Question

A nurse in provider's clinic is caring for a client who has heart failure.

First Clinic visti:
Client arrives to clinic with report of increasing shortness of breath, fatigue, and weakness. States they get short of breath with minimal activity.
Client is alert and oriented to person, place, and time. Moves all extremities well, follows simple commands.
Sinus tachycardia. Pulses to lower ectremities weak with +2 dependent edema present.
Slightly labored respirations at rest. Chest with wheezes and crackles in the bases. Reports productive cough, especially during the overnight hours.
Bowel sounds all present. Abdomen distended. Reports bowel movement this a.m.
States voiding without difficulty, clear yellow urine.
Teaching provided on nutrition therapy and adhering to a lo-sodium diet, monitoring fluid intake, and lifestyle changes for heart failure. Provided medication teaching following provider's increase in furosemide dosage from 20 mg to 40 mg daily. V.S. T 98 F, HR 106/min, R 26/min, BP 162/88 mm Hg, O2 sat 93% on room air, weight 185 lbs
Client will return in 2 weeks for f/u.

Second visit:
Client arrived for f/u visit 2 weeks later.
Client is alert and oriented to person, place, and time. Moves all extxremities well, follows simple commands.
Sinus rhythm. Pulses to lower extremities weak. +1 dependent edema present.
Respiration even. Chest clear. Reports less coughing.
Bowel sounds all present. Abdomen slightly distended. Reports last bowel movement previous evening.
Stat es voiding without difficulty, clear yellow urine. States urination has increased with encreased dose of furosemide. V.S. T 98 F, HR 86/min, R 22/min, BP 142/78 mm Hg, O2 sat 94% on room air, weight 180 lbs

A nurse is evaluating teaching for a client who has heart failure. Which of the following 3 statements by the client indicates an understanding of the teaching?
A) "I have been weighing myself every other morning"
B) "I am trying to decrease my intake of foods with potasium."
C) "I am limiting my sodium intake to 2 g daily."
D) "I am eating fewer potato chips and more fruit for snacks"
D) "I lie down and rest after meals"
E) "I know to call my doctor if I gain 3 lbs or more in 2 days"

Answer 1

The client shows an understanding of heart failure management by limiting sodium intake and knowing when to contact their doctor if they experience significant weight gain or signs of fluid overload.

Step-by-step explanation:

The client with heart failure has indicated an understanding of the teaching through several statements. The most relevant statements that reflect the client's comprehension include statement C) "I am limiting my sodium intake to 2 g daily," and statement E) "I know to call my doctor if I gain 3 lbs or more in 2 days." Contrarily, statement B) "I am trying to decrease my intake of foods with potassium," does not show an accurate understanding of their condition, as patients on diuretics like furosemide often need to maintain adequate potassium intake due to the risk of hypokalemia caused by increased urination.

Loop diuretics such as furosemide work by inhibiting sodium (Na+) and chloride (Cl−) reabsorption in the ascending limb of the loop of Henle, which leads to increased urine production as more sodium and water are excreted.