A patient with a history of chronic heart failure is admitted to ...

[mynx]

A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse do first?
 
  a. Auscultate the abdomen.
  b. Check the capillary refill.
  c. Auscultate the breath sounds.
  d. Assess the level of orientation.

Question 2

A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving?
 
  a. Furosemide (Lasix) 60 mg
  b. Captopril (Capoten) 25 mg
  c. Digoxin (Lanoxin) 0.125 mg
  d. Carvedilol (Coreg) 3.125 mg

[bitingbit]

Answer to Question 1

ANS: C
This patient's severe dyspnea and cough indicate that acute decompensated heart failure (ADHF) is occurring. ADHF usually manifests as pulmonary edema, which should be detected and treated immediately to prevent ongoing hypoxemia and cardiac/respiratory arrest. The other assessments will provide useful data about the patient's volume status and also should be accomplished rapidly, but detection (and treatment) of pulmonary complications is the priority.

Answer to Question 2

ANS: D
Although carvedilol is appropriate for the treatment of chronic heart failure, it is not used for patients with acute decompensated heart failure (ADHF) because of the risk of worsening the heart failure. The other medications are appropriate for the patient with ADHF.