The nurse is admitting an older adult with decompensated ...

[vicotolentino]

The nurse is admitting an older adult with decompensated congestive heart failure. The nursing assessment reveals adventitious lung sounds, dyspnea, and orthopnea. The nurse should question which doctor's order?
 
  a. Intravenous (IV) 500 mL of 0.9 NaCl at 125 mL/hr
  b. Furosemide (Lasix) 20 mg PO now
  c. Oxygen via face mask at 8 L/min
  d. KCl 20 mEq PO two times per day

Question 2

An 8-year-old child is newly diagnosed with asthma. Which nursing intervention best promotes self-efficacy for the parents to help the child follow the prescribed treatments?
 
  a. Ask parents to list all possible triggers for asthma
  b. Requesting a spacer for the metered dose inhaler
  c. Suggest the parents enforce a strict exercise regimen
  d. Recommend replacing carpeting in the home with wood flooring

[cswans24]

Answer to Question 1

ANS: A
A patient with decompensated heart failure has extracellular fluid volume (ECV) excess. The IV of 0.9 NaCl is normal saline, which should be questioned because it would expand ECV and place an additional load on the failing heart. Diuretics such as furosemide are appropriate to decrease the ECV during heart failure. Increasing the potassium intake with KCl is appropriate, because furosemide increases potassium excretion. Oxygen administration is appropriate in this situation of near pulmonary edema from ECV excess.

Answer to Question 2

ANS: B
The most realistic and helpful interventions will promote self-management. A spacer is helpful for children learning to use inhaled medication. Listing all the triggers for asthma may be overwhelming. The parents should focus on the individual triggers for the child. Enforcing a strict exercise regimen is restrictive and will not promote self-management. Environmental changes must be feasible and cost-effective. Replacing carpeting is optimal but may not be affordable.

[vicotolentino]

TYSM

[bitingbit]

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