45. Which teaching point is most important for a client star…
Questions
45. Which teаching pоint is mоst impоrtаnt for а client starting selegiline (Eldepryl) for Parkinson’s disease?
Mr. Jаmes, а 72-yeаr-оld male, presents tо the emergency department with increasing shоrtness of breath, fatigue, and confusion over the past two days. His daughter reports he’s been sleeping upright in a chair and has had noticeable swelling in his ankles. He has a history of congestive heart failure (CHF), atrial fibrillation, COPD, and hypertension. He takes furosemide, lisinopril, metoprolol, and albuterol PRN. 1. What initial clinical signs and symptoms indicate Mr. James may be experiencing decompensated heart failure with respiratory compromise? 2. Which of the following would be the priority assessment upon Mr. James’s arrival? A. Blood pressureB. Heart rateC. Oxygen saturationD. Temperature 3. Explain how congestive heart failure can lead to respiratory symptoms in Mr. James. 4. Mr. James has the following vital signs: BP: 144/86 HR: 112 (irregular) RR: 28 SpO₂: 88% on 2L NC Temp: 98.9°F Which order should the nurse implement first? A. Start IV furosemideB. Increase O₂ to 4L and elevate HOBC. Administer metoprololD. Request chest X-ray 5. Mr. James is ordered IV furosemide and metoprolol. What nursing assessments are essential before and after administering these medications? 6. Mr. James’s labs: BNP: 1,240 pg/mL K⁺: 3.0 mEq/L ABG: pH 7.33, PaCO₂ 48 mmHg, HCO₃ 28 Troponin: 0.02 ng/mL Which action is most appropriate? A. Begin CPRB. Notify provider and request potassium replacementC. Administer aspirinD. Restrict fluids completely 7. Mr. James becomes more confused and restless. His SpO₂ remains at 89% on 4L, and RR is 30/min.What 3 nursing actions are priorities at this stage? 8. True or false. Mr. James is a low fall risk at this stage of his acute illness. 9. Mr. James’s daughter asks, “Why did he get so confused?”What is the most accurate response? A. “He likely has an infection that is affecting his brain.”B. “Low oxygen levels can cause confusion, especially in older adults.”C. “This is common in people with high blood pressure.”D. “It’s probably just the stress of being in the hospital.” 10. Mr. James is prescribed the following medications at discharge: Furosemide 40 mg PO daily Lisinopril 10 mg PO daily Metoprolol 50 mg PO BID Apixaban 5 mg PO BID The nurse is reviewing the discharge medication list with him. Which statement by Mr. James requires follow-up for patient safety? A. “I may feel dizzy when I first stand up, especially with these medications, so rise slowly.”B. “Ill try to take my blood pressure before my morning meds and keep a log for my provider.”C. “If I miss a dose of my blood thinner, I can just take two pills the next time to catch up.”D. "I will call my doctor if I notice unusual bruising or dark-colored stools while on apixaban.” 11. At his follow-up appointment, Mr. James reports he has gained 4 pounds in 3 days, feels more short of breath when walking across the room, and notices increased swelling in his legs. Which nursing instruction is most important at this time? A. Reassure him that this is expected with age.B. Immediately report these findings to the provider for evaluation.C. Advise him to restrict all fluids until his next appointment.D. Instruct him to double his furosemide dose for the next two days.