1. A client with congestive heart failure is receiving intravenous digoxin (Cardoxin) therapy. The registered nurse identifies that which items on the client’s care plan are appropriate for a licensed practical nurse (LPN) to perform? Select all that apply. Correct2 Monitor the client’s vitals every 30 minutes. Correct3 Administer adequate oral fluids to the client. 4 Prepare the nursing diagnosis after assessing the client. 5 Administer the digoxin (Cardoxin) if the client has chest pain.

To provide safe care, the nurse should act within the scope of practice and certification. The licensed practice nurse (LPN) can monitor the vitals, ambulate the client, and administer oral fluids to prevent dehydration. The LPN cannot administer medications intravenously and cannot formulate nursing diagnosis; therefore, these two actions do not fall within the scope of the LPN’s practice. Maintaining adequate gas exchange and minimizing hypoxia with pulmonary edema are critical; therefore, assessing the effectiveness of furosemide therapy as it relates to the respiratory system is most important. Furosemide inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule, causing diuresis; as diuresis occurs fluid moves out of the vascular compartment, thereby reducing pulmonary edema and the bilateral crackles. Although a liter of fluid weighs approximately 2.2 pounds (1 kilogram) and weight loss will reflect the amount of fluid lost, it will take time before a change in weight can be measured. Although identifying a greater output versus intake indicates the effectiveness of furosemide, it is the client's pulmonary status that is most important with acute pulmonary edema. Although the lessening of a client's dependent edema reflects effectiveness of furosemide therapy, it is the client's improving pulmonary status that is most important. Unusual fatigue is attributed to inadequate perfusion of body tissues because of decreased cardiac output in response to cardiac ischemia; women more commonly report unusual fatigue than men. Dependent edema occurs with right ventricular failure because of hypervolemia. Dyspnea at night, which usually requires the assumption of the orthopneic position, is a sign of left ventricular failure. Orthopnea, a compensatory mechanism, limits venous return, which decreases pulmonary congestion and promotes ventilation, easing the Multi-System (heart/vent) EXAM 2023-2024 ACCURATE SUMMER FALL EXAM GENUINE EXAM 1. A client with congestive heart failure is receiving intravenous digoxin (Cardoxin) therapy. The registered nurse identifies that which items on the client’s care plan are appropriate for a licensed practical nurse (LPN) to perform? Select all that apply. Correct2 Monitor the client’s vitals every 30 minutes. Correct3 Administer adequate oral fluids to the client. 4 Prepare the nursing diagnosis after assessing the client. 5 Administer the digoxin (Cardoxin) if the client has chest pain. 2. A client is admitted to the hospital with a diagnosis of heart failure and acute pulmonary edema. The healthcare provider prescribes furosemide 40 mg intravenous (IV) stat to be repeated in 1 hour. What nursing action will best evaluate the effectiveness of the furosemide in managing the client’s condition? 1 Perform daily weights Correct2 Auscultate breath sounds 3 Monitor intake and output 4 Assess for dependent edema