Which of the following is the most important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of heart failure (HF) in older adults?

Control fluid balance.

Control blood pressure.

Prevent deconditioning.

Maintain client safety.

Answer and Explanation

The Correct Answer is A

Choice A reason: Controlling fluid balance is the most important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of HF in older adults, as fluid overload is the main cause of HF worsening and hospital admission. Fluid balance can be controlled by monitoring weight, intake and output, edema, and lung sounds, and by administering diuretics, restricting sodium and fluid intake, and elevating the legs.

Choice B reason: Controlling blood pressure is an important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of HF in older adults, as hypertension is a risk factor and a complication of HF. However, it is not the most important goal, as blood pressure may not always reflect the fluid status or the severity of HF. Blood pressure can be controlled by administering antihypertensive medications, such as angiotensin-converting enzyme inhibitors, beta-blockers, or calcium channel blockers, and by encouraging lifestyle modifications, such as smoking cessation, weight management, and stress reduction.

Choice C reason: Preventing deconditioning is an important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of HF in older adults, as deconditioning is a common problem in HF patients due to reduced physical activity, fatigue, and muscle wasting. However, it is not the most important goal, as deconditioning may not directly affect the fluid balance or the cardiac function. Deconditioning can be prevented by providing exercise training, such as aerobic, resistance, or interval training, and by promoting self-care and adherence to the treatment regimen.

Choice D reason: Maintaining client safety is an important goal in the nursing plan of care to decrease the frequency of hospitalizations for acute exacerbations of HF in older adults, as HF patients are at risk of falls, injuries, infections, or adverse drug reactions. However, it is not the most important goal, as client safety may not specifically address the fluid balance or the cardiac function. Client safety can be maintained by providing a safe environment, such as removing clutter, providing adequate lighting, and using assistive devices, and by preventing complications, such as monitoring for signs of infection, bleeding, or electrolyte imbalance, and by educating the client and the family about the medications, the signs and symptoms of HF worsening, and the emergency measures.

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Correct Answer is A

Explanation

Choice A reason: Wearing well-fitting shoes is a good intervention for the older adult man to reduce his discomfort, as it can prevent pressure, friction, or injury to his feet, which can worsen the burning sensation. The nurse would advise the older adult man to choose shoes that are comfortable, supportive, and breathable, and to avoid shoes that are too tight, too loose, or have high heels or pointed toes.

Choice B reason: Soaking the feet in warm water is not a recommended intervention for the older adult man to reduce his discomfort, as it can dry out his skin, increase the risk of infection, or cause thermal injury if the water is too hot. The nurse would advise the older adult man to wash his feet daily with mild soap and lukewarm water, and to dry them thoroughly, especially between the toes.

Choice C reason: Applying antifungal powder on the feet is not a necessary intervention for the older adult man to reduce his discomfort, unless he has a fungal infection, such as athlete's foot, which can cause itching, burning, or cracking of the skin. The nurse would advise the older adult man to check his feet regularly for any signs of infection, such as redness, swelling, or pus, and to seek medical attention if he has any.

Choice D reason: Wearing knee-high nylon stockings is not a helpful intervention for the older adult man to reduce his discomfort, as it can impair his blood circulation, trap moisture, or irritate his skin. The nurse would advise the older adult man to wear socks that are made of cotton or wool, and to change them daily or whenever they are wet or dirty.

A. Constipation B. Poor liquid intake C. Diarrhea D. Poor solid food intake

Correct Answer is A

Explanation

Choice A reason: Constipation is the nurse's priority for preventive care, as it is a common and serious side effect of morphine and other opioids, which can slow down the bowel movements and cause hard, dry stools. The nurse would advise the older adult to increase their fiber and fluid intake, use stool softeners or laxatives as prescribed, and report any signs of bowel obstruction, such as abdominal pain, bloating, nausea, or vomiting.

Choice B reason: Poor liquid intake is not the nurse's priority for preventive care, as it is not directly related to the use of morphine, although it can contribute to constipation and dehydration. The nurse would advise the older adult to drink enough fluids, unless they have a fluid restriction, and to monitor their urine output, color, and specific gravity.

Choice C reason: Diarrhea is not the nurse's priority for preventive care, as it is not a common side effect of morphine, although it can occur in some cases due to an allergic reaction, intolerance, or overdose. The nurse would advise the older adult to report any episodes of diarrhea, as it can cause dehydration, electrolyte imbalance, or malabsorption.

Choice D reason: Poor solid food intake is not the nurse's priority for preventive care, as it is not directly related to the use of morphine, although it can affect the nutritional status and wound healing of the older adult. The nurse would advise the older adult to eat a balanced diet that meets their caloric and protein needs, and to avoid foods that can cause gas, indigestion, or constipation.

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