A client with mitral stenosis has now developed atrial fibrillation. Which drug would the nurse anticipate being ordered to manage this new condition?

a. Warm flushed extremities: In acute heart failure, there is typically inadequate cardiac output to perfuse the peripheral tissues adequately. This can lead to vasoconstriction and decreased blood flow to the extremities, resulting in cool and pale or mottled skin rather than warm flushed extremities.

b. Increased urine output: Acute heart failure is characterized by impaired cardiac function, which can lead to decreased cardiac output and reduced renal perfusion. This can result in decreased urine output rather than increased urine output. In acute heart failure, the kidneys may activate compensatory mechanisms such as the renin-angiotensin-aldosterone system, leading to sodium and water retention and decreased urine output.

c. Orthostatic hypotension: Orthostatic hypotension, a drop in blood pressure upon standing, is not typically associated with acute heart failure. Instead, acute heart failure is more commonly associated with signs and symptoms of fluid overload such as peripheral edema, pulmonary congestion, and jugular venous distension.

d. Decreased skin turgor: Decreased skin turgor is not a typical finding in acute heart failure. It is more commonly associated with dehydration or volume depletion rather than acute heart failure, which is characterized by fluid overload.

a. Warfarin: Warfarin is an anticoagulant medication used to prevent blood clot formation. While it is commonly prescribed for certain cardiac conditions such as atrial fibrillation or mechanical heart valves to prevent thromboembolic events, it does not directly improve the force of cardiac contraction. Therefore, warfarin is not the appropriate medication for improving cardiac contraction in a client with pulmonary edema.

b. Enalapril: Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used to manage hypertension and heart failure. While ACE inhibitors can help reduce preload and afterload on the heart, leading to improved cardiac function over time, they do not directly improve the force of cardiac contraction acutely. Therefore, enalapril is not the appropriate medication for improving cardiac contraction in a client with pulmonary edema.

c. Bumetanide: Bumetanide is a loop diuretic medication used to promote diuresis and reduce fluid overload in conditions such as heart failure and pulmonary edema. While reducing fluid overload can indirectly improve cardiac function by reducing preload on the heart, loop diuretics do not directly improve the force of cardiac contraction.

d. Dobutamine: Dobutamine is a positive inotropic medication that directly stimulates beta-1 adrenergic receptors in the heart, leading to increased myocardial contractility (force of cardiac contraction) and improved cardiac output. It is commonly used in the treatment of acute heart failure, including pulmonary edema, to enhance cardiac function and reduce symptoms of congestion.