The nursing instructor is discussing heart failure during post-conference. Which statement by the student confirms their understanding of a contributing factor to a patient's increased risk for developing heart failure?

"Young people do not have to worry about heart failure, just older people."

"Progressive kidney failure contributes to the development and severity of heart failure."

"The elderly patient used cocaine as a teenager and complains of occasional anxiety."

"The patient takes 20mg of losartan every day and their potassium level is 3.8 mEq/L."

Answer and Explanation

The Correct Answer is B

Choice A reason: The statement that young people do not have to worry about heart failure, just older people, is incorrect. While heart failure is more common in older adults, it can occur at any age, particularly in individuals with underlying health conditions or risk factors.

Choice B reason: Progressive kidney failure contributes to the development and severity of heart failure. Kidney function and heart function are closely related. When the kidneys are not working properly, they can contribute to fluid retention, increased blood pressure, and additional strain on the heart, leading to heart failure.

Choice C reason: The elderly patient using cocaine as a teenager and complaining of occasional anxiety is less relevant to the immediate risk factors for developing heart failure. While past cocaine use can have long-term cardiovascular effects, occasional anxiety is not a significant contributing factor to heart failure.

Choice D reason: The patient taking 20mg of losartan every day and having a potassium level of 3.8 mEq/L is relevant to managing their heart condition but does not directly address the development of heart failure. Losartan is a medication used to manage blood pressure and heart failure, and the potassium level is within the normal range.

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Correct Answer is A

Explanation

Choice A reason: Administering intravenous normal saline at 300 mL/hour is the appropriate initial intervention for a patient presenting with a hyperglycemic emergency. Fluid replacement is crucial to correct dehydration and improve circulatory volume, which will help improve renal perfusion and facilitate the excretion of excess glucose and ketones.

Choice B reason: Administering regular insulin 20 units subcutaneously is not the immediate priority. Intravenous insulin is preferred in a hyperglycemic emergency to ensure rapid and effective lowering of blood glucose levels.

Choice C reason: Starting a bicarbonate infusion intravenously is not indicated unless there is severe acidosis (pH < 7.0) or the patient is in shock. The pH of 7.20, while low, can typically be corrected with fluid and insulin therapy.

Choice D reason: Administering potassium chloride 40 mEq orally is not necessary at this point. The potassium level of 3.6 mEq/L is within the normal range, and potassium should be monitored and replaced as needed during ongoing treatment, especially when insulin therapy is initiated.

A. Advise the patient to consume protein and carbohydrates immediately. B. Notify the provider of the result and recommend that the patient's insulin dose be increased. C. Instruct the patient to withhold the next scheduled dose of insulin. D. Suggest that the patient asks their provider to start them on metformin therapy.

Correct Answer is B

Explanation

Choice A reason: Advising the patient to consume protein and carbohydrates immediately is not appropriate in this context. The presence of ketones in the urine indicates that the body is using fat for energy due to a lack of insulin. Increasing carbohydrate intake without addressing the underlying insulin deficiency can worsen hyperglycemia and ketoacidosis.

Choice B reason: Notifying the provider of the result and recommending that the patient's insulin dose be increased is the appropriate intervention. The presence of ketones in the urine indicates inadequate insulin levels, and adjusting the insulin dose can help correct the metabolic imbalance and prevent further complications such as diabetic ketoacidosis.

Choice C reason: Instructing the patient to withhold the next scheduled dose of insulin is incorrect. Insulin is essential for managing blood glucose levels and preventing ketosis in patients with type 1 diabetes. Withholding insulin can lead to severe hyperglycemia and ketoacidosis.

Choice D reason: Suggesting that the patient ask their provider to start them on metformin therapy is not appropriate for type 1 diabetes. Metformin is used primarily for type 2 diabetes and is not effective in type 1 diabetes, where insulin is required for glucose management.

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The nursing instructor is discussing heart failure during post-conference. Which statement by the student confirms their understanding of a contributing factor to a patient's increased risk for developing heart failure?

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