NUR 211 COMPLETED EXAM QNS & ANS 20232024 (EXCELSIOR UNI), Exams of Nursing

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NUR 211

COMPLETED EXAM

QNS & ANS

1. As the RN caring for a client with heart failure, how would you evaluate the client’s physical assessment findings to determine if the client was experiencing left-sided heart failure, right-sided heart failure, or bi-ventricular failure? Right sided heart failure may be seen in the patient with symptoms of fatigue and gastrointestinal complaints. The patient would present with ascites, dependent and pitting edema, distended jugular veins, and spleen and liver enlargement. Left sided heart failure may be seen in the patient that presents with symptoms of confusion, restlessness, fatigue, orthopnea, exertional dyspnea, tachypnea, tachycardia, cyanosis, and pulmonary congestion. Biventricular heart failure may cause a patient to exhibit symptoms of dyspnea and edema, as both sides of the heart are affected. [ CITATION Hin18 \l 1033 ]
2. Heart failure is a chronic condition and client education is an essential component of quality, client-centered care. Formulate an interactive teaching plan, prioritizing the three most important topics for the client being discharged with heart failure. How will the RN evaluate the effectiveness of these medications? Looking at the concept map, what would your teachings be for this patient?
   • (Sample Answer Synopsis) - Heart failure is a serious condition that requires ongoing education and self-management. As a nurse, you can help your client learn how to cope with their condition and prevent complications. Here are some possible topics and strategies for your teaching plan:
     • Medications: Explain the purpose, dosage, frequency, and side effects of each medication that your client is prescribed. Emphasize the importance of taking them as

oxygen saturation should be assessed to ensure that the heart can pump enough blood/oxygen to the body tissues. The patient should be assessed for pulmonary congestion and adventitious breath sounds. The patient should be assessed for ascites. The patient will require ongoing monitoring to evaluate the effectiveness of medications. [ CITATION Lad20 \l 1033 ]

4. How will the RN evaluate the effectiveness of these medications? The effectiveness of a diuretic for a patient with right-sided heart failure will be reflected in a decrease in edema, decreased ascites, and weight loss. Vasodilators and ACE inhibitors will show effectiveness with improved ejection fraction, which is a measurement of how much blood is pumped out of the heart per heartbeat. Digoxin and inotropics will show effectiveness by showing improvement in heart pumping and blood flow, as these medications help improve myocardial contractility
5. Looking at the concept map, what would your teachings be for this patient? The patient should monitor their weight daily and check their weight at the same time every day. They should be advised to contact their provider if their weight gain exceeds 2 pounds in one day or 4 pounds in a week. The patient should be encouraged to follow a low-sodium diet. Salt causes the body to retain and store fluids. A fluid intake restriction may also be suggested to avoid edema. The patient should be encouraged to lose weight, as an

overweight patient’s heart must work harder to supply blood and oxygen to the rest of the body. The patient should be encouraged to quit smoking and limit alcohol intake. Smoking increases the patient’s risk of a heart attack and decreases the amount of oxygen that is supplied to the heart and the rest of the body. The patient should be encouraged to exercise regularly, as this can help improve fatigue, dyspnea, and can encourage the heart to strengthen so it pumps more efficiently. References Burchum, J. R. (2019). Lehne’s pharmacology for nursing care (10th ed.). St. Louis: Elsevier. Hinkle, J. &. (2018). Brunner and Suddarth’s textbook of medical-surgical nursing (14th ed.). Philadelphia: Wolters Kluwer Health.