Author Question: A nurse is assessing a patient with heart failure. The patient complains of shortness of breath, and ... (Read 279 times)

ap345 · **on:** Jul 23, 2018

A nurse is assessing a patient with heart failure. The patient complains of shortness of breath, and the nurse auscultates crackles in both lungs. The nurse understands that these symptoms are the result of:

a. decreased force of ventricular contraction.
b. increased force of ventricular contraction.
c. decreased ventricular filling.
d. increased ventricular filling.

Question 2

A patient is taking a beta1-adrenergic drug to improve the stroke volume of the heart. The nurse caring for this patient knows that this drug acts by increasing:

a. cardiac afterload.
b. cardiac preload.
c. myocardial contractility.
d. venous return.

Question 3

While performing an admission assessment on a patient, the nurse learns that the patient is taking furosemide (Lasix), digoxin, and spironolactone (Aldactone). A diet history reveals the use of salt substitutes.

The patient is confused and dyspneic and complains of hand and foot tingling. Which is an appropriate nursing action for this patient?
a. Contact the provider to request orders for an electrocardiogram and serum electrolyte levels.
b. Evaluate the patient's urine output and request an order for intravenous potassium.
c. Hold the next dose of furosemide and request an order for intravenous magnesium sulfate.
d. Request an order for intravenous insulin to help this patient regulate extracellular potassium.

nickk12214 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: A
In the failing heart Starling's law breaks down, and the force of contraction no longer increases in proportion to the amount of ventricular filling. The result is the backup of blood into the lungs and the symptoms of shortness of breath and crackles caused by fluid. Increased ventricular contraction would not result in a backup of blood into the lungs. Changes in ventricular filling are not the direct cause of this symptom.

Answer to Question 2

How great was that.Thank you so much.

Answer to Question 3

ANS: A
This patient is taking a potassium-sparing diuretic and is ingesting dietary potassium in salt substitutes. The patient shows signs of hyperkalemia: confusion, shortness of breath, and tingling of the hands and feet. The cardiac effects can be fatal, especially if a patient also is taking digoxin. The most appropriate first action would be to obtain an ECG and serum electrolyte levels to evaluate the extent of the patient's hyperkalemia. The patient does not need increased potassium. Furosemide is a potassium-wasting diuretic and would be helpful. Magnesium sulfate is not indicated. Until the patient's status has been assessed further, intravenous insulin is not indicated.