During report the LPN is told that the patient has orthopnea due to valvular heart disease. The LPN expects to find the patient:
Laying in Trendelenburg position
Laying flat on their back
Laying in bed in semi-Fowler's position with multiple pillows under their head
Laying prone in the bed flat
The Correct Answer is C
A. Laying in Trendelenburg position: This position involves placing the head lower than the feet, which significantly increases venous return to the heart. In a patient with valvular disease, this extra volume would exacerbate pulmonary congestion and severely worsen respiratory distress. This position is strictly contraindicated for anyone experiencing orthopnea or congestive heart failure.
B. Laying flat on their back: A supine position allows fluid to redistribute from the lower extremities into the pulmonary circulation. This increase in preload overwhelms the failing heart's ability to pump, leading to acute shortness of breath. Patients with orthopnea cannot tolerate lying flat and will instinctively seek an upright position to breathe.
C. Laying in bed in semi-Fowler's position with multiple pillows under their head: Elevating the upper body uses gravity to keep fluid in the lower extremities and reduce the volume of blood returning to the heart. This decreases pulmonary capillary pressure and allows for better lung expansion and gas exchange. Using multiple pillows is a classic compensatory behavior for patients with valvular-induced heart failure.
D. Laying prone in the bed flat: The prone position restricts chest wall expansion and does not address the issue of fluid redistribution to the lungs. Lying flat in any orientation will trigger the sensation of breathlessness associated with orthopnea. Proper nursing care for these patients requires maintaining a high-Fowler's or semi-Fowler's position to optimize respiratory effort.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Obtain manual blood pressure: Assessing the hemodynamic status is the priority when a client reports a racing heartbeat and shortness of breath. An irregular rhythm following conversion of atrial fibrillation requires immediate validation of perfusion and blood pressure stability. Manual measurement provides the most accurate clinical data for determining the severity of the cardiovascular change.
B. Measure airflow via incentive spirometry: Incentive spirometry is used to prevent atelectasis and is not a diagnostic tool for acute shortness of breath or cardiac arrhythmias. It does not provide information regarding the underlying cause of the "racing heartbeat" or the irregular rhythm. Priority must be placed on cardiovascular assessment rather than routine respiratory exercises.
C. Insert indwelling urinary catheter: There is no immediate clinical indication for an invasive urinary catheter based on the client's current symptoms of palpitations and dyspnea. While monitoring output is important in heart failure, it is secondary to stabilizing the client's heart rate and rhythm. Catheterization poses an unnecessary infection risk in this acute assessment phase.
D. Assist the patient to get dressed to work with physical therapy: Engaging in physical exertion while experiencing tachycardia and shortness of breath is dangerous and contraindicated. The client's reports of a "racing heartbeat" and irregular rhythm indicate a potential relapse into atrial fibrillation with rapid response. Physical activity should be deferred until the client is hemodynamically stable.
Correct Answer is C
Explanation
A. "If I miss a dose of hy medication I can just double up the next day.": Doubling the dose of an anticoagulant like warfarin significantly increases the risk of life-threatening hemorrhage. Because warfarin has a narrow therapeutic index and a long half-life, sudden changes in dosing lead to unpredictable fluctuations in the INR. Patients should be instructed to take the missed dose as soon as remembered or skip it entirely as directed.
B. "I will eat broccoli and collard greens three times a week and I can have extra helpings to improve my iron intake.": Broccoli and collard greens are extremely rich in Vitamin K, which functions as the direct physiological antagonist to warfarin. Increasing the intake of these vegetables will lower the INR and render the anticoagulant therapy ineffective, increasing the risk of stroke. Patients must maintain a consistent, stable intake of Vitamin K rather than increasing it.
C. "I will need to get frequent blood work to check the INR level, that shows if this medication is at the right dose.": The International Normalized Ratio (INR) is the standardized laboratory measurement used to monitor the effectiveness of warfarin therapy. Regular testing is essential to ensure the patient remains within the target therapeutic range, usually between 2 and 3 for atrial fibrillation. This statement confirms the patient understands the necessity of ongoing clinical monitoring for safety.
D. "I should eat 1-2 bananas a day because this medication can cause me to loose potassium through my urine.": Warfarin does not affect renal tubular function or cause the excretion of electrolytes like potassium. This instruction is relevant for patients taking loop or thiazide diuretics, but it has no pharmacological basis for those on anticoagulant therapy. This statement indicates a confusion between the side effects of diuretics and those of vitamin K antagonists.
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