Ch 35 IGGY and Mosbys

The nurse is reviewing the laboratory results for a patient whose chief complaint is dyspnea. Which diagnostic test best differentiates between heart failure and lung dysfunction? a. Arterial blood gas b. B- type natriuretic peptide c. Hemoglobin and hematocrit d. Serum electrolytes

B

The surgical noninvasive intervention of a balloon valvuloplasty is often used for which type of patient? a. Young adults with a genetic valve defect b. Older adults who are nonsurgical candidates c. Adults whose open-heart surgery failed d. Older adults who need replacement valves

B

What is the common treatment for rheumatic carditis? a. Pericardiocentesis b. Antibiotics for 10 days c. Pain medication for substernal pain control d. Rest with observation for further necessary treatment

B

What is the definitive treatment for a patient with chronic constrictive pericarditis? a. Antibiotic therapy b. Surgical excision of the pericardium c. Administration of beta blockers and cortico steroids d. Pericardiocentesis

B

What is the expected outcome for the collaborative problem potential for pulmonary edema? a. No dysrhythmias b. Clear lung sounds c. Less fatigue d. No disorientation

B

When is B-type natriuretic peptide (BNP) produced and released for a patient with heart failure? a. When a patient has an enlarged liver b. When a patient has fluid overload c. When a patient's ejection fraction is lower than normal d. When a patient has ventricular hypertrophy

B

Which treatment intervention applies to a patient with infective endocarditis? a. Administration of oral penicillin for 6 weeks or more b. Hospitalization for initial IV antibiotics, possibly with a central line c. Complete bedrest for the duration of treatment d. Long-term anticoagulation therapy with heparin

B

The nurse identifies a priority problem of fatigue and weakness for the patient with heart failure. After ambulating 200 feet down the hall, the patient's blood pressure change is more than 20 mm Hg. How does the nurse interpret this data? a. The patient is building endurance. b. The activity is too stressful. c. The patient could walk farther. d. The activity is appropriate.

B . The activity is too stressful

The patient has endocarditis. Which findings does the nurse expect when assessing this patient? (Select all that apply.) a. Pericardial friction rub b. Osler's nodes c. Petechiae d. A new regurgitant murmur e. Grating pain that is aggravated by breathing

B, C, D

Which characteristic describes mitral valve prolapse? (Select all that apply.) a. Hepatomegaly is a late sign. b. Leaflets enlarge and fall back into left atrium during systole. c. Most patients are asymptomatic. d. Patients have normal heart rate and blood pressure. e. Mitral valve prolapse is becoming a disorder of aging populations.

B, C, D

A patient comes to the ED extremely anxious, tachycardic, struggling for air, and with a moist cough productive of frothy, blood-tinged sputum. What is the priority nursing intervention? a. Apply a pulse oximeter and cardiac monitor. b. Administer high-flow oxygen therapy via facemask. c. Prepare for continuous positive airway pressure ventilation. d. Prepare for intubation and mechanical ventilation.

B. Administer high-flow oxygen therapy via facemask

Which type of cardiomyopathy results from replacement of myocardial tissue with fibrous and fatty tissue? a. Hypertrophic cardiomyopathy b. Arrhythmogenic right ventricular cardiomyopathy c. Dilated cardiomyopathy d. Restrictive cardiomyopathy

B. Arrhythmogenic right ventricular cardiomyopathy

The nurse hears in report that a patient has been diagnosed with mitral insufficiency. Which early symptom is most likely to be first reported by the patient? a. Atypical chest pain b. Chronic weakness c. Anxiety d. Dyspnea

B. Chronic weakness

In what way does arterial embolization to the brain manifest itself in a patient with infective endocarditis? a. Dysarthria b. Dysphagia c. Atelectasis d. Electrolyte imbalances

B. Dysphagia

A patient is prescribed bumetanide (Bumex).What is an important teaching point for the nurse to include about this medication? a. Caution to move slowly when changing positions, especially from lying to sitting b. Information about potassium-rich foods to include in the diet c. Written instructions on how to count the radial pulse rate d. Information about low-sodium diets and reading food labels for sodium content

B. Information about potassium-rich foods to include in the diet

The nurse is assessing a patient with pericarditis. In order to hear a pericardial friction rub, which technique does the nurse use? a. Place the diaphragm at the apex of the heart. b. Place the diaphragm at the left lower sternal border. c. Place the bell just below the left clavicle. d. Place the bell at several points while the patient holds his or her breath.

B. Place the diaphragm at the left lower sternal border

A patient has received a heart transplant for dilated cardiomyopathy. Because the patient has a high risk for cardiac tamponade, of which sign/symptoms does the nurse immediately notify the provider? a. Crackles and wheezes of the lungs b. Pulsus paradoxus and muffled heart sounds c. Hepatomegaly and ascites d. Dependent edema and fluid retention

B. Pulsus paradoxus and muffled heart sounds

Which characteristics describe mitral valve stenosis? (Select all that apply.) a. Classic signs of dyspnea, angina, and syncope b. Rumbling apical diastolic murmur c. S3 often present due to severe regurgitation d. Right-sided failure results in neck vein distention e. The patient may experience palpitations while lying on left side

B. Rumbling apical diastolic murmur D. Right-sided heart failure results in neck vein distention

The nurse is reviewing the ECG of a patient admitted for acute pericarditis. Which ECG change does the nurse anticipate? a. Normal ECG b. ST-T spiking c. Peaked T waves d. Wide QRS complexes

B. ST-T spiking

A patient is prescribed diuretics for treatment of heart failure. Because of this therapy, the nurse pays particular attention to which laboratory test level? a. Peak and trough of medication b. Serum potassium c. Serum sodium d. Prothrombin time (PT) and partial thromboplastin time (PTT)

B. Serum potassium

The nurse is giving discharge instructions to a patient who had valve surgery. Which home care instructions does the nurse include in the teaching plan? (Select all that apply.) a. Increase consumption of foods high in vitamin K. b. Use an electric razor to avoid skin cuts. c. Report any bleeding or excessive bruising. d. Watch for and report any fever, drainage, or redness at the site. e. Avoid heavy lifting for 3 to 6 months. f. Report dyspnea, syncope, dizziness, edema, and palpitations.

B. Use an electric razor to avoid skin cuts C. Report any bleeding or excessive bruising D. Watch for and report any fever, drainage, or redness at the site E. Avoid heavy lifting for 3-6 months F. Report dyspnea, syncope, dizziness, edema, and palpitations

A patient with aortic valve endocarditis reports fatigue and shortness of breath. Crackles are heard on lung auscultation. What do these assessment findings most likely indicate? a. Emboli to the lung b. Valve incompetence resulting in heart failure c. Valve stenosis resulting in increased chamber size d. Coronary artery disease

B. Valve incompetence resulting in heart failure

Long-term anticoagulant therapy for a patient with valvular heart disease and chronic atrial fibrillation includes which drug? a. Heparin sodium b. Warfarin sodium (Coumadin) c. Diltiazem (Cardizem) d. Enoxaparin (Lovenox)

B. Warfarin Sodium (Coumadin)

A patient has recently been diagnosed with acute heart failure. Which medication order does the nurse question? a. Dobutamine (Dobutrex), a beta-adrenergic agonist b. Milrinone (Primacor), a phosphodiesterase inhibitor c. Levosimendan (Simdax), a positive inotropic d. Carvedilol (Coreg), a beta blocker

D. Carvedilol (Coreg), a beta blocker

What is the most common preventable cause of valvular heart disease? a. Congenital disease or malformation b. Calcium deposits and thrombus formation c. Beta-hemolytic streptococcal infection d. Hypertension or Marfan syndrome

C

Which definition best describes left-sided heart failure? a. Increased volume and pressure develop and result in peripheral edema. b. Can occur when cardiac output remains normal or above normal. c. Decreased tissue perfusion from poor cardiac output and pulmonary congestion from increased pressure in the pulmonary vessels. d. Percentage of blood ejected from the heart during systole.

C

Which patient is at greatest risk for developing viral pericarditis? a. 35-year-old woman with tuberculosis b. 45-year-old man who has had radiation therapy for lung cancer c. 30-year-old man with a respiratory infection d. 50-year-old woman with chest trauma

C

The nurse is teaching a patient with heart failure about signs and symptoms that suggest a return or worsening of heart failure. What does the nurse include in the teaching? (Select all that apply.) a. Rapid weight loss of 3 lbs. in a week b. Increase in exercise tolerance lasting 2 to 3 days c. Cold symptoms (cough) lasting more than 3 to 5 days d. Excessive awakening at night to urinate e. Development of dyspnea or angina at rest or worsening angina f. Increased swelling in the feet, ankles, or hands

C, D, E, F

A patient with a history of valvular heart disease requires a routine colonoscopy. The nurse notifies the health care provider to obtain a patient prescription for which type of medication? a. Anticoagulants b. Antihypertensives c. Antibiotics d. Antianginals

C. Antibiotics

The nurse is caring for a patient who had a valvuloplasty. The nurse monitors for which common complication in the post procedural period? a. Myocardial infarction b. Angina c. Bleeding and emboli d. Infection

C. Bleeding and emboli

A patient is admitted for possible infective endocarditis. Which test does the nurse anticipate will be performed to confirm a positive diagnosis? a. CT scan b. MRI c. Blood cultures d. Echocardiogram

C. Blood cultures

Which is a characteristic of dilated cardiomyopathy? a. Results from replacement of myocardial tissue with fibrous tissue b. Causes stiff ventricles that restrict filling during diastole c. Causes symptoms of left ventricular failure d. Causes a stiff left ventricle

C. Causes symptoms of left ventricular failure

A patient with heart failure has excessive aldosterone secretion and is therefore experiencing thirst and continuously asking for water. What instruction does the nurse give the unlicensed assistive personnel (UAP)? a. Severely restrict fluid to 500 mL plus output from the previous 24 hours. b. Give the patient as much water as desired to prevent dehydration. c. Restrict fluid to a normal 2 L daily, with accurate intake and output. d. Frequently offer the patient ice chips and moistened toothettes.

C. Restrict fluid to a normal 2 L daily, with accurate intake and output

Which laboratory test does the nurse monitor for potential cardiac problems and digoxin toxicity? a. Complete blood count b. BUN and creatinine level c. Serum potassium level d. PT and International Normalized Ratio (INR)

C. Serum potassium level

A patient is admitted for pericarditis. In order to assist the patient to feel more comfortable, what does the nurse instruct the patient to do? a. Sit in a semi-Fowler's position with pillows under the arms. b. Lie on the side in a fetal position. c. Sit up and lean forward. d. Lie down and bend the legs at the knees.

C. Sit up and lean forward

A patient's bilateral radial pulses are occasionally weak and irregular. Which assessment technique does the nurse use first to investigate this finding? a. Check the color and the capillary refill in the upper extremities. b. Check the peripheral pulses in the lower extremities. c. Take the apical pulse for 1 minute, noting any irregularity in heart rhythm. d. Check the cardiac monitor for irregularities in rhythm.

C. Take the apical pulse for 1 minute, noting any irregularity in heart rhythm

Why does the nurse document the precise location of crackles auscultated in the lungs of a patient with heart failure? a. Crackles will eventually change to wheezes as the pulmonary edema worsens. b. The level of the fluid spreads laterally as the pulmonary edema worsens. c. The level of the fluid ascends as the pulmonary edema worsens. d. Crackles will eventually diminish as the pulmonary edema worsens.

C. The level of the fluid ascends as the pulmonary edema worsens

A patient may die without any symptoms from which type of cardiomyopathy? a. Dilated cardiomyopathy b. Arrhythmogenic right ventricular cardiomyopathy c. Restrictive cardiomyopathy d. Hypertrophic cardiomyopathy

D. Hypertrophic cardiomyopathy

The nurse is reviewing the ECG of a patient on digoxin therapy. What early sign of digitalis toxicity does the nurse look for? a. Tachycardia b. Peaked T wave c. Atrial fibrillation d. Loss of P wave

D. Loss of P wave

During assessment of a patient with heart failure, the nurse notes that the patient's pulses alternate in strength. What does this assessment indicate to the nurse? a. Pulsus paradoxus b. Orthostatic hypotension c. Hypotension d. Pulsus alternans

D. Pulsus alternanas

A patient is receiving digoxin therapy for heart failure. What assessment does the nurse perform before administering the medication? a. Auscultate the apical pulse rate and heart rhythm. b. Assess for nausea and abdominal distention. c. Auscultate the lungs for crackles. d. Check for increased urine output.

A

A patient who reports having a sore throat 2 weeks ago now reports chest pain. On physical assessment, the nurse hears a new murmur, pericardial friction rub, and tachycardia. ECG shows a prolonged P-R interval. What condition does the nurse suspect in this patient? a. Rheumatic carditis b. Heart failure c. Cardiomyopathy d. Aortic stenosis

A

54. A client with left ventricular heart failure is taking digoxin (Lanoxin) 0.25 mg/daily. What changes does the nurse expect to find if this medication is therapeutically effective? SATA 1. Diuresis 2. Tachycardia 3. Decreased edema 4. Decreased pulse rate 5. Reduced heart murmur 6. JVD

1. Diuresis 3. Decreased edema 4. Decreased pulse rate

55. A nurse identifies signs of electrolyte depletion in a client with HF who is receiving bumetanide (Bumex) and digoxin (Lanoxin). What does the nurse determine is the cause of the depletion? 1. Diuretic therapy 2. Sodium restriction 3. Continuous dyspnea 4. Inadequate oral intake

1. Diuretic therapy

77. What clinical indicators is the nurse MOST likely to identify hen taking the admission history of a client with right ventricular failure? SATA 1. Edema 2. Vertigo 3. Polyuria 4. Dyspnea 5. Palpitations

1. Edema 4. Dyspnea

78. What changes in pressure does the nurse conclude is responsible for the lower extremity pitting edema of a client with right ventricular HF? 1. Increase in plasma hydrostatic pressure 2. Increase in tissue colloid osmotic pressure 3. Decrease in the tissue hydrostatic pressure 4. Decrease in the plasma colloid osmotic pressure

1. Increase in plasma hydrostatic pressure

82. What effect of anxiety makes it particularly important for the nurses to allay the anxiety of a client with heart failure? 1. Increases the cardiac workload 2. Interferes with usual respirations 3. Produces an elevation in temperature 4. Decreases the amount of oxygen used

1. Increases the cardiac workload

80. What dietary choices should the nurse instruct the client taking spironolactone (Aldactone) to avoid? SATA 1. Potatoes 2. Red meat 3. Cantaloupe 4. Wheat bread 5. Flavored yogurt

1. Potatoes 3. Cantaloupe

76. A client admitted to the hospital has edematous ankles. What should the nurse do to BEST reduce edema of the lower extremities? 1. Restrict fluids 2. Elevate the legs 3. Apply elastic bandages 4. Do range-of-motion exercises

2. Elevate the legs

A patient had an emergency pericardiocentesis for cardiac tamponade. Which nursing interventions are included in the post procedural care of this patient? (Select all that apply.) a. Closely monitor for the recurrence of tamponade. b. Be prepared to provide adequate fluid volumes to increase cardiac output. c. Be prepared to assist in emergency sternotomy if tamponade recurs. d. Administer diuretics to decrease fluid volumes around the heart. e. Send the pericardial effusion specimen to the laboratory for culture.

A, B, C, E

81. A nurse is advising a client about the risks associated with failing to seek treatment for acute pharyngitis caused by beta-hemolytic streptococcus. For what health problem is the client at risk? 1. Asthma 2. Anemia 3. Endocarditis 4. Reye Syndrome

3. Endocarditis

79. The family of a client with right ventricular HF expresses concern about the client's increasing abdominal girth. What physiologic change should the nurse consider when explaining the client's condition? 1. Loss of cellular constituents in blood 2. Rapid osmosis from tissue spaces to cells 3. Increased pressure within the circulatory system 4. Rapid diffusion of solutes and solvents into plasma

3. Increased pressure within the circulatory system

75. A client has edema in the lower extremities during the day, which disappears at night. With which medical problem does the nurse conclude this clinical finding is consistent? 1. Pulmonary edema 2. Myocardial infarction 3. Right ventricular HF 4. Chronic obstructive lung disease

3. Right ventricular HF

83. What should the nurse do to help alleviate the distress of a client with HF and pulmonary edema? 1. Encourage frequent coughing 2. Elevate the client's lower extremities 3. Prepare for modified postural drainage 4. Place the client in the orthopneic position

4. Place the client in the orthopneic position

A patient is admitted for pericarditis. How will the patient likely describe his pain? a. Grating substernal pain that is aggravated by inspiration. b. Sharp pain that radiates down the left arm. c. Dull ache that feels vaguely like indigestion. d. Continuous boring pain that is relieved with rest.

A

A patient is diagnosed with mitral valve stenosis. Which finding warrants immediate notification of the health care provider because of potential for decompensation? a. Irregularly irregular heart rhythm signifying atrial fibrillation b. Slow, bounding peripheral pulses associated with bradycardia c. An increase and decrease in pulse rate that follows inspiration and expiration d. An increase in pulse rate and blood pressure after exertion

A

A patient with heart failure is anxious to recover quickly. After ambulating with the UAP, the nurse observes that the patient has dyspnea. The nurse asks the patient to rate her exertion on a scale of 1 to 20 and the patient says, "I can keep going. It's only about a 15." What is the nurse's best response? a. "Slow down a bit; ideally you should be less than 12" b. "As long as you are less than 18, you can keep going" c. "Stop right now; you should not tax your heart beyond 5" d. "You should go slower; you cannot reach level 0 in one day"

A

The nurse is assessing the pulses of a patient with valvular disease and finds "bounding" arterial pulses. What is this finding most characteristic of? a. Aortic regurgitation b. Aortic stenosis c. Mitral valve prolapse d. Mitral insufficiency

A

What is the most common problem for the patient with valvular heart disease? a. Reduced cardiac output b. Difficulty coping c. Shortness of breath d. Altered body image

A

Which medication is used to treat rheumatic carditis? a. Antibiotic (penicillin) b. NSAIDs c. Pain medications (opioids) d. Steroids

A

Which test is the best tool for diagnosing heart failure? a. Echocardiography b. Pulmonary artery catheter c. Radionuclide studies d. Multigated angiographic (MUGA) scan

A

A patient with heart failure has inadequate tissue perfusion. Which nursing interventions are included in the plan of care for this patient? (Select all that apply.) a. Monitor respiratory rate, rhythm, and quality every 1 to 4 hours. b. Auscultate breath sounds every 4 to 8 hours. c. Provide supplemental oxygen to maintain oxygen saturation at 90% or greater. d. Place the patient in a supine position with pillows under each leg. e. Assist the patient in performing coughing and deep-breathing exercises every 2 hours.

A, B, C, E

The nurse is assessing a patient with left-sided heart failure. Which assessment findings does the nurse expect to see in this patient? (Select all that apply.) a. Displacement of the apical impulse to the left b. S3 heart sound c. Paroxysmal nocturnal dyspnea d. Jugular venous distention e. Oliguria during the day f. Wheezes or crackles

A, B, C, E, F

Which descriptions accurately characterize restrictive cardiomyopathy? (Select all that apply.) a. Prognosis is poor. b. Symptoms are similar to left-or right sided heart failure. c. Some patients die without any symptoms. d. It is the most common type of cardiomyopathy. e. It is the rarest of cardiomyopathies.

A, B, E

The cause of dilated cardiomyopathy may include which factors? (Select all that apply.) a. Alcohol abuse b. Sedentary lifestyle c. Infection d. Chemotherapy e. Poor nutrition

A, C, D, E

Which patients are at greatest risk of developing infective endocarditis? (Select all that apply.) a. IV drug user b. Patient with a myocardial infarction c. Patient with a prosthetic mitral valve replacement, postoperative d. Patient with mitral stenosis who recently had an abscessed tooth removed e. Older adult patient with urinary tract infection and valve damage f. Patient with cardiac dysrhythmias

A, C, D, E

Which interventions-are effective for a patient with a potential for pulmonary edema caused by heart failure? (Select all that apply.) a. Sodium and fluid restriction b. Slow infusion of hypotonic saline c. Administration of potassium d. Administration of loop diuretics e. Position in semi-Fowler's to high-Fowler's position f. Weekly weight monitoring

A, D, E

The nurse is assessing a patient who has received a heart transplant. Which clinical manifestations suggest transplant rejection? (Select all that apply.) a. Shortness of breath b. Depression c. Severe abdominal pain d. New bradycardia e. Hypotension f. Decreased ejection fraction

A, D, E, F

A patient has an ejection fraction of less than 30%. The nurse prepares to provide patient education about which potential treatment? a. Automatic implantable cardio-defibrillator b. Heart transplant c. Mechanical implanted pump d. Ventricular reconstructive procedures

A. Automatic implantable cardio-defibrillator

The nurse is assessing a patient with right sided heart failure. Which assessment findings does the nurse expect to see in this patient? (Select all that apply.) a. Dependent edema b. Weight loss c. Polyuria at night d. Hypotension e. Hepatomegaly f. Angina

A. Dependent Edema C. Polyuria at night E. Hepatomegaly

A patient is diagnosed with moderate mitral valve stenosis. Which findings is the nurse most likely to encounter during the physical assessment of this patient? (Select all that apply.) a. Dyspnea on exertion b. Orthopnea c. Palpitations d. Asymptomatic e. Neck vein distention

A. Dyspnea on exertion B. Orthopnea C. Palpitations E. Neck vein distention

The health care provider recommends to a patient that diagnostic testing be performed to assess for valvular heart disease. The nurse teaches the patient about which test that is commonly used for this purpose? a. Echocardiography b. Electrocardiography c. Exercise testing d. Thallium scanning

A. Echocardiography

The nurse is teaching a patient about the treatment regimen for heart failure. Which statement by the patient indicates a need for further instruction? a. "I must weigh myself once a month and watch for fluid retention" b. "If my heart feels like it is racing, I should call the doctor" c. "I'll need to consider my activities for the day and rest as needed" d. "I'll need periods of rest and activity, and I should avoid activity after meals"

A. I must weigh myself once a month and watch for fluid retention

The nurse is assessing a patient at risk for valvular disease and finds pitting edema. This finding is a sign for which type of valvular disease? a. Mitral valve stenosis and insufficiency b. Aortic valve stenosis and insufficiency c. Tricuspid valve prolapse d. Mitral valve prolapse

A. Mitral valve stenosis and insufficiency

A patient is receiving an infusion of nesiritide (Natrecor) for treatment of heart failure. What is the priority nursing assessment while administering this medication? a. Monitor for hypotension. b. Assess for cardiac dysrhythmias. c. Observe for respiratory depression. d. Monitor for peripheral vasoconstriction.

A. Monitor for hypotension

Which signs/symptoms occur with chronic constrictive pericarditis? (Select all that apply.) a. Pericardium becomes rigid b. Heart valves stiffen c. Ventricles inadequately fill d. Signs of left-sided heart failure appear e. Heart failure eventually occurs

A. Pericardium becomes rigid C. Ventricles inadequately fill E. Heart failure eventually occurs

A patient is a candidate for a xenograft valve. The nurse emphasizes that this type of valve does not require anticoagulant therapy, but will require which intervention? a. Replacement in about 7 to 10 years b. An exercise program to develop collateral circulation c. Daily temperature checks to watch for signs of rejection d. Frequent monitoring for pulmonary edema

A. Replacement in about 7-10 years

A patient is treated for acute pulmonary edema. Which medications does the nurse prepare to administer to this patient? (Select all that apply.) a. Sublingual nitroglycerin b. IV Lasix c. IV morphine sulfate d. IV beta blocker e. IV nitroglycerin

A. Sublingual nitroglycerin B. IV lasix C. IV Morphine Sulfate E. IV Nitroglycerin

The nursing student is assisting in the care of a patient with advanced right-sided heart failure. In addition to bringing a stethoscope, what additional piece of equipment does the student bring in order to assess this patient? a. Tape measure b. Glasgow coma scale c. Portable Doppler d. Bladder ultrasound scanner

A. Tape measure

A patient is diagnosed with new-onset infective endocarditis. Which recent procedure is the patient most likely to report? a. Teeth cleaning b. Urinary bladder catheterization c. Chest radiography d. ECG

A. Teeth cleaning

An older adult patient with heart failure is volume-depleted and has a low sodium level. The health care provider has ordered valsartan (Diovan), an angiotensin-receptor blocker (ARB). After the initial dose, for what complication does the nurse carefully monitor in this patient? a. Hypotension b. Cough c. Fluid retention d. Chest pain

A. hypotension

A patient who was admitted for newly diagnosed heart failure is now being discharged. The nurse instructs the patient and family on how to manage heart failure at home. What major self-management categories should the nurse include? (Select all that apply.) a. Medications b. Weight c. Heart transplants d. Activity e. Diet

A. medications B. weight D. activity E. diet

When heart failure develops, what is the initial compensatory mechanism of the heart that maintains cardiac output? a. Sympathetic stimulation b. Parasympathetic stimulation c. Renin-angiotensin activation system (RAAS) d. Myocardial hypertrophy

A. sympathetic stimulation

A patient with a prosthetic valve replacement must understand that postoperative care will include lifelong therapy with which type of medication? a. Antibiotics b. Anticoagulants c. Immunosuppressants d. Pain medication

B

Assessment findings for a patient with acute pericarditis indicate neck vein distention, clear lungs, muffled heart sounds, tachycardia, tachypnea, and a greater than 10 mm Hg difference in systolic pressure on inspiration than on expiration. What is the nurse's first response to these assessment findings? a. Continue to monitor the patient; these are normal signs of pericarditis. b. Administer oxygen and immediately report the findings to the health care provider. c. Monitor oxygen saturation and seek order for pain medication to control symptoms. d. Check ECG, administer morphine for pain, and administer diuretics.

B

The home health nurse is evaluating a patient being treated for heart failure. Which statement by the patient is the best indicator of hope and well-being as a desired psychological outcome? a. "I'm taking the medication and following the doctor's orders" b. "I'm looking forward to dancing with my wife on our wedding anniversary" c. "I'm planning to go on a long trip; I'll never go back to the hospital again" d. "I want to thank you for all that you have done. I know you did your best"

B

The nurse is interviewing a patient with a history of high blood pressure and heart problems. Which statement by the patient causes the nurse to suspect the patient may have heart failure? a. "I noticed a very fine red rash on my chest" b. "I had to take off my wedding ring last week" c. "I've had fever quite frequently" d. "I have pain in my shoulder when 1 cough"

B

An older adult patient is taking digoxin for treatment of heart failure. What is the priority nursing action for this patient related to the medication therapy? a. Give the medication in conjunction with an antacid. b. Keep the patient on the cardiac monitor and observe for ventricular dysrhythmias. c. Check that the dose is in the lowest possible range for therapeutic effect. d. Advise the patient that there is increased mortality related to toxicity.

C

The night shift nurse is listening to report and hears that a patient has paroxysmal nocturnal dyspnea. What does the nurse plan to do next? a. Instruct the patient to sleep in a side-lying position and then check on the patient every 2 hours to help with switching sides. b. Make the patient comfortable in a bedside recliner with several pillows to keep the patient more upright throughout the night. c. Check on the patient several hours after bedtime and assist the patient to sit upright and dangle the feet when dyspnea occurs. d. Check the patient frequently because the patient has insomnia due to a fear of suffocation

C

The nurse assesses a patient and notes red, flat, pinpoint spots on the mucous membranes. Which finding has the nurse assessed? a. Pericardial friction rub b. Splinter hemorrhages c. Petechiae d. Systemic emboli

C

The patient has excess fluid in the pericardial cavity seen on echo cardiogram. For which complication is the patient at increased risk? a. Pericardial friction rub b. Pulsus paradoxus c. Cardiac tamponade d. Systemic emboli

C

The nurse is taking a history on a patient recently diagnosed with heart failure. The patient admits to "sometimes having trouble catching my breath" but is unable to provide more specific details. What question does the nurse ask to gather more data about the patient's symptoms? a. "Do you have any medical problems, such as high blood pressure?" b. "What did your doctor tell you about your diagnosis?" c. "What was your most strenuous activity in the past week?" d. "How do you feel about being told that you have heart failure?"

C. What was your most strenuous activity in the past week?

A patient is scheduled for valve surgery. Which medication does the nurse advise the patient to discontinue for several days before the procedure? a. Antihypertensives b. Diuretics c. Anticoagulants d. Antibiotics

C. anticoagulants

The nurse is reviewing diagnostic test results for a patient who is hypertensive. Which laboratory result is an early warning sign of decreased heart compliance, and prompts the nurse to immediately notify the health care provider? a. Normal B-type natriuretic peptide b. Decreased hemoglobin and hematocrit c. Elevated thyroxine (T4) d. Presence of micro albuminuria

D

What is an early sign of left ventricular failure that a patient-is most likely to report? a. Nocturia b. Weight gain c. Swollen legs d. Nocturnal coughing

D

The health care provider has ordered an ARB for a patient with heart failure. The parameters are to maintain a systolic blood pressure ranging from 90 to 110 mm Hg. Today the patient has a blood pressure of 110/80 mm Hg, but shows acute confusion. What is the nurse's first priority action? a. Give the medication because blood pressure is within the parameters. b. Call the health care provider about the new onset of confusion. c. Hold the medication and document the new findings. d. Assess the patient for other symptoms of decreased tissue perfusion.

D. Assess the patient for other symptoms of decreased tissue perfusion

A patient is admitted to the unit with assessment findings that include substernal pain that radiates to the left shoulder. The pain is described by the patient as grating, and is worse with inspiration and coughing. What likely is the cause of this patient's symptoms? a. Chronic constrictive pericarditis b. Cardiac tamponade c. Hypertrophic cardiomyopathy d. Acute pericarditis

D. acute pericaditis

A patient is at risk for heart failure, but currently has no official medical diagnosis. While assessing the patient's lungs, the nurse hears profuse fine crackles. What does the nurse do next? a. Report the finding to the health care provider. b. Document the finding as a baseline for later comparison. c. Give the patient low-flow supplemental oxygen. d. Ask the patient to cough and reauscultate the lungs.

D. ask the pt to cough and reauscultate the lungs

Based on the etiology and the main cause of heart failure, which patient has the greatest need for health promotion measures to prevent heart failure? a. Alzheimer's patient b. Patient with cystitis c. Patient with asthma d. Patient with hypertension

D. patient with hypertension

A patient is admitted for heart failure and has edema, neck vein distention, and ascites. What is the most reliable way to monitor fluid gain or loss in this patient? a. Check for pitting edema in the dependent body parts. b. Auscultate the lungs for crackles or wheezing. c. Assess skin turgor and the condition of mucous membranes. d. Weigh the patient daily at the same time with the same scale.

D. weight the patient daily at the same time with the same scale