After receiving change-of-shift report on a heart failure unit, which client should the nurse assess first?

Client who is taking digoxin and has a potassium level of 3.1 mEq/L

Client who is taking captopril and has a frequent nonproductive cough

Client who is taking carvedilol (Coreg) and has a heart rate of 58

Client who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache

Answer and Explanation

The Correct Answer is D

The client taking isosorbide dinitrate/hydralazine (BiDil) and experiencing a headache should be assessed first. Isosorbide dinitrate/hydralazine is a medication combination used to treat heart failure, particularly in African American patients. However, one of the side effects of hydralazine is headaches.

Headache in a client taking this medication may indicate increased blood pressure as a compensatory response to vasodilation. If not addressed promptly, it may lead to worsening heart failure or other complications. Therefore, it is essential to assess the client's blood pressure, signs of worsening heart failure, and evaluate the severity and duration of the headache.

The other options may also require attention:

A) A client taking digoxin with a potassium level of 3.1 mEq/L needs assessment, as hypokalemia can increase the risk of digoxin toxicity. However, the headache in the BiDil client takes priority due to the potential complications related to increased blood pressure.

B) A client taking captopril and experiencing a frequent nonproductive cough may indicate a side effect of the medication. While it should be assessed, it is not as immediately concerning as the headache in the BiDil client.

C) A client taking carvedilol (Coreg) with a heart rate of 58 is within an acceptable range, especially if the client is tolerating it well without symptoms. It may not require immediate assessment unless there are other concerning symptoms.

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Correct Answer is B

Explanation

Hemodialysis is a treatment used to remove waste products and excess fluids from the blood in individuals with kidney failure or chronic kidney disease. The primary purpose of hemodialysis is to filter and clear the blood of waste products that the kidneys can no longer remove adequately. As a result, one of the key indicators that hemodialysis is having the desired effect is a decrease in serum creatinine levels. Creatinine is a waste product that builds up in the blood when the kidneys are not functioning properly. A decrease in serum creatinine indicates that the dialysis treatment is effectively removing waste products from the blood.

Weight loss is also a positive sign after hemodialysis since it indicates that excess fluid is being removed from the body. In individuals with kidney failure, the kidneys cannot adequately remove extra fluid, leading to fluid retention and weight gain. Hemodialysis helps to eliminate this excess fluid, leading to weight loss and reducing the risk of fluid overload-related complications.

The other options listed (decreased hematocrit and diuresis, increased potassium level and improved appetite, and decreased white blood cell count and diaphoresis) are not direct indicators of the effectiveness of hemodialysis in removing waste products and excess fluid from the blood.

A. Left-sided HF B. Right-sided HF C. Chronic heart failure (HF) D. Acute decompensated heart failure (ADHF)

Correct Answer is B

Explanation

The assessment findings of jugular venous distention, weight gain, peripheral edema, and a heart rate of 108/minute are consistent with right-sided heart failure (HF). Right-sided HF occurs when the right ventricle of the heart is unable to pump effectively, leading to congestion in the venous circulation. This can result in jugular venous distention (JVD) due to increased pressure in the jugular veins, peripheral edema due to fluid retention, and weight gain due to fluid accumulation.

Option A (Left-sided HF) may also present with similar symptoms like jugular venous distention, weight gain, and peripheral edema. However, in left-sided HF, there would typically be signs of pulmonary congestion, such as crackles in the lungs and shortness of breath.

Option C (Chronic heart failure) is a general term used for heart failure that has been present for an extended period, and it does not specify whether it is left-sided or right-sided heart failure.

Option D (Acute decompensated heart failure - ADHF) is a form of heart failure that presents with severe symptoms and requires urgent treatment. It is more of a clinical classification rather than a specific complication related to the symptoms mentioned in the scenario.

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After receiving change-of-shift report on a heart failure unit, which client should the nurse assess first?

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Naxlex Comprehensive Predictor Exams

Which assessment finding of a patient with chronic kidney disease indicates to the nurse that hemodialysis is having the desired effect?

Correct Answer is B

Explanation

The assessment findings of a patient with myocardial infarction (MI) include jugular venous distention, weight gain, peripheral edema, and a heart rate of 108/minute. The nurse suspects what complication?

Correct Answer is B

Explanation

The nurse recalls that which type of drug therapy is used to treat volume overload in patients with acute decompensated heart failure (ADHF)?

Which diagnostic test will be most useful to the nurse in determining whether a client admitted with acute shortness of breath has heart failure?

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The nurse teaches a student nurse about diagnostic studies used for acute coronary syndrome. Which statement made by the student nurse indicates effective learning?

The nurse identifies that a patient with chronic kidney disease is at risk for which electrolyte disturbance?

After receiving change-of-shift report on a heart failure unit, which client should the nurse assess first?

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