Which of the following nursing interventions should a nurse perform when caring for a client with congestive heart failure who has decreased cardiac output?

Correct Answer: C

Rationale: In caring for a client with congestive heart failure and decreased cardiac output, it is crucial for nurses to prioritize interventions that support the patient's cardiovascular function. Option C, which is to assess the apical heart rate before administering digitalis, is the correct nursing intervention in this scenario. Digitalis is a medication commonly used to improve cardiac output in patients with heart failure. However, it can also slow down the heart rate and potentially cause adverse effects like bradycardia. Therefore, assessing the patient's heart rate prior to giving digitalis is essential to ensure that the medication is safe to administer at that time. Option A, encouraging activities that engage the Valsalva maneuver, is incorrect in this context. The Valsalva maneuver involves forced exhalation against a closed airway, which can lead to a sudden drop in blood pressure and potentially worsen cardiac output in a patient with heart failure. Option B, encouraging the client to perform exercises, may not be appropriate for a patient with congestive heart failure and decreased cardiac output. While exercise is generally beneficial for heart health, in this particular situation, the patient's cardiac output is already compromised, and engaging in physical activity without proper assessment and monitoring could be harmful. Option D, offering small, frequent feedings, is not directly related to addressing decreased cardiac output in a patient with congestive heart failure. While nutrition is important for overall health, it is not the priority intervention when managing a patient with a cardiac condition that impacts their cardiac output. In an educational context, understanding the rationale behind each nursing intervention is crucial for providing safe and effective care to patients with cardiovascular conditions. Nurses must be able to critically think through the implications of each option and choose the most appropriate intervention based on the patient's specific condition and needs. By knowing the effects of medications like digitalis and the potential complications of certain actions like the Valsalva maneuver, nurses can make informed decisions that promote positive outcomes for their patients.

Correct Answer: D

Rationale: The correct answer is option D: they have the right to refuse the medication and to withdraw from the study. This answer is correct because it upholds the patient's autonomy and right to make decisions about their own healthcare. In the context of research studies, it is crucial to respect the principle of informed consent, which includes the right to refuse treatment and withdraw from the study at any time without facing negative consequences. Option A is incorrect because while participation in research studies can contribute to improving patient outcomes, it should not override the patient's right to make decisions about their own care. Option B is incorrect as it disregards the patient's autonomy and fails to acknowledge their right to refuse treatment. Option C is incorrect because the primary investigator speaking with the patient does not change the fact that the patient ultimately has the right to refuse the medication. From an educational standpoint, it is essential for healthcare providers, especially those involved in research, to understand and respect the ethical principles of autonomy and informed consent. Upholding these principles not only ensures ethical conduct in research but also fosters trust and collaboration between patients and healthcare professionals. It is vital to empower patients to make informed decisions about their care, even in the context of research studies.

Correct Answer: C

Rationale: In assessing for intermittent claudication, the correct answer is C) Is the leg pain relieved by rest? This is because intermittent claudication is characterized by leg pain or cramping that occurs with activity and is relieved by rest. The pain is typically due to decreased blood flow to the muscles during exertion. Rest allows for the oxygen demand of the muscles to decrease, relieving the pain. Option A) Does shortness of breath accompany the leg pain? is incorrect because shortness of breath is more indicative of a cardiac or pulmonary issue rather than intermittent claudication, which is specifically related to blood flow to the legs during activity. Option B) Does this same type of pain occur without activity? is incorrect as intermittent claudication is specifically associated with pain during activity due to inadequate blood flow, not at rest. Option D) Is the leg pain relieved with elevation? is incorrect because elevation typically worsens symptoms of intermittent claudication by decreasing blood flow further to the affected area. Educationally, understanding the specific characteristics of intermittent claudication is crucial for healthcare providers, especially nurses, in accurately assessing and managing patients with peripheral arterial disease. Recognizing the pattern of pain associated with intermittent claudication can help in differentiating it from other causes of leg pain and guide appropriate interventions to improve patient outcomes.

Correct Answer: D

Rationale: High Systemic Vascular Resistance (SVR) can have significant implications on various organs, but the organ most likely to be damaged is the kidney. Rationale: - Correct Answer (D - Kidney): The kidneys receive a large portion of the cardiac output, and high SVR can lead to increased pressure within the renal vasculature. Prolonged high SVR can damage the delicate structures of the kidneys, impairing their function over time. - Incorrect Answers: A) Brain: While high SVR can affect cerebral perfusion, leading to conditions like hypertension and stroke, direct damage to the brain is less common compared to other organs like the kidneys. B) Heart: High SVR can lead to increased afterload on the heart, potentially causing conditions like left ventricular hypertrophy, but direct damage to the heart is not as immediate or severe as to the kidneys. C) Retina: High SVR can affect retinal blood flow and contribute to conditions like hypertensive retinopathy, but the kidneys are more vulnerable to sustained high SVR-induced damage. Educational Context: Understanding the impact of high SVR on different organs is crucial in cardiovascular physiology. It highlights the interplay between the cardiovascular system and vital organs, emphasizing the consequences of hemodynamic changes on organ function. This knowledge is essential in clinical practice to assess and manage conditions like hypertension and vascular diseases effectively.

Correct Answer: D

Rationale: In this scenario, patient D should be taught first about preventing coronary artery disease (CAD) because they are at the greatest risk based on their lipid profile results. Patient D has a total cholesterol of 250 mg/dL, triglycerides of 164 mg/dL, LDL of 172 mg/dL, and HDL of 32 mg/dL, which indicate elevated levels of LDL (bad cholesterol) and triglycerides, and low levels of HDL (good cholesterol), all of which are significant risk factors for CAD. Patients A, B, and C have more favorable lipid profiles compared to patient D. While patient C has higher total cholesterol and LDL levels, their HDL level is higher compared to patient D. Patients A and B have even better lipid profiles with lower total cholesterol, LDL, and triglycerides, and higher HDL levels compared to patient D. In an educational context, it is crucial for nurses to understand how to interpret lipid profile results and identify patients at higher risk for CAD. Teaching patients about lifestyle modifications, such as healthy diet, regular exercise, smoking cessation, and medication adherence, is essential in preventing CAD. Patient D requires immediate education and intervention to address their elevated risk factors and reduce the likelihood of developing CAD.