A nurse is caring for a client with cardiomyopathy and is receiving a dobutamine drip. Which assessment finding indicates that the medication is effectively working?

Increased respiratory rate.

Decreased blood pressure.

Increased urine output.

Decreased blood glucose.

Answer and Explanation

The Correct Answer is C

A. Increased respiratory rate: An increased respiratory rate may indicate persistent heart failure, hypoxia, or worsening pulmonary congestion rather than improvement. Dobutamine is intended to enhance myocardial contractility and improve cardiac output, which should reduce compensatory tachypnea associated with poor perfusion.

B. Decreased blood pressure: Dobutamine is a beta-1 adrenergic agonist that increases myocardial contractility and stroke volume, typically improving cardiac output and supporting blood pressure. A decrease in blood pressure may indicate worsening cardiac function or excessive vasodilation, not effective therapy.

C. Increased urine output: Improved cardiac output enhances renal perfusion, leading to increased glomerular filtration rate and urine production. In clients with cardiomyopathy, low urine output often reflects poor forward flow. An increase in urine output suggests improved tissue perfusion and effective inotropic support.

D. Decreased blood glucose: Dobutamine does not directly lower blood glucose levels. Its primary action is to stimulate beta-1 receptors in the heart to increase contractility and cardiac output. Blood glucose changes are not used as indicators of therapeutic effectiveness for this medication.

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Correct Answer is B

Explanation

The dysrhythmia on the cardiac monitor is Atrial Fibrillation (AFib). Here is why:

Irregular Rhythm: In AFib, the atria are quivering (fibrillating) rather than contracting effectively. This leads to an "irregularly irregular" ventricular response. There is also no distinct P waves. The R-R intervals are variable
Pulse Deficit: This is the hallmark of AFib. It occurs when the heart contracts so rapidly or ineffectively that some beats don't pump enough blood to produce a palpable peripheral pulse. If you feel the radial pulse while listening to the apical heart sound, you’ll notice the apical rate is higher than the radial rate.
Sudden Palpitations and Dizziness: The loss of the "atrial kick" (which normally contributes about 20–30% of cardiac output) causes a sudden drop in blood pressure and oxygenation, leading to fatigue and lightheadedness.

A. A vein in the leg was used to bypass the coronary artery. B. A filter is inserted in the leg to prevent embolization. C. The arteries in the extremities are examined during surgery. D. This is the access site for the heart-lung machine.

Correct Answer is A

Explanation

A. A vein in the leg was used to bypass the coronary artery: During CABG surgery, the saphenous vein from the leg is commonly harvested to create a graft that bypasses blocked coronary arteries. The leg dressing protects the incision site, prevents infection, and promotes healing after vein harvesting.

B. A filter is inserted in the leg to prevent embolization: Inferior vena cava (IVC) filters are sometimes placed to prevent pulmonary embolism, but this is unrelated to CABG surgery. There is no routine filter insertion in the leg during bypass surgery.

C. The arteries in the extremities are examined during surgery: Although vascular assessment may occur, the leg is not routinely opened for examination of arteries during CABG. The incision is specifically for vein harvesting rather than diagnostic assessment.

D. This is the access site for the heart-lung machine: The heart-lung machine typically connects via central vessels such as the aorta and right atrium, not through the leg. The leg incision is unrelated to cardiopulmonary bypass access.

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A nurse is caring for a client with cardiomyopathy and is receiving a dobutamine drip. Which assessment finding indicates that the medication is effectively working?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is A

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