A nurse is admitting a client who has acute heart fallure. Which of the following prescriptions from the provider should the nurse anticipate?

Ambulate the client every 4 hr while awake.

Infuse 0.9% sodium chloride 500 mL IV bolus over 1 hr.

Provide the client with a 4 g sodium diet.

Administer enalapril 2.5 mg PO twice daily.

Answer and Explanation

The Correct Answer is D

A.   Although activity is encouraged, clients with acute heart failure may require rest to minimize cardiac demand.
B.   Clients with acute heart failure typically need fluid restrictions, not boluses, which could exacerbate heart failure symptoms.
C.   A low-sodium diet is usually recommended for heart failure clients to help manage fluid retention, not a high-sodium diet.
D.   Enalapril is an ACE inhibitor often prescribed for clients with heart failure as it helps reduce blood pressure and decrease the workload on the heart.

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Correct Answer is A

Explanation

A. Encouraging the use of assistive devices like canes can help improve stability and prevent falls in individuals with multiple sclerosis who may experience balance issues. This statement promotes safety and independence in mobility.
B. While exercise is beneficial for individuals with multiple sclerosis, recommending a rigorous program may not be appropriate initially and could potentially exacerbate symptoms.
C. Hot baths can exacerbate symptoms in individuals with multiple sclerosis due to heat sensitivity, so this advice may not be suitable.
D. Scatter rugs can pose a tripping hazard, especially for individuals with mobility issues, so this statement is incorrect and may increase the risk of falls.

A. Encourage the client to lie down in a quiet room. B. Avoid eye contact with the client. C. Ask the client directly what he is hearing. D. Refer to the hallucinations as if they are real.

Correct Answer is C

Explanation

A. While rest and a quiet environment can be beneficial, encouraging the client to address the hallucinations directly is more appropriate.
B. Avoiding eye contact may be perceived as dismissive or unhelpful.

C. Engaging the client in open communication about their hallucinations can help build trust and rapport, as well as provide valuable information for treatment planning.
D. Validating hallucinations as real can reinforce delusional thinking and may not be therapeutically beneficial.

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A nurse is admitting a client who has acute heart fallure. Which of the following prescriptions from the provider should the nurse anticipate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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