototoxicity is an adverse effect of loop diuretics. Rationale 2: Severe hypotension, known as first-dose phenomenon, can occur after the initial administration of enalapril (Vasotec). Rationale 3 Irregular pulse is an adverse effect of beta blockers. Rationale 4: Stevens–Johnson syndrome is an adverse effect of beta blockers. Global Rationale: Severe hypotension, known as first-dose phenomenon, can occur after the initial administration of enalapril (Vasotec). Ototoxicity is an adverse effect of loop diuretics. Stevens–Johnson syndrome is an adverse effect of beta blockers. Irregular pulse is an adverse effect of beta blockers. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-4 Describe the nurse’s role in the pharmacologic management of heart failure. MNL Learning Outcome: 4.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 400 Question 12 Type: MCSA The patient takes insulin for diabetes mellitus. The physician orders metoprolol (Lopressor) for hypertension. After medication teaching, the nurse determines that learning has occurred when the patient makes which statement? 1. "I might not need to check my blood sugars as often with metoprolol (Lopressor)." 2. "I might be able to change from insulin to a pill with metoprolol (Lopressor)." 3. "I might need less insulin when I take metoprolol (Lopressor)." 4. "I might need more insulin when I take metoprolol (Lopressor)." Correct Answer: 3 Rationale 1: The patient will most likely need more frequent blood glucose assessments, as metoprolol (Lopressor) may enhance the hypoglycemic effects of insulin. Rationale 2: Metoprolol (Lopressor) will not change a diabetic patient's need for insulin; the patient might just require less insulin. Rationale 3: Metoprolol (Lopressor) may enhance the hypoglycemic effects of insulin and oral hypoglycemic agents, so the patient might require less insulin. Rationale 4: Metoprolol (Lopressor) may enhance the hypoglycemic effects of insulin and oral hypoglycemic agents, so the patient might require less, not more, insulin. Global Rationale: Metoprolol (Lopressor) may enhance the hypoglycemic effects of insulin and oral hypoglycemic agents, so the patient might require less insulin. Metoprolol (Lopressor) may enhance the hypoglycemic effects of insulin and oral hypoglycemic agents, so the patient might require less, not more, insulin. Metoprolol (Lopressor) will not change a diabetic patient's need for insulin; the patient might just require less insulin. The patient will most likely need more frequent blood glucose assessments, as metoprolol (Lopressor) may enhance the hypoglycemic effects of insulin. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 27-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 4.3.3 Compare the classes of medication used in pharmacologic management. Page Number: 404 Question 13 Type: MCSA The patient has heart failure and receives digoxin (Lanoxin). Prior to discharge, what will the best teaching plan by the nurse include? 1. "Report development of a metallic taste in the mouth." 2. "Report mental changes such as depression." 3. "Stop the medication if your pulse is irregular." 4. "If you miss a dose, take two doses." Correct Answer: 2 Rationale 1: Metallic taste is not associated with digoxin. Rationale 2: Depression may occur with this drug. Rationale 3: If the pulse is irregular, the patient should notify the physician and not stop the medication unless directed to do so. Rationale 4: Patients should not take a double dose; this is considered an overdose that could lead to toxicity. Global Rationale: Depression may occur with this drug. Metallic taste is not associated with digoxin. If the pulse is irregular, the patient should notify the physician and not stop the medication unless directed to do so. Patients should not take a double dose; this is considered an overdose that could lead to toxicity. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-6 Use the nursing process to care for patients receiving pharmacotherapy for heart failure. MNL Learning Outcome: 4.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 408 Question 14 Type: MCSA The patient has a history of cardiac disease and receives digoxin (Lanoxin). The nurse determines that education about dietary needs with this medication has been effective when the patient makes which selection for lunch? 1. Cottage cheese, peach salad, and blueberry pie 2. Baked fish, sweet potatoes, and banana pudding 3. Green bean soup, whole-wheat bread, and an apple 4. Hamburger, French fries, and chocolate chip cookies Correct Answer: 2 Rationale 1: Cottage cheese, peach salad, and blueberry pie are not significant sources of potassium needed to help prevent digoxin toxicity. Rationale 2: Fish, sweet potatoes, and bananas are high in potassium, which will help prevent digoxin toxicity. Rationale 3: Green bean soup, whole-wheat bread, and an apple are not significant sources of potassium needed to help prevent digoxin toxicity. Rationale 4: The hamburger is high in potassium, but the French fries are not appropriate for a cardiac patient. Global Rationale: Fish, sweet potatoes, and bananas are high in potassium, which will help prevent digoxin toxicity. The hamburger is high in potassium, but the French fries are not appropriate for a cardiac patient. Green bean soup, whole-wheat bread, and an apple are not significant sources of potassium needed to help prevent digoxin toxicity. Cottage cheese, peach salad, and blueberry pie are not significant sources of potassium needed to help prevent digoxin toxicity. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-6 Use the nursing process to care for patients receiving pharmacotherapy for heart failure. MNL Learning Outcome: 4.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 403 Question 15 Type: MCSA Which individual listed below would be at the greatest risk for developing heart disease? 1. 35-year-old with diabetes mellitus and prehypertension 2. 75-year-old with Parkinson’s disease and normal blood pressure 3. 52-year-old with osteoporosis and stage 1 hypertension 4. 68-year-old with stage 2 hypertension and recent myocardial infarction Correct Answer: 4 Rationale 1: Cardiac tissue weakens as people age and can be caused or accelerated by chronic hypertension, myocardial infarction, diabetes mellitus, and other cardiac-related diseases. This patient is at somewhat less risk due to age. Rationale 2: Cardiac tissue weakens as people age and can be caused or accelerated by chronic hypertension, myocardial infarction, diabetes mellitus, and other cardiac-related diseases. This patient has no other risk factors except age. Rationale 3: Cardiac tissue weakens as people age and can be caused or accelerated by chronic hypertension, myocardial infarction, diabetes mellitus, and other cardiac-related diseases. Osteoporosis is not a risk factor. Rationale 4: Cardiac tissue weakens as people age and can be caused or accelerated by chronic hypertension, myocardial infarction, diabetes mellitus, and other cardiac-related diseases. The 68-year-old patient has the most risk factors for developing heart failure. Global Rationale: Cardiac tissue weakens as people age and can be caused or accelerated by chronic hypertension, myocardial infarction, diabetes mellitus, and other cardiac-related diseases. The 68-year-old patient has the most risk factors for developing heart failure. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-1 Identify major diseases that accelerate the progression of heart failure. MNL Learning Outcome: 4.3.1 Examine etiology, pathophysiology, clinical manifestations, and mechanisms to maintain perfusion. Page Number: 396 Question 16 Type: MCSA Which statement is accurate regarding the physiological changes associated with heart failure? 1. Blood backs up into the lungs due to right ventricular hypertrophy. 2. The walls of the heart shrink, leading to lower cardiac output. 3. Cardiac remodeling occurs after prolonged ventricular hypertrophy. 4. Blood pressure increases, resulting in lowered afterload. Correct Answer: 3 Rationale 1: Blood can back up into the lungs, but this would be a result of left ventricular hypertrophy, not right. Rationale 2: Heart walls do not shrink. Rationale 3: Heart walls thicken and enlarge with heart failure. These changes occur over time and are referred to as cardiac remodeling. Rationale 4: Blood pressure can go up but would result in a higher, not lower, afterload. Global Rationale: Heart walls thicken and enlarge with heart failure. These changes occur over time and are referred to as cardiac remodeling. Blood can back up into the lungs, but this would be a result of left ventricular hypertrophy, not right. Blood pressure can go up but would result in a higher, not lower, afterload. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-2 Relate how the symptoms associated with heart failure may be caused by weakened heart muscle and diminished cardiac output. MNL Learning Outcome: 4.3.1 Examine etiology, pathophysiology, clinical manifestations, and mechanisms to maintain perfusion. Page Number: 397 Question 17 Type: MCSA Which situation would lead to an increase in cardiac output? 1. Reduced cardiac contractility 2. Hypovolemia 3. Peripheral vascular resistance 4. Increase in preload Correct Answer: 4 Rationale 1: A reduction in cardiac contractility results in lower preload and subsequent cardiac output. Rationale 2: Hypovolemia is a lower blood volume and will result in lower cardiac output. Rationale 3: Peripheral vascular resistance increases afterload and increases the workload on the heart. Rationale 4: Increased preload results in a more forceful contraction and increases cardiac output. Global Rationale: Increased preload results in a more forceful contraction and increases cardiac output. A reduction in cardiac contractility results in lower preload and subsequent cardiac output. Hypovolemia is a lower blood volume and will result in lower cardiac output. Peripheral vascular resistance increases afterload and increases the workload on the heart. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-2 Relate how the symptoms associated with heart failure may be caused by weakened heart muscle and diminished cardiac output. MNL Learning Outcome: 4.3.1 Examine etiology, pathophysiology, clinical manifestations, and mechanisms to maintain perfusion. Page Number: 396 Question 18 Type: MCSA Which medication would be of most help to increase myocardial contractility in a patient with heart failure? 1. Digoxin (Lanoxin) 2. Lisinopril (Prinivil) 3. Carvedilol (Coreg) 4. Furosemide (Lasix) Correct Answer: 1 Rationale 1: Cardiac glycosides increase cardiac output by increasing the force of contraction. Rationale 2: ACE inhibitors lower peripheral vascular resistance and blood volume. Rationale 3: Beta blockers lower heart rate. Rationale 4: Diuretics lower blood volume. Global Rationale: Cardiac glycosides increase cardiac output by increasing the force of contraction. ACE inhibitors lower peripheral vascular resistance and blood volume. Beta blockers lower heart rate. Diuretics lower blood volume. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 27-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 4.3.3 Compare the classes of medication used in pharmacologic management. Page Number: 399 Question 19 Type: MCSA Lisinopril (Prinivil) is often used to treat heart failure because it lowers blood volume. Which statement best explains how lisinopril lowers blood volume? 1. It has an antagonistic effect on angiotensin-converting enzyme. 2. It lowers aldosterone secretion, a hormone that increases sodium reabsorption. 3. It causes hypernatremia and increased renal tubule permeability, resulting in a diuretic effect. 4. It causes a diuretic effect by lowering the amount of sodium lost in the urine. Correct Answer: 2 Rationale 1: ACE inhibitors have an antagonistic effect on angiotensin-converting enzyme, but this action lowers blood pressure by reducing peripheral vascular resistance, not by lowering blood volume. Rationale 2: ACE inhibitors lower blood volume by lowering the secretion of aldosterone from the adrenal cortex. Rationale 3: Increasing sodium in the blood will not lower blood volume. Rationale 4: Aldosterone is a hormone that increases the reabsorption of sodium and water. Global Rationale: ACE inhibitors lower blood volume by lowering the secretion of aldosterone from the adrenal cortex. ACE inhibitors have an antagonistic effect on angiotensin-converting enzyme, but this action lowers blood pressure by reducing peripheral vascular resistance, not by lowering blood volume. Increasing sodium in the blood will not lower blood volume. Aldosterone is a hormone that increases the reabsorption of sodium and water. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 4.3.3 Compare the classes of medication used in pharmacologic management. Page Number: 401 Question 20 Type: MCSA Which statement is accurate regarding the use of beta-adrenergic blockers for use in patients with heart failure? 1. Higher doses are used initially until optimal vital signs are achieved. 2. Dosage changes are done on a daily basis for the first 2 weeks. 3. This drug class does not have an effect on the bronchioles of the lungs. 4. They are generally used in combination with other heart-failure drugs. Correct Answer: 4 Rationale 1: Initial doses are small. Rationale 2: Initial doses are doubled every 2 weeks until the optimal dose is achieved. Rationale 3: Beta-adrenergic blockers can be selective to beta1 receptors or non-selective. Non-selective blockers block beta1 and beta2 receptors. The blockage of beta2 receptors can affect the bronchioles of the lungs. Rationale 4: Beta-adrenergic blockers are rarely used to treat heart failure alone. They are commonly used in combination with ACE inhibitors. Global Rationale: Beta-adrenergic blockers are rarely used to treat heart failure alone. They are commonly used in combination with ACE inhibitors. Initial doses are small, and are doubled every 2 weeks until the optimal dose is achieved. Beta-adrenergic blockers can be selective to beta1 receptors or non-selective. Non-selective blockers block beta1 and beta2 receptors. The blockage of beta2 receptors can affect the bronchioles of the lungs. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 27-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 4.3.3 Compare the classes of medication used in pharmacologic management. Page Number: 402 Question 21 Type: MCSA Which vital sign is of greatest concern to the nurse prior to administering digoxin (Lanoxin)? 1. Heart rate 2. Temperature 3. Blood pressure 4. Respiratory rate Correct Answer: 1 Rationale 1: An apical pulse should be checked for one full minute prior to administering digoxin. If the heart rate is low (generally 60 bpm), the medication should be held and the ordering practitioner informed. Digoxin can suppress electrical activity within the heart and lower heart rate. Rationale 2: Temperature is not a specific concern. Rationale 3: Blood pressure is not a specific concern. Rationale 4: Respiratory rate is not a specific concern. Global Rationale: An apical pulse should be checked for one full minute prior to administering digoxin. If the heart rate is low (generally 60 bpm), the medication should be held and the ordering practitioner informed. Digoxin can suppress electrical activity within the heart and lower heart rate. The remaining vital signs are not specific concerns. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-4 Describe the nurse’s role in the pharmacologic management of heart failure. MNL Learning Outcome: 4.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 403 Question 22 Type: MCSA Which is the most serious adverse effect associated with milrinone (Primacor)? 1. Ventricular dysrhythmia 2. Nausea 3. Headache 4. Atrial dysrhythmia Correct Answer: 1 Rationale 1: Milrinone is a phosphodiesterase inhibitor that can cause ventricular dysrhythmias. Rationale 2: Nausea can occur but is not as serious as another adverse effect. Rationale 3: Headache can occur but is not as serious as another adverse effect. Rationale 4: Atrial dysrhythmias can occur but are not as serious as another adverse effect. Global Rationale: Milrinone is a phosphodiesterase inhibitor that can cause ventricular dysrhythmias. Atrial dysrhythmias can occur but ventricular dysrhythmias are more serious. Headache and nausea also can occur but are not as serious as ventricular dysrhythmias. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 27-5 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 4.3.3 Compare the classes of medication used in pharmacologic management. Page Number: 406 Question 23 Type: MCMA The nurse is concerned that a patient is developing right heart failure. What did the nurse assess in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Ankle edema 2. Enlarged liver 3. Displaced apical heart rate 4. Shortness of breath 5. Cough Correct Answer: 1,2,3 Rationale 1: In right heart failure, the blood backs up into veins, resulting in peripheral edema. Rationale 2: In right heart failure, the blood backs up into veins, resulting in engorgement of organs such as the liver. Rationale 3: A displaced apical heart rate would indicate cardiac hypertrophy, which is associated with right heart failure. Rationale 4: Shortness of breath is a manifestation of left heart failure. Rationale 5: A cough is a manifestation of left heart failure. Global Rationale: In right heart failure, the blood backs up into veins, resulting in peripheral edema and engorgement of organs such as the liver. A displaced apical heart rate would indicate cardiac hypertrophy, which is associated with right heart failure. Shortness of breath is a manifestation of left heart failure. A cough is a manifestation of left heart failure. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-2 Relate how the symptoms associated with heart failure may be caused by weakened heart muscle and diminished cardiac output. MNL Learning Outcome: 4.3.1 Examine etiology, pathophysiology, clinical manifestations, and mechanisms to maintain perfusion. Page Number: 397 Question 24 Type: MCMA The nurse is caring for a patient who has been diagnosed with heart failure. The nurse knows that which conditions may have contributed to the development of heart failure in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Uncontrolled hypertension 2. Coronary artery disease (CAD) 3. Diabetes (DM) 4. HIV 5. Mitral stenosis Correct Answer: 1,2,3,5 Rationale 1: Uncontrolled hypertension is associated with the development of heart failure. Rationale 2: Coronary artery disease is associated with the development of heart failure. Rationale 3: Diabetes is associated with the development of heart failure. Rationale 4: HIV is not associated with the development of heart failure. Rationale 5: Mitral stenosis is associated with the development of heart failure. Global Rationale: Uncontrolled hypertension, CAD, DM, and mitral stenosis are all associated with the development of heart failure. There is not a direct relationship with HIV status. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-1 Identify major diseases that accelerate the progression of heart failure. MNL Learning Outcome: 4.3.1 Examine etiology, pathophysiology, clinical manifestations, and mechanisms to maintain perfusion. Page Number: 396 Question 25 Type: MCMA The nurse is educating a patient diagnosed with heart failure (HF). The nurse knows that instruction regarding compensatory mechanisms has been effective when the patient states, Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "My heart enlarged in order to compensate for the effects of heart failure." 2. "My nervous system kicks in to compensate for the effects of heart failure." 3. "My body will decrease blood flow to other organs in order to compensate for heart failure." 4. "My body will increase urine output in order to compensate for the effects of heart failure." 5. "My body will produce anti-inflammatory agents to compensate for heart failure." Correct Answer: 1,2,3 Rationale 1: Ventricular hypertrophy occurs as a compensatory mechanism to heart failure. Rationale 2: One of the fastest homeostatic responses to diminished cardiac output is activation of the sympathetic nervous system (SNS). The increased heart rate resulting from sympathetic activation is a normal compensatory mechanism that serves to increase cardiac output. Rationale 3: When cardiac output in a patient with HF is diminished, blood flow to the kidneys is reduced. Rationale 4: Vasopressin (antidiuretic hormone), which is elevated in HF patients, causes fluid retention and worsens this condition. Rationale 5: Two pro-inflammatory substances, tumor necrosis factor (TNF) and interleukin, are found in high levels in patients with HF and are associated with a poor prognosis. Global Rationale: Ventricular hypertrophy occurs as a compensatory mechanism to heart failure. One of the fastest homeostatic responses to diminished cardiac output is activation of the sympathetic nervous system (SNS). The increased heart rate resulting from sympathetic activation is a normal compensatory mechanism that serves to increase cardiac output. When cardiac output in a patient with HF is diminished, blood flow to the kidneys is reduced. Vasopressin (antidiuretic hormone), which is elevated in HF patients, causes fluid retention and worsens this condition. Two pro-inflammatory substances, tumor necrosis factor (TNF) and interleukin, are found in high levels in patients with HF and are associated with a poor prognosis. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 27-2 Relate how the symptoms associated with heart failure may be caused by weakened heart muscle and diminished cardiac output. MNL Learning Outcome: 4.3.1 Examine etiology, pathophysiology, clinical manifestations, and mechanisms to maintain perfusion. Page Number: 397 Question 26 Type: MCMA The nurse is caring for a patient with heart failure. Which assessment findings indicate the patient is currently experiencing class 2 heart failure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Fatigue with physical activity 2. Palpitations with physical activity 3. No symptoms with physical activity 4. Dyspnea with physical activity 5. Angina at rest Correct Answer: 1,2,4 Rationale 1: Patients experiencing class 2 heart failure often experience fatigue. Rationale 2: Patients experiencing class 2 heart failure often experience palpitations. Rationale 3: Patients experiencing no symptoms with physical activity are classified as having class 1 heart failure. Rationale 4: Patients experiencing class 2 heart failure often experience dyspnea. Rationale 5: Patients experiencing class 4 heart failure are unable to perform physical activity and have symptoms at rest. Global Rationale: Patients experiencing class 2 heart failure often experience fatigue, palpitations, and dyspnea. Patients experiencing no symptoms with physical activity are classified as having class 1 heart failure. Patients experiencing class 4 heart failure are unable to perform physical activity and have symptoms at rest. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 27-3 Explain how heart failure is classified. MNL Learning Outcome: 4.3.1 Examine etiology, pathophysiology, clinical manifestations, and mechanisms to maintain perfusion. Page Number: 398 Question 27 Type: MCMA The nurse is caring for a patient who is being treated pharmacologically for the symptoms of heart failure. What would be included in the nurse's role of pharmacologic management of this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Teaching the patient how to space medications to decrease adverse effects 2. Teaching the patient the long-term benefits of beta blockers 3. Continually monitoring the patient during IV infusions 4. Decreasing medication dosages when the patient complains of adverse effects 5. Changing a medication that is no longer working to decrease the patient's symptoms Correct Answer: 1,2,3 Rationale 1: One role of the nurse is patient teaching. The nurse should teach the patient how to space medications to decrease the hypotensive effects that can occur during treatment for heart failure. Rationale 2: Beta blockers can have many adverse effects that can affect adherence. The nurse should teach the patient the long-term benefits in order to increase medication adherence. Rationale 3: Patients who are receiving medications used to treat heart failure by IV require continual monitoring by the nurse. Rationale 4: The nurse cannot change a dose of a medication without a health care provider's order. This is outside the nurse's scope of practice. Rationale 5: The nurse cannot prescribe medications; it is outside the nurse's scope of practice to change a medication without a health care provider's order. Global Rationale: One role of the nurse is patient teaching. The nurse should teach the patient how to space medications to decrease the hypotensive effects that can occur during treatment for heart failure. Beta blockers can have many adverse effects that can affect adherence. The nurse should teach the patient the long-term benefits in order to increase medication adherence. Patients who are receiving medications used to treat heart failure by IV require continual monitoring by the nurse. The nurse cannot change a dose of a medication without a health care provider's order. This is outside the nurse's scope of practice. The nurse cannot prescribe medications; it is outside the nurse's scope of practice to change a medication without a health care provider's order. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-4 Describe the nurse’s role in the pharmacologic management of heart failure. MNL Learning Outcome: 4.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 407 Question 28 Type: MCMA The nurse is caring for a patient being treated pharmacologically for heart failure. Which laboratory values is the nurse careful to monitor during treatment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Potassium levels 2. BUN 3. Creatinine 4. Liver function tests 5. Serum drug levels Correct Answer: 1,2,3,5 Rationale 1: It is important to monitor electrolyte levels, especially potassium, when a patient is being treated pharmacologically for heart failure. Rationale 2: It is important to monitor renal function while a patient is being treated pharmacologically for heart failure. Rationale 3: It is important to monitor renal function while a patient is being treated pharmacologically for heart failure. Rationale 4: It is not necessary to monitor liver function while a patient is being treated pharmacologically for heart failure. Rationale 5: It is important to monitor serum drug levels while a patient is being treated pharmacologically for heart failure. Global Rationale: It is important to monitor electrolyte levels, especially potassium, when a patient is being treated pharmacologically for heart failure. It is important to monitor renal function (BUN/creatinine) while a patient is being treated pharmacologically for heart failure. It is important to monitor serum drug levels while a patient is being treated pharmacologically for heart failure. It is not necessary to monitor liver function while a patient is being treated pharmacologically for heart failure. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 27-4 Describe the nurse’s role in the pharmacologic management of heart failure. MNL Learning Outcome: 4.3.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education. Page Number: 407 Question 29 Type: MCMA A nurse has been assigned to provide care for a patient who has class IV heart failure. Which nursing interventions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Assist nursing support personnel with the patient’s bed bath. 2. Accompany the patient on a walk to the courtyard. 3. Monitor that the patient’s position is changed every 2 hours. 4. Take vital signs before and after physical therapy weight-bearing exercises. 5. Assist the patient with meals as indicated. Correct Answer: 1,3,5 Rationale 1: This patient will most likely require a total bed bath. Rationale 2: This patient is not likely to tolerate walking. Rationale 3: This patient may not be able to initiate frequent moving in bed, so the nurse must intervene. Rationale 4: The patient will not be able to participate in weight-bearing exercises. Rationale 5: The patient may have difficulty feeding self, so monitoring and assistance are indicated. Global Rationale: This patient will most likely require a total bed bath. This patient may not be able to initiate frequent moving in bed, so the nurse must intervene. The patient may have difficulty feeding self, so monitoring and assistance are indicated. This patient is not likely to tolerate walking. The patient will not be able to participate in weight-bearing exercises. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 27-3 Explain how heart failure is classified. MNL Learning Outcome: 4.3.1 Examine etiology, pathophysiology, clinical manifestations, and mechanisms to maintain perfusion. Page Number: 398 Question 30 Type: MCMA A patient says, “Ever since I changed jobs I just don’t feel as good. I think my heart medicine is not working.” What nursing assessment questions are priority? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “How well are you sleeping?” 2. “How did your new job change your work schedule?” 3. “How did your new job change your insurance coverage?” 4. “How has your job change affected your home life?” 5. “In what way do you not feel as well?” Correct Answer: 2,3,5 Rationale 1: Sleeping is always of concern but is not the highest priority in this assessment. Rationale 2: If the patient has had a change in work schedule, it may be that medications are being taken at a different time or at various times during the week. This would affect their efficacy. Rationale 3: If a change in insurance coverage has occurred, it may be that the brand of medication covered is changed. The patient who is doing well on one brand of medication should not change brands. Rationale 4: While this question may reveal information about stressors at home, it is not of the highest priority in this conversation. Rationale 5: The nurse’s first question should clarify what the patient means by not feel