The nurse is caring for a client diagnosed with acute decompensated heart failure. The client is increasingly anxious and restless. The nurse should plan to implement which prescribed orders to assist in relieving these symptoms?

Dopamine and 50% non-rebreather mask

Nesiritide IV infusion and digoxin PO

Diazepam IV push and metoprolol IV

Morphine IV and oxygen 2 liters via nasal cannula

Answer and Explanation

The Correct Answer is D

A. Dopamine and 50% non-rebreather mask: Dopamine is a vasopressor used in hypotension or shock, an inotropic agent used to improve cardiac output, not typically first-line for anxiety or respiratory distress. A non-rebreather mask may provide high oxygen levels but can be overwhelming and exacerbate anxiety if not well tolerated.

B. Nesiritide IV infusion and digoxin PO: Nesiritide is a vasodilator which may reduce preload and afterload in heart failure, and digoxin is a positive inotrope that can improve contractility, but neither offers rapid relief for anxiety and dyspnea. These medications have slower onset and are not used primarily for symptom control in acute distress.

C. Diazepam IV push and metoprolol IV: While diazepam may reduce anxiety, it can depress respiration, which is dangerous in decompensated heart failure with potential pulmonary edema. Metoprolol reduces heart rate and contractility and must be used cautiously in acute settings.

D. Morphine IV and oxygen 2 liters via nasal cannula: Morphine reduces preload, anxiety, and the sensation of breathlessness, making it ideal in acute decompensated heart failure. Low-flow oxygen improves oxygenation without overwhelming the patient. This combination directly targets both physiologic and psychological distress.

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Correct Answer is A

Explanation

A. The TEE evaluates if emboli are present if cardioversion is required: A transesophageal echocardiogram (TEE) provides detailed imaging of the heart’s chambers, particularly the left atrium and left atrial appendage, where clots often form in atrial fibrillation. It is used to rule out thrombi before cardioversion to reduce the risk of stroke during the procedure.

B. The study will use electric current to stop the abnormal conduction pathway: This describes electrical cardioversion, not TEE. TEE is a diagnostic imaging procedure and does not involve the delivery of electrical currents to modify the heart's rhythm or conduction.

C. A TEE will help restore the client's underlying baseline normal rhythm: TEE does not treat arrhythmias. Its role is diagnostic—to visualize cardiac structures, not to restore normal rhythm. Cardioversion or pharmacologic agents are required to correct atrial fibrillation.

D. A TEE is required prior to implantable defibrillator placement in clients with atrial fibrillation: TEE is not routinely required before implantable cardioverter-defibrillator (ICD) placement. ICD decisions are usually based on ejection fraction, rhythm stability, and risk of sudden cardiac arrest, not the presence or absence of atrial thrombi.

Correct Answer is ["125"]

Explanation

Calculate the total volume to be infused in drops.

Total drops = Total volume (mL) × Drop factor (gtts/mL)

= 1000 mL × 60 gtts/mL

= 60000 gtts

Calculate the total infusion time in minutes.

Total infusion time (minutes) = Total hours × 60 minutes/hour

= 8 hours × 60 minutes/hour

= 480 minutes

Calculate the IV flow rate in drops per minute (gtts/min).

IV rate (gtts/min) = Total drops / Total infusion time (minutes)

= 60000 gtts / 480 minutes

= 125

=125 gtts/min

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The nurse is caring for a client diagnosed with acute decompensated heart failure. The client is increasingly anxious and restless. The nurse should plan to implement which prescribed orders to assist in relieving these symptoms?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is admitted with uncontrolled atrial fibrillation with a rate between 120's-130's. IV heparin therapy is prescribed. In addition, the nurse prepares the client for a transesophageal echocardiogram (TEE). What does the nurse understand about this diagnostic study?

Correct Answer is A

Explanation

A client is to receive LR 1000 ml over 8 hours. The IV tubing drop rate is 60 gtts/ml. What is the correct rate (gtts/min)? DOCUMENT ANSWER AS: RATE gtts/min (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["125"]

Explanation

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