The nursing students are preparing a care plan for a patient with heart failure. The patient will be prescribed diuretic therapy after discharge. What evidence-based instructions will the nurse include in this plan?

Potassium supplements can cause irregular heart rhythm and must be avoided.

Instruct the patient to take diuretics at bedtime to promote diuresis during the night.

Notify the physician if weight increases by three pounds in one week.

Administer diuretics in the morning and notify physician of decreased urine output.

Answer and Explanation

The Correct Answer is C

Choice A reason: Potassium supplements can actually be important for patients on diuretic therapy, especially if they are taking loop diuretics like furosemide, which can cause potassium loss. However, it is important to monitor potassium levels and follow the physician's guidance on supplement use.

Choice B reason: Instructing the patient to take diuretics at bedtime is not recommended. Diuretics should be taken in the morning to avoid frequent urination during the night, which can disrupt sleep.

Choice C reason: Notifying the physician if weight increases by three pounds in one week is a key instruction for patients with heart failure. Rapid weight gain can indicate fluid retention and worsening heart failure, requiring prompt medical evaluation and adjustment of treatment.

Choice D reason: Administering diuretics in the morning and notifying the physician of decreased urine output is important, but the focus on notifying the physician about significant weight gain provides a more specific and actionable guideline for managing heart failure.

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Correct Answer is B

Explanation

Choice A reason: Starting with a rapid infusion rate to meet the patient's nutritional needs as quickly as possible is not recommended. Rapid infusion can cause complications such as fluid overload, hyperglycemia, and electrolyte imbalances. It is important to start TPN at a slow rate and gradually increase it as tolerated.

Choice B reason: Initiating the infusion slowly and monitoring the patient's fluid and glucose tolerance is the appropriate action. This allows the nurse to assess the patient's response to TPN, prevent complications, and make necessary adjustments to the infusion rate.

Choice C reason: Changing the rate of administration every 4 hours based on serum electrolyte values is not a standard practice. The rate should be adjusted based on the patient's overall tolerance and clinical condition, rather than frequent changes.

Choice D reason: Increasing the rate of infusion at mealtimes to mimic the circadian rhythm of the body is not appropriate for TPN. TPN is typically administered continuously over 24 hours to provide steady nutrition and prevent complications.

A. pH 7.30, PaCO2 59, HCO3 30 B. pH 7.50, PaCO2 30, HCO3 24 C. pH 7.48, PaCO2 42, HCO3 29 D. pH 7.33, PaCO2 34, HCO3 18

Correct Answer is A

Explanation

Choice A reason: The lab results pH 7.30, PaCO2 59, HCO3 30 indicate respiratory acidosis with partial compensation. This is a typical finding in patients with chronic obstructive pulmonary disease (COPD) due to chronic hypoventilation and CO2 retention. The elevated PaCO2 reflects respiratory acidosis, and the elevated HCO3 indicates renal compensation to maintain acid-base balance.

Choice B reason: The lab results pH 7.50, PaCO2 30, HCO3 24 indicate respiratory alkalosis. This is not typical for COPD, where respiratory acidosis is more common.

Choice C reason: The lab results pH 7.48, PaCO2 42, HCO3 29 indicate metabolic alkalosis with partial compensation, which is not consistent with the primary respiratory issues seen in COPD.

Choice D reason: The lab results pH 7.33, PaCO2 34, HCO3 18 indicate metabolic acidosis with partial compensation, which is not typical for COPD. COPD primarily causes respiratory acidosis due to CO2 retention.

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