12. A client has a blood pressure of 145/83 mm Hg and an ejection fraction of 50%. Before discharge from the hospital, the client will need instructions on taking which drug(s)?
12. A client has a blood pressure of 145/83 mm Hg and an ejection fraction of 50%. Before discharge from the hospital, the client will need instructions on taking which drug(s)?
. A thiazide diuretic.
. Digoxin and furosemide.
. A beta blocker and an ACE inhibitor.
. An anticoagulant.
Test-Taking Tip
The problem is with the pumping effectiveness of the heart. Select the option with the greatest effect on improving cardiac output and client survival.
Content Area: Adult Health, Cardiovascular; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Pharmacological and Parenteral Therapies/Medication Administration
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Answer 1 is incorrect because, although thiazide diuretics are often first-line therapy for hypertension, the heart failure is correctly managed with beta blockers and angiotensin-converting enzyme (ACE) inhibitors. Diuretics would be added only if there was insufficient clinical response to the other drugs. Answer 2 is incorrect because digoxin and furosemide, long considered the treatment of choice in heart failure, were found not to reduce mortality. Heart failure should be treated with beta blockers and/or ACE inhibitors. Answer 3 is correct because the ejection fraction is low, indicating a problem with cardiac output. The ejection fraction of a healthy heart is 60% to 70%. Beta blockers and ACE inhibitors reduce morbidity and mortality in heart failure. Answer 4 is incorrect because, although heart failure can increase the risk of thromboembolism, the usefulness of anticoagulation in clients without atrial fibrillation or a history of blood clots is not well established.