Which topic will the nurse plan to include in discharge teaching ...

[go.lag]

Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 33?
 
  a. Need to begin an aerobic exercise program several times weekly
  b. Use of salt substitutes to replace table salt when cooking and at the table
  c. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
  d. Importance of making an annual appointment with the primary care provider

Question 2

The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective?
 
  a. Weight loss of 2 pounds in 24 hours
  b. Hourly urine output greater than 60 mL
  c. Reduction in patient complaints of chest pain
  d. Reduced dyspnea with the head of bed at 30 degrees

[31809pancho]

Answer to Question 1

ANS: C
The core measures for the treatment of heart failure established by The Joint Commission indicate that patients with an ejection fraction (EF) <40 receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise may not be appropriate for a patient with this level of heart failure, salt substitutes are not usually recommended because of the risk of hyperkalemia, and the patient will need to see the primary care provider more frequently than annually.

Answer to Question 2

ANS: D
Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees. The other assessment data also may indicate that diuresis or improvement in cardiac output has occurred, but are not as specific to evaluating this patient's response.