NUR 242 MED/SURG EXAM 3| COMPLETE QUESTIONS WITH EXPERT
SOLUTIONS | 2026 LATEST UPDATED | GET A+
An older client with a history of congestive heart failure expresses concern about potential
exposure to tuberculosis (TB) from his or her roommate at the extended care facility. The
roommate coughs a great deal and sometimes spits up blood. Which is the primary reason that
the nurse pursues more information about the roommate? - (answer)TB adversely affects older
adults with chronic illness
When the clinic nurse is teaching a group of clients with heart failure (HF) about dietary
interventions to prevent fluid overload, which topic will be included? - (answer)Use of fresh or
frozen vegetables instead of canned ones / low sodium
Which action would the nurse take first when a client with heart failure has an episode of
paroxysmal nocturnal dyspnea (PND)? - (answer)Assist the client to sit on the edge of the bed
When caring for a client with a diagnosis of right ventricular heart failure, the nurse expects
which assessment findings? Select all that apply. One, some, or all responses may be correct. -
(answer)Dependent edema
Swollen hands and fingers
Right upper quadrant discomfort
The nurse's physical assessment of a client with heart failure reveals tachypnea and bilateral
crackles. Which is the priority nursing intervention? - (answer)Place client in a high-Fowler
position.
Which treatment would the nurse anticipate when caring for an infant with heart failure? -
(answer)Medications that are prescribed for both children and adults
Which feeding education would the nurse provide the parent of a 2-month-old infant with the
diagnosis of heart failure? - (answer)Feed slowly while allowing time for adequate periods of
rest
,Which assessment finding would indicate improvement in a 4-month-old infant admitted to the
pediatric unit with a diagnosis of congestive heart failure? - (answer)Weight loss during next 2
days
The parent of an infant with heart failure questions the necessity of weighing the baby every
morning. Which would the nurse say that this daily information is important in determining? -
(answer)fluid retention
While auscultating the heart, a health care provider notices S 3 heart sounds in four clients.
Which client is at highest risk for heart failure? - (answer)Older adult client
Which assessment finding is a late sign of heart failure? - (answer)Peripheral edema
Heart failure develops in a 4-month-old infant with a congenital heart defect, and the infant
exhibits marked dyspnea at rest. Which assessment finding would the nurse expect in this infant?
- (answer)Bilateral crackles
Which method would the nurse use to weigh a 2-month-old in heart failure with practitioner
orders for semi-Fowler positioning? - (answer)Placing the infant in an infant seat, recording the
weight, and then subtracting the weight of the seat
Which early sign of heart failure would the nurse recognize in an infant who has a congenital
heart defect with left-to-right shunting of blood? - (answer)Increased respiratory rate
A 2-month-old infant with the diagnosis of heart failure is discharged with a prescription for oral
digoxin 0.05 mg every 12 hours. The bottle of digoxin is labeled "0.05 mg/mL." Which item
would the nurse teach the mother to use when administering the medication? -
(answer)Calibrated syringe
,An infant with a diagnosis of heart failure is being given furosemide twice a day. Which
laboratory value would the nurse report to the health care provider? - (answer)Potassium of 3.0
mEq/L (3.0 mmol/L)
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. One, some, or all responses may be
correct. - (answer)Help the client ambulate when required.
Monitor the client's vitals every 30 minutes
Administer adequate oral fluids to the client
The nurse taught a client with heart failure who is scheduled for discharge about how
medications, diet, and exercise improve activity tolerance. During a follow-up visit, the nurse
finds that the client has learned how to adapt his or her exercise prescription to increase activity
tolerance. Which theory did the nurse follow to achieve this positive outcome? - (answer)Roy's
theory
Which intervention would the nurse use after observing that a 6-month-old child lies quietly,
rarely smiles or babbles, and has his basic needs barely met by the primary caregiver, who is a
grandparent with chronic heart failure? - (answer)Initiate a referral for assessment of home
health and schedule a family conference.
A client with heart failure weighed 175 lb (79.4 kg) yesterday, and today's weight is 181 lb (82.1
kg). How many milliliters of fluid has the client retained? . ___mL - (answer)2700 ml
An infant with a congenital heart defect is in heart failure and is receiving daily weight
measurements. Which complication of heart failure would daily weights help monitor? -
(answer)Fluid retention
Which intervention would the nurse implement for a 4-month-old infant with tetralogy of Fallot
and heart failure? - (answer)Providing small, frequent feedings
, The nurse provides teaching to a client who is being discharged after an acute exacerbation of
chronic obstructive pulmonary disease (COPD). The nurse would instruct the client to monitor
for which indication of right-sided heart failure? - (answer)Weight gain
When a client with heart failure reports frequent sudden waking during the night with shortness
of breath, how will the nurse document this finding? - (answer)Paroxysmal nocturnal dyspnea
The nurse explains to a pregnant client with a class II heart failure that in pregnancy the cardiac
system is most compromised during which time? - (answer)First 2 days after the birth
Which sign would indicate possible heart failure in a client with heart disease in the immediate
postpartum period? - (answer)Tachypnea
A client takes furosemide and digoxin for heart failure. Why would the nurse advise the client to
drink a glass of orange juice every day? - (answer)Maintaining potassium levels
A client takes furosemide and digoxin for heart failure. Why would the nurse advise the client to
drink a glass of orange juice every day? - (answer)Maintaining potassium levels
When a client with type 1 diabetes develops heart failure, digoxin is prescribed. Which nursing
action is important to include when planning care? - (answer)Monitor the client for cardiac
dysrhythmias.
A client with left ventricular heart failure and supraventricular tachycardia is prescribed digoxin
0.25 mg daily. Which changes would the nurse expect to find if this medication is therapeutically
effective? Select all that apply. One, some, or all responses may be correct. - (answer)Diuresis
Decreased edema
Decreased pulse rate
SOLUTIONS | 2026 LATEST UPDATED | GET A+
An older client with a history of congestive heart failure expresses concern about potential
exposure to tuberculosis (TB) from his or her roommate at the extended care facility. The
roommate coughs a great deal and sometimes spits up blood. Which is the primary reason that
the nurse pursues more information about the roommate? - (answer)TB adversely affects older
adults with chronic illness
When the clinic nurse is teaching a group of clients with heart failure (HF) about dietary
interventions to prevent fluid overload, which topic will be included? - (answer)Use of fresh or
frozen vegetables instead of canned ones / low sodium
Which action would the nurse take first when a client with heart failure has an episode of
paroxysmal nocturnal dyspnea (PND)? - (answer)Assist the client to sit on the edge of the bed
When caring for a client with a diagnosis of right ventricular heart failure, the nurse expects
which assessment findings? Select all that apply. One, some, or all responses may be correct. -
(answer)Dependent edema
Swollen hands and fingers
Right upper quadrant discomfort
The nurse's physical assessment of a client with heart failure reveals tachypnea and bilateral
crackles. Which is the priority nursing intervention? - (answer)Place client in a high-Fowler
position.
Which treatment would the nurse anticipate when caring for an infant with heart failure? -
(answer)Medications that are prescribed for both children and adults
Which feeding education would the nurse provide the parent of a 2-month-old infant with the
diagnosis of heart failure? - (answer)Feed slowly while allowing time for adequate periods of
rest
,Which assessment finding would indicate improvement in a 4-month-old infant admitted to the
pediatric unit with a diagnosis of congestive heart failure? - (answer)Weight loss during next 2
days
The parent of an infant with heart failure questions the necessity of weighing the baby every
morning. Which would the nurse say that this daily information is important in determining? -
(answer)fluid retention
While auscultating the heart, a health care provider notices S 3 heart sounds in four clients.
Which client is at highest risk for heart failure? - (answer)Older adult client
Which assessment finding is a late sign of heart failure? - (answer)Peripheral edema
Heart failure develops in a 4-month-old infant with a congenital heart defect, and the infant
exhibits marked dyspnea at rest. Which assessment finding would the nurse expect in this infant?
- (answer)Bilateral crackles
Which method would the nurse use to weigh a 2-month-old in heart failure with practitioner
orders for semi-Fowler positioning? - (answer)Placing the infant in an infant seat, recording the
weight, and then subtracting the weight of the seat
Which early sign of heart failure would the nurse recognize in an infant who has a congenital
heart defect with left-to-right shunting of blood? - (answer)Increased respiratory rate
A 2-month-old infant with the diagnosis of heart failure is discharged with a prescription for oral
digoxin 0.05 mg every 12 hours. The bottle of digoxin is labeled "0.05 mg/mL." Which item
would the nurse teach the mother to use when administering the medication? -
(answer)Calibrated syringe
,An infant with a diagnosis of heart failure is being given furosemide twice a day. Which
laboratory value would the nurse report to the health care provider? - (answer)Potassium of 3.0
mEq/L (3.0 mmol/L)
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. One, some, or all responses may be
correct. - (answer)Help the client ambulate when required.
Monitor the client's vitals every 30 minutes
Administer adequate oral fluids to the client
The nurse taught a client with heart failure who is scheduled for discharge about how
medications, diet, and exercise improve activity tolerance. During a follow-up visit, the nurse
finds that the client has learned how to adapt his or her exercise prescription to increase activity
tolerance. Which theory did the nurse follow to achieve this positive outcome? - (answer)Roy's
theory
Which intervention would the nurse use after observing that a 6-month-old child lies quietly,
rarely smiles or babbles, and has his basic needs barely met by the primary caregiver, who is a
grandparent with chronic heart failure? - (answer)Initiate a referral for assessment of home
health and schedule a family conference.
A client with heart failure weighed 175 lb (79.4 kg) yesterday, and today's weight is 181 lb (82.1
kg). How many milliliters of fluid has the client retained? . ___mL - (answer)2700 ml
An infant with a congenital heart defect is in heart failure and is receiving daily weight
measurements. Which complication of heart failure would daily weights help monitor? -
(answer)Fluid retention
Which intervention would the nurse implement for a 4-month-old infant with tetralogy of Fallot
and heart failure? - (answer)Providing small, frequent feedings
, The nurse provides teaching to a client who is being discharged after an acute exacerbation of
chronic obstructive pulmonary disease (COPD). The nurse would instruct the client to monitor
for which indication of right-sided heart failure? - (answer)Weight gain
When a client with heart failure reports frequent sudden waking during the night with shortness
of breath, how will the nurse document this finding? - (answer)Paroxysmal nocturnal dyspnea
The nurse explains to a pregnant client with a class II heart failure that in pregnancy the cardiac
system is most compromised during which time? - (answer)First 2 days after the birth
Which sign would indicate possible heart failure in a client with heart disease in the immediate
postpartum period? - (answer)Tachypnea
A client takes furosemide and digoxin for heart failure. Why would the nurse advise the client to
drink a glass of orange juice every day? - (answer)Maintaining potassium levels
A client takes furosemide and digoxin for heart failure. Why would the nurse advise the client to
drink a glass of orange juice every day? - (answer)Maintaining potassium levels
When a client with type 1 diabetes develops heart failure, digoxin is prescribed. Which nursing
action is important to include when planning care? - (answer)Monitor the client for cardiac
dysrhythmias.
A client with left ventricular heart failure and supraventricular tachycardia is prescribed digoxin
0.25 mg daily. Which changes would the nurse expect to find if this medication is therapeutically
effective? Select all that apply. One, some, or all responses may be correct. - (answer)Diuresis
Decreased edema
Decreased pulse rate
