A client with heart failure is receiving digoxin (Lanoxin). Which finding indicates that the medication is effective?

Correct Answer: B

Rationale: The correct answer is B: Decreased pedal edema. Digoxin is a medication commonly used to treat heart failure by improving the heart's ability to pump effectively. As the medication helps to reduce fluid buildup in the body, a decrease in pedal edema (swelling in the feet and ankles) indicates that digoxin is effectively managing the client's heart failure. Increased heart rate (A) may indicate digoxin toxicity, elevated blood pressure (C) is not a typical indicator of digoxin effectiveness, and improved urine output (D) may be a result of diuretic therapy rather than specifically digoxin efficacy in heart failure management.

Correct Answer: B

Rationale: The correct answer is B: Lowered cholesterol levels. Atorvastatin is a statin medication used to lower cholesterol levels, reducing the risk of further cardiovascular events in patients with a history of MI. Lowering cholesterol helps prevent plaque buildup in arteries, reducing the likelihood of another MI. Increased blood pressure (A) and decreased heart rate (C) are not direct indicators of atorvastatin's effectiveness. Improved liver function (D) may be a consideration due to potential side effects, but the primary goal of atorvastatin is to lower cholesterol levels to prevent cardiovascular events.

Correct Answer: C

Rationale: The correct answer is C because the behavior exhibited by the resident may stem from touch deprivation rather than being intentional sexual harassment. Here's a step-by-step rationale: 1. Understanding the resident's age and environment (extended care facility) helps in interpreting his behavior. 2. The resident's actions suggest a need for touch, which is common in older adults who may lack physical contact. 3. Educating the resident on appropriate ways to express his need for touch can address the underlying issue. 4. Reassigning the UAP or reporting the incident as sexual harassment (options A and B) may not address the root cause of the behavior and could potentially harm the resident's well-being. In summary, choice C focuses on addressing the resident's potential touch deprivation in a compassionate and understanding manner, making it the best assessment of the situation.

Correct Answer: A

Rationale: The correct answer is A: Exercise in a swimming pool. This option is ideal for a 16-year-old with JRA because it provides a low-impact environment that helps strengthen muscles and improve joint mobility without putting excessive stress on the joints. Swimming also helps reduce pain and stiffness associated with JRA. Choice B (Splint affected joints during activity) is incorrect because splinting may restrict movement and hinder muscle strengthening. Choice C (Perform passive range of motion exercises twice daily) is not as effective as active exercises in improving muscle strength and joint mobility. Choice D (Begin a training program of lifting weights and running) can be too high-impact and may exacerbate joint inflammation and pain in individuals with JRA.

Correct Answer: B

Rationale: Step 1: Initiating short, frequent contacts with the client will promote trust by establishing a consistent and supportive presence. Step 2: This approach allows the nurse to build rapport and demonstrate genuine concern for the client's well-being. Step 3: Regular interactions can help the client feel understood and supported, leading to a more trusting relationship. Step 4: By maintaining frequent contact, the nurse can monitor the client's well-being and provide reassurance as needed. Step 5: This proactive approach fosters trust and a therapeutic alliance, enhancing the client's overall care experience.