NCLEX-RN
Cardiovascular System NCLEX RN Questions Questions
Extract:
The nurse is caring for a client who was admitted for an exacerbation of congestive heart failure.
• Click to highlight the findings in the nurses' note which indicate that the client is progressing towards discharge.
Nurses Notes
Day 1 - 0900 - The client was ambulated 25 feet and did not tolerate the ambulation reporting dyspnea. Gait was unsteady. Provided education on aerobic exercise and the benefits for heart failure.
Client verbally taught back the education with understanding.
Day 3 - 0915 - The client ambulated 30 feet in the hallway without assistance. Gait was steady. The oxygen saturation after ambulation was 95% on room air. Scheduled furosemide was refused by the client.
Educated the client on the purpose of the medication and its benefits.
Question 1 of 5
Click to highlight the findings in the nurses' note which indicate that the client is progressing towards discharge.
Correct Answer: C,D,E
Rationale: C: Correct - Education with client understanding indicates progress in self-management. D: Correct - Ambulating 30 feet without assistance and with steady gait shows improved physical tolerance. E: Correct - Oxygen saturation of 95% on room air post-ambulation indicates stable respiratory status. A, B, F: Incorrect - Dyspnea, unsteady gait, and medication refusal suggest ongoing issues, not progress toward discharge.
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Question 2 of 5
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Question 3 of 5
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Question 4 of 5
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Question 5 of 5
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