A client with heart failure is receiving intravenous furosemide (Lasix). Which assessment finding indicates that the medication is having the desired effect?

Correct Answer: A

Rationale: The correct answer is A: Decreased peripheral edema. Furosemide is a diuretic that helps to remove excess fluid from the body, which can reduce peripheral edema in patients with heart failure. This indicates that the medication is effectively reducing fluid overload in the body. Elevated blood pressure (choice B) would not be an expected outcome of furosemide use. Increased heart rate (choice C) is not a direct effect of furosemide and can indicate worsening heart failure. Decreased urine output (choice D) would be an adverse effect of furosemide and would indicate the medication is not working as intended.

Correct Answer: B

Rationale: The correct answer is B: Infection. Prednisone is a corticosteroid that suppresses the immune system, increasing the risk of infections in patients. The nurse should monitor for signs of infection such as fever, increased white blood cell count, and localized symptoms. Rationale: A: Hypoglycemia is not a common side effect of prednisone. Prednisone typically causes hyperglycemia. C: Hypotension is not a common side effect of prednisone. Prednisone can actually cause fluid retention and increased blood pressure. D: Weight loss is not a common side effect of prednisone. Prednisone can actually cause weight gain due to fluid retention and increased appetite.

Correct Answer: B

Rationale: The correct answer is B: Diminished cough effort. In myasthenia gravis, muscle weakness can affect the respiratory muscles, leading to ineffective coughing and clearance of airways. Diminished cough effort can result in ineffective airway clearance, putting the client at high risk for respiratory complications. A: Pain when coughing is not the primary etiology for ineffective airway clearance in myasthenia gravis. C: Thick, dry secretions may contribute to airway clearance issues but are not the most likely etiology compared to diminished cough effort. D: Excessive inflammation is not typically associated with ineffective airway clearance in myasthenia gravis.

Correct Answer: B

Rationale: The correct answer is B because it violates patient confidentiality. Reading a client's history and physical in a public area breaches the client's privacy rights. The other choices do not directly compromise patient confidentiality. A involves discussing a cure for AIDS, which is not a breach of confidentiality. C involves sharing personal experiences with the client, and D involves discussing a client's history of drug abuse in a visitor's lounge, which may not be overheard by the client or staff directly involved in the client's care.

Correct Answer: A

Rationale: The correct answer is A: Remove the glass of water and speak to the UAP. The rationale is as follows: 1) Drinking water with low intermittent suction can cause complications. 2) Immediate action is necessary to prevent harm. 3) Speaking to the UAP clarifies the situation and provides education. 4) Removing the glass of water ensures the client's safety. Incorrect choices: B: Discussing at the end of the day delays action and puts the client at risk. C: Writing an incident report is important, but immediate intervention is needed first. D: Reminding the client of electrolyte imbalance does not address the current issue of drinking water with a nasogastric tube.