A home health nurse is teaching a client who has heart failure. Which of the following responses should the nurse identify as an indication that the client understands the teaching?

Answer:

• Metoprolol 15 mg IV bolus: Metoprolol is a beta-blocker used to manage tachycardia and irregular heart rhythms in myocardial infarction (MI), which aligns with this patient's symptoms.
• Oxygen at 2 L/min via nasal cannula: Oxygen should be administered to improve oxygenation, as the client’s oxygen saturation is 93%, which is slightly low and suggests inadequate oxygenation.
• Draw electrolytes along with Hgb and Hct: Due to medications affecting electrolytes (like beta-blockers), and the risk of arrhythmias, monitoring electrolytes is crucial. Hgb and Hct are important to assess for anemia, which could worsen myocardial ischemia, and to establish a baseline in case of bleeding complications from antiplatelet or anticoagulant therapies.
• Morphine 6 mg IV bolus every 3 hr as needed for pain: Morphine is used for pain relief in acute MI, reducing myocardial oxygen demand and alleviating pain, which is crucial for this patient with severe chest pain.
• Nitroglycerin 0.5 mg SL now may repeat every 5 min up to 3 doses: Nitroglycerin helps relieve chest pain in MI by reducing myocardial oxygen demand, making it appropriate for this patient's symptoms.
• Obtain daily weight: While important for monitoring fluid status in heart failure, obtaining daily weight is not an immediate priority during the acute phase of suspected MI.
• Atropine 0.5 mg IV bolus every 5 min up to 2 mg if heart rate drops below 60: Atropine is used for bradycardia, but this patient has tachycardia (110/min), so atropine would worsen the heart rate and is not appropriate in this case.

Rationale:

A. "I have a nagging, dry cough." A dry cough is a well-known adverse effect of lisinopril and other ACE inhibitors. This occurs in some clients due to the accumulation of bradykinin and can be bothersome enough to require discontinuation of the medication.

B. "I have a heightened sense of taste." A heightened sense of taste is not a common side effect of lisinopril. It is not an indication of an adverse effect and may be unrelated to the medication.

C. "I have to urinate frequently." Frequent urination is not a typical side effect of lisinopril. However, it could be related to other conditions such as a urinary tract infection or diabetes, and it is not commonly associated with ACE inhibitors.

D. "I seem to be bruising more easily." Easy bruising is more commonly associated with medications like anticoagulants or antiplatelets, rather than lisinopril. While bruising is possible, it is not a primary concern with ACE inhibitors.