The client diagnosed with acute heart failure is prescribed an infusion of dopamine at a low dose. Which assessment parameter should the nurse use to best evaluate the effectiveness of this medication?

Urine output has increased from 30 mL to 50 mL per hour

Blood pressure decreased from 140/80 to 90/50

Heart rate has increased from 80 to 110 beats per minute

Client is awake, alert and oriented to time, place and person

Answer and Explanation

The Correct Answer is A

A.   Dopamine at low doses primarily increases renal perfusion, which can lead to improved urine output. An increase in urine output is a key indicator that the medication is effectively improving kidney function and blood flow. This is the most direct way to assess its effectiveness.
B.   A decrease in blood pressure is not an expected effect of low-dose dopamine, which should actually help improve perfusion and raise blood pressure.
C.   An increase in heart rate is more likely with higher doses of dopamine and is not an optimal indicator of the drug's effectiveness for acute heart failure.
D.   Client alertness is important but does not directly reflect the primary effects of dopamine on renal perfusion and cardiac output in acute heart failure.

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Correct Answer is A

Explanation

A. This question assesses the client's level of orthopnea, which is a condition where the client experiences difficulty breathing when lying flat. People with heart failure may need to use multiple pillows to prop themselves up to breathe more easily at night, making it an important question to assess respiratory status.
B. Chest pain with exertion can be indicative of cardiovascular issues but this question does not directly assess the client's respiratory status.
C. Tight rings and shoes can indicate fluid retention and edema, but it does not provide specific information about respiratory status.
D. Frequent nighttime voiding (nocturia) is common in heart failure, but it relates more to kidney function and fluid retention rather than respiratory function.

A. Marked limitation with physical activity but comfortable at rest B. Angioedema and urticaria C. Increased urine output D. Chest pain during sleep that is relieved with nitroglycerin

Correct Answer is A

Explanation

A. Clients with left-sided heart failure often experience symptoms like shortness of breath, fatigue, and fluid retention, which limit physical activity. However, they may still feel relatively comfortable when resting.
B. These symptoms are more commonly associated with allergic reactions or side effects of medications (such as ACE inhibitors) rather than heart failure.
C. This is not typical in the later stages of left-sided heart failure. In fact, clients may experience reduced urine output due to poor kidney perfusion.
D. Chest pain can occur due to ischemia, but this is not a hallmark symptom of left-sided heart failure, which is more characterized by dyspnea and fatigue.

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The client diagnosed with acute heart failure is prescribed an infusion of dopamine at a low dose. Which assessment parameter should the nurse use to best evaluate the effectiveness of this medication?

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