chapter 23

heart failure with reduced ejection fraction

clinical heart failure syndrome with left ventricular ejection fraction that is less than or equal to 40%

A client had a percutaneous transluminal coronary angioplasty (PTCA). What medication will the nurse administer to prevent thrombus formation in the stent? Clopidogrel Isosorbide mononitrate Metoprolol Diltiazem

clopidogrel

pulseless electrical activity

condition in which electrical activity is present on an electrocardiogram but there is not a physiologically adequate pulse or blood pressure

CPK

creatine phosphokinase

myocardial infarction

death of heart tissue caused by lack of oxygenated blood flow

A patient is undergoing a pericardiocentesis. Following withdrawal of pericardial fluid, which assessment by the nurse indicates that cardiac tamponade has been relieved? Decrease in central venous pressure (CVP) Increase in CVP Decrease in blood pressure Absence of cough

decrease in central venous pressure

morphine is given to

decrease workload of the heart by relaxing the heart

LDL normal level

<130mg/dL

triglycerides normal levels

<150 mg/dL

total cholesterol normal levels

<200 mg/dL

HDL normal level

>45mg/dl

A health care provider in the outpatient department examines a client with chronic heart failure to investigate recent-onset peripheral edema and increased shortness of breath. The nurse documents the severity of pitting edema as +1. What is the best description of this type of edema? A Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours B Detectable depression of less than 5 mm when the thumb is released from the swollen area; normal foot and leg contours C A 5- to 10-mm depression when the thumb is released from the swollen area; foot and leg swelling D A depression of more than 1 cm when the thumb is released from the swollen area; severe foot and leg swelling

A

Which is a diagnostic marker for inflammation of vascular endothelium? A C-reactive protein (CRP) B Low-density lipoprotein (LDL) C High-density lipoprotein (HDL) D Triglyceride

A

A client presents to the emergency room with characteristics of atherosclerosis. What characteristics would the client display? A Fatty deposits in the lumen of arteries B Cholesterol plugs in the lumen of veins C Blood clots in the arteries D Emboli in the veins

A (Atherosclerosis is a condition in which the lumen of arteries fill with fatty deposits called plaque. Therefore, the other options are incorrect.)

A nurse is caring for a client in the cardiovascular intensive care unit following a coronary artery bypass graft. Which clinical finding requires immediate intervention by the nurse? A Central venous pressure reading of 1 B Pain score 5/10 C Blood pressure 110/68 mm Hg D Heart rate 66 bpm

A (The central venous pressure (CVP) reading of 1 is low (2-6 mm Hg) and indicates reduced right ventricular preload, commonly caused by hypovolemia. Hypovolemia is the most common cause of decreased cardiac output after cardiac surgery. Replacement fluids such as colloids, packed red blood cells, or crystalloid solutions may be prescribed. The other findings require follow-up by the nurse; however, addressing the CVP reading is the nurse's priority.)

After percutaneous transluminal coronary angioplasty (PTCA), the nurse confirms that a client is experiencing bleeding from the femoral site. What will be the nurse's initial action? A Apply manual pressure at the site of the insertion of the sheath. B Review the results of the latest blood cell count, especially the hemoglobin and hematocrit. C Decrease anticoagulant or antiplatelet therapy. D Notify the health care provider.

A (The immediate nursing action would be to apply pressure to the femoral site. Reviewing blood studies will not stop the bleeding. The nurse cannot decrease anticoagulation therapy independently. If the bleeding does not stop, the health care provider needs to be notified.)

The nurse is administering a calcium channel blocker to a patient who has symptomatic sinus tachycardia at a rate of 132 bpm. What is the anticipated action of the drug for this patient? A Decreases the sinoatrial node automaticity B Increases the atrioventricular node conduction C Increases the heart rate D Creates a positive inotropic effect

A Calcium channel blockers have a variety of effects on the ischemic myocardium. These agents decrease sinoatrial node automaticity and atrioventricular node conduction, resulting in a slower heart rate and a decrease in the strength of myocardial contraction (negative inotropic effect).

Which of the following is inconsistent as a condition related to metabolic syndrome? A Hypotension B insulin resistance CAbdominal obesity D Dyslipidemia

A (A diagnosis of metabolic syndrome includes three of the following conditions: insulin resistance, abdominal obesity, dyslipidemia, hypertension, proinflammatory state, and prothrombotic state.)

A client comes to the emergency department (ED) reporting precordial chest pain. In describing the pain, the client describes it as pressure with a sudden onset. What disease process would the nurse suspect in this client? A Coronary artery disease B Raynaud syndrome C Cardiogenic shock D Venous occlusive disease

A (The classic symptom of CAD is chest pain (angina) or discomfort during activity or stress. Such pain or discomfort typically is manifested as sudden pain or pressure that may be centered over the heart (precordial) or under the sternum (substernal). Raynaud syndrome in the hands presents with symptoms of hands that are cold, blanched, and wet with perspiration. Cardiogenic shock is a complication of an MI. Venous occlusive disease occurs in the veins, not the arteries.)

In the treatment of coronary artery disease (CAD), medications are often ordered to control blood pressure in the client. Which of the following is a primary purpose of using beta-adrenergic blockers in the nursing management of CAD? A To dilate coronary arteries B To decrease workload of the heart C To decrease homocysteine levels D To prevent angiotensin II conversion

B Beta-adrenergic blockers are used in the treatment of CAD to decrease the consumption of myocardial oxygen by reducing heart rate and workload of the heart. Nitrates are used for vasodilation. Anti-lipid drugs (such as statins and B vitamins) are used to decrease homocysteine levels. ACE inhibitors inhibit the conversion of angiotensin.

The nurse is assigned to care for a patient with heart failure. What classification of medication does the nurse anticipate administering that will improve symptoms as well as increase survival? ACE inhibitor Calcium channel blocker Diuretic Bile acid sequestrants

ACE inhibitor

A nurse is caring for a client with left-sided heart failure. During the nurse's assessment, the client is wheezing, restless, tachycardic, and has severe apprehension. The clients reports that these symptoms came on suddenly. The nurse knows that these are symptoms of what condition? Acute pulmonary edema Progressive heart failure Pulmonary hypertension Cardiogenic shock

Acute pulmonary edema

The nurse is caring for a client with Raynaud syndrome. What is an important instruction for a client who is diagnosed with this disease to prevent an attack? A Report changes in the usual pattern of chest pain. B Avoid situations that contribute to ischemic episodes. C Avoid fatty foods and exercise. D Take over-the-counter decongestants.

B (Teaching for clients with Raynaud syndrome and their family members is important. They need to understand what contributes to an attack. The nurse should instruct the clients to avoid situations that contribute to ischemic episodes. Reporting changes in the usual pattern of chest pain or avoiding fatty foods and exercise does not help the client to avoid an attack; it is more contributory for clients with CAD. In addition, the nurse advises clients to avoid over-the-counter decongestants.)

myoglobin

An oxygen-storing, pigmented protein in muscle cells.

A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion? Assess for reduced urine output. Assess for reduced blood sodium levels. Assess for elevated blood potassium levels. Assess for elevated blood urea nitrogen levels.

Assess for elevated blood urea nitrogen levels

The nurse understands that a client with which cardiac arrhythmia is most at risk for developing heart failure? Atrial fibrillation First-degree heart block Supraventricular tachycardia Sinus tachycardia

Atrial fibrillation

A client is ordered a nitroglycerine transdermal patch for treatment of CAD and asks the nurse why the patch is removed at bedtime. Which is the best response by the nurse? A"Nitroglycerine causes headaches, but removing the patch decreases the incidence." B "You do not need the effects of nitroglycerine while you sleep." C "Removing the patch at night prevents drug tolerance while keeping the benefits." D "Contact dermatitis and skin irritations are common when the patch remains on all day."

C

The nurse is caring for a client after cardiac surgery. What is the most immediate concern for the nurse? A weight gain of 6 ounces B serum glucose of 124 mg/dL C potassium level of 6 mEq/L D bilateral rales and rhonchi

C (Changes in serum electrolytes should be immediately reported, especially a potassium level of 6 mEq/L. An elevated blood sugar is common postoperatively, and the weight gain is not significant. The abnormal breath sounds are of concern, but the electrolyte imbalance is the most immediate condition that needs to be addressed.)

A client comes to the emergency department reporting chest pain. An electrocardiogram (ECG) reveals myocardial ischemia and an anterior-wall myocardial infarction (MI). Which ECG characteristic does the nurse expect to see? A Prolonged PR interval B Absent Q wave C Elevated ST segment D Widened QRS complex

C (Ischemic myocardial tissue changes cause elevation of the ST segment, an inverted T wave, and a pathological Q wave. A prolonged PR interval occurs with first-degree heart block, the least dangerous atrioventricular heart block; this disorder may arise in healthy people but sometimes results from drug toxicity, electrolyte or metabolic disturbances, rheumatic fever, or chronic degenerative disease of the conduction system. An absent Q wave is normal; an MI may cause a significant Q wave. A widened QRS complex indicates a conduction delay in the His-Purkinje system.)

Which discharge instruction for self-care should the nurse provide to a client who has undergone a percutaneous transluminal coronary angioplasty (PTCA) procedure? A Cleanse the site with disinfectants and dress the wound appropriately B Refrain from sexual activity for 1 month C Monitor the site for bleeding or hematoma. D Normal activities of daily living can be resumed the first day after surgery

C (The nurse provides certain discharge instructions for self-care, such as monitoring the site for bleeding or the development of a hard mass indicative of hematoma. A nurse does not advise the client to clean the site with disinfectants or refrain from sexual activity for 1 month.)

pulmonary edema

accumulation of fluid in the interstitial spaces and alveoli of the lungs causing severe respiratory distress

surgical interventions for MI

CABG (Side street around the blocked artery) angioplasty stent

The nurse is caring for a client in the hospital with chronic heart failure who has marked limitations in his physical activity. The client is comfortable when resting in the bed or chair, but when ambulating in the room or hall, the client becomes short of breath and fatigued easily. What type of heart failure is this considered according to the New York Heart Association (NYHA)? Class I (Mild) Class II (Mild) Class III (Moderate) Class IV (Severe)

Class III Moderate

The pathophysiology of pericardial effusion is associated with all of the following except: Increased right and left ventricular end-diastolic pressures. Atrial compression. Increased venous return. Inability of the ventricles to fill adequately.

increased venous return

When assessing a client who reports recent chest pain, the nurse obtains a thorough history. Which client statement most strongly suggests angina pectoris? A "The pain lasted about 45 minutes." B "The pain resolved after I ate a sandwich." C "The pain got worse when I took a deep breath." D "The pain occurred while I was mowing the lawn."

D

When the postcardiac surgery client demonstrates restlessness, nausea, weakness, and peaked T waves, the nurse reviews the client's serum electrolytes, anticipating which abnormality? Hypercalcemia Hyperkalemia Hypomagnesemia Hyponatremia

Hyperkalemia (Hyperkalemia is indicated by mental confusion, restlessness, nausea, weakness, and dysrhythmias (tall, peaked T waves). Hypercalcemia would likely be demonstrated by asystole. Hypomagnesemia would likely be demonstrated by hypotension, lethargy, and vasodilation. Hyponatremia would likely be indicated by weakness, fatigue, and confusion, without a change in T wave formation.)

The nurse is assessing a patient who reports no symptoms of heart failure at rest but is symptomatic with ordinary physical activity. Under what classification does the nurse understand this patient would be categorized? I II III IV

II

myoglobin over 90 mc/L indicates

MI

troponin T greater than 0.1-0.2 indicates

MI

NOAM

Nitro oxygen ASA (aspirin) morphine

A patient in the recovery room after cardiac surgery begins to have extremity paresthesia, peaked T waves, and mental confusion. What type of electrolyte imbalance does the nurse suspect this patient is having? Calcium Magnesium Potassium Sodium

Potassium (Hyperkalemia (high potassium) can result in the following ECG changes: tall peaked T waves, wide QRS, and bradycardia. The nurse should be prepared to administer a diuretic or an ion-exchange resin (sodium polystyrene sulfonate [Kayexalate]); IV sodium bicarbonate, or IV insulin and glucose. Imbalances in the other electrolytes listed would not result in peaked T waves.)

troponin

a cardiac muscle biomarker, measurement is used as an indicator of heart muscle injury

heart failure

a clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricle to fill or eject blood

metabolic syndrome

a cluster of metabolic abnormalities including insulin resistance, obesity, dyslipidemia and hypertension that increase risk of cardiovascular disease

congestive heart failure

a fluid overload condition (congestion) associated with heart failure

stent

a metal mesh that provides structural support to a coronary vessel, preventing its closure

Raynaud's disease

a peripheral arterial occlusive disease in which intermittent attacks are triggered by cold or stress

thrombolytic

a pharmacologic agent that breaks down blood clots

percutaneous coronary intervention

a procedure in which a catheter is placed in a coronary artery and one of several methods is employed to reduce blockage within the artery

high density lipoprotein

a protein-bound lipid that transports cholesterol to the liver for excretion in the bile; composed of a higher proportion of protein to lipid than low-density lipoprotein; exerts a beneficial effect on the arterial wall

low-density lipoprotein (LDL)

a protein-bound lipid that transports cholesterol to tissues in the body; composed of a lower proportion of protein to lipid than high-density lipoprotein; exerts a harmful effect on the arterial wall

coronary artery bypass graft

a surgical procedure in which a blood vessel from another part of the body is grafted onto the occluded coronary artery below the occlusion in such a way that blood flow bypasses the blockage

cardiac resynchronization therapy

a treatment for heart failure in which a device paces both ventricles to synchronize contractions

percutaneous transluminal coronary angioplasty (PTCA)

a type of percutaneous coronary intervention in which a balloon is inflated within a coronary artery to break an atheroma and open the vessel lumen, improving artery blood flow

contractility

ability of the cardiac muscle to shorten in response to electrical impulses

atherosclerosis

abnormal accumulation of lipid deposits and fibrous tissue within arterial vessels and the lumen

sudden cardiac death

aburpt cessation of effective heart activity

heart failure with midrange ejection fraction

clinical heart failure syndrome with left ventricle fraction that is 40% to 49%

Heart failure with preserved ejection fraction (HFpEF)

clinical heart failure syndrome with left ventricular ejection fraction that is greater than or equal to 50%

The nurse is discussing basic cardiac hemodynamics and explains preload to the client. What nursing intervention will decrease preload? application of antiembolic stockings increasing activity administration of a vasodilating drug (as ordered by a health care provider) sustained elevation of the client's legs

adminstration of a vasodilating drug Preload is the amount of blood presented to the ventricles just before systole. Anything that decreases the amount of blood returning to the heart will decrease preload, such as vasodilation or blood pooling in the extremities. Anything that assists in returning blood to the heart (antiembolic stockings) or preventing blood from pooling in the extremities will increase preload.

ascites

an accumulation of serous fluid in the peritoneal cavity

cardiac enzymes

blood test to determine the level of enzymes specific to heart muscles in the blood

A client who has developed congestive heart failure must learn to make dietary adaptations. The client should avoid: canned peas. dried peas. angel food cake. ready-to-eat cereals.

canned peas

angina pectoris

chest pain brought about by myocardial ischemia

oliguria

diminished urine output, less than 0.5 mL/kg/h over at least 6 hours or less than 400 mL in 24 hours

The nurse is interviewing a client during an initial visit at a cardiologist's office. What symptom will the nurse expect to find as an early symptom of chronic heart failure? fatigue pedal edema nocturia irregular pulse

fatigue

hemoglobin normal range

female: 12-16 male: 14-18

hematocrit normal range

female: 37-47% male: 42-52%

atheroma

fibrous cap composed of smooth muscle cells that forms over lipid deposits within arterial vessels and protrudes into the lumen of the vessel, narrowing the lumen and obstructing blood flow; also called plaque

high CPK levels indicate:

heart damage; levels rise 4 to 8 hours after an MI peaking at 16 to 30 hours

A nurse is monitoring the vital signs and blood results of a client who is receiving anticoagulation therapy. What does nurse identify as a major indication of concern? blood pressure of 129/72 mm Hg heart rate of 87 bpm hemoglobin of 16 g/dL hematocrit of 30%

hematocrit of 30%

MUGA scan

imaging the motion of heart wall muscles and assessing the function of the heart via a multiple-gated acquisition scan, which uses radioactive chemicals

systolic heart failure

inability of the heart to pump sufficiently because of an alteration in the ability of the heart to contract; term used to describe a type of heart failure

left sided heart failure

inability of the left ventricle to fill or eject sufficient blood into the systemic circulation

right sided heart failure

inability of the right ventricle to fill or eject sufficient blood into the pulmonary circulation

The critical care nurse is caring for a client with cardiogenic shock. What is the premise for inserting an intra-aortic balloon pump? coronary artery stenosis inadequate tissue perfusion myocardial ischemia right atrial flutter

inadequate tissue perfusion

ischemia

insufficient tissue oxygenation

The nurse is receiving a client from the emergency in cardiogenic shock. What mechanical device does the nurse anticipate will be inserted into the client? cardiac pacemaker hypothermia-hyperthermia machine defibrillator intra-aortic balloon pump

intra-aortic balloon pump

The nurse is preparing a client for a multiple gated acquisition (MUGA) scan. What would be an important instruction for the nurse to give a client who is to undergo a MUGA scan? Avoid any activity at least 2 hours before the test. Drink plenty of fluids during the test. Avoid dairy products a day before and a day after the test. Lie very still at intermittent times during the test.

lie very still at intermittent times during the test

The nurse is assigned to care for a client with heart failure. What medication does the nurse anticipate administering that will improve client symptoms as well as increase survival? lisinopril diltiazem bumetanide cholestyramine

lisinopril

aspiring is given to

loosen congestion of platelets

A client has been rushed to the ED with pulmonary edema and is going to need oxygen immediately. Which oxygen delivery system should be used first? mask nasal cannula intubation mechanical ventilation

mask (Because pulmonary edema can be fatal, lung congestion needs to be relieved as quickly as possible. Supplemental oxygen is one of the first tools used to fight pulmonary edema. A mask, rather than nasal cannula, is needed to deliver the maximum percentages of oxygen. Intubation is reserved for when respiratory failure occurs. Mechanical ventilation is applied once respiratory failure occurs).

Troponin I greater than 1.5 indicates

myocardial infarction

A nurse is teaching clients newly diagnosed with coronary heart disease (CHD) about the disease process and risk factors for heart failure. Which problem can cause left-sided heart failure (HF)? Ineffective right ventricular contraction Myocardial ischemia Pulmonary embolus Cystic fibrosis

myocardial ischemia

ejection fraction

percentage of blood volume in the ventricles at the end of diastole that is ejected during systole; a measurement of contractility

pericardiocentesis

procedure that involves aspiration of fluid from the pericardial sac

A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." What additional assessment information would be important for the CSU nurse to obtain? hypertension high urine output dry mucous membranes pulmonary crackles

pulmonary crackles

A client is admitted to the ICU with a diagnosis of heart failure. The client is exhibiting symptoms of weakness, ascites, weight gain, and jugular vein distention. The nurse would know that the client is exhibiting signs of what kind of heart failure? Left-sided heart failure Chronic heart failure Acute heart failure Right-sided heart failure

right sided heart failure

paryoxysmal nocturnal dyspnea

shortness of breath that occurs suddenly during sleep

orthopnea

shortness of breath when lying flat

acute coronary syndrom

signs and symptoms that indicate unstable angina or acute myocardial infarction

pericardiotomy

surgically created opening of the pericardium

pulsus paradoxus

systolic blood pressure that is more than 10 mm Hg lower during inhalation than during exhalation, difference is normally less than 10 mm Hg

diastolic heart failure

the inability of the left ventricle of the heart to fill and pump sufficiently, term used to define a type of heart failure aka heart failure with preserved ejection fraction

The nurse is administering furosemide to a client with heart failure. What best describes the therapeutic action of the medication? Furosemide blocks reabsorption of potassium on the collecting tubule. Furosemide promotes sodium secretion into the distal tubule. The medication blocks sodium reabsorption in the ascending loop and dilate renal vessels. The medication promotes potassium secretion into the distal tubule and constrict renal vessels.

the medication blocks sodium reabsorption in the ascending loop and dilate renal vessels

angioplasty

the technique of mechanically widening a narrowed or obstructed blood vessel

The nurse is assisting in the care of a client who is receiving cardiopulmonary resuscitation (CPR). For which reason will the client be prescribed to receive amiodarone during the resuscitation efforts? Correct metabolic acidosis. Treat pulseless ventricular tachycardia. Prevent the development of hypotension. Reduce the development of torsade de pointes.

treat pulseless ventricular tachycardia (During CPR, the medications provided will depend upon the client's condition and response to therapy. Amiodarone is used to treat pulseless ventricular tachycardia. Sodium bicarbonate is used to correct metabolic acidosis. Norepinephrine and dopamine are used to prevent the development of hypotension. Magnesium sulfate is used for the client with torsade de pointes.)

anuria

urine output of less than 50 mL/24 h

nitrogen is given to

vasodilate for my oxygen to left ventricle

A client is awaiting the availability of a heart for transplant. What option may be available to the client as a bridge to transplant? Implanted cardioverter-defibrillator (ICD) Pacemaker Intra-aortic balloon pump (IABP) Ventricular assist device (VAD)

ventricular assist device (VAD) VADs may be used for one of three purposes:(1) a bridge to recovery, (2) a bridge to transplant, or (2) destination therapy (mechanical circulatory support when there is no option for a heart transplant). An implanted cardioverter-defibrillator or pacemaker is not a bridge to transplant and will only correct the conduction disturbance and not the pumping efficiency. An IABP is a temporary, secondary mechanical circulatory pump to supplement the ineffectual contraction of the left ventricle. The IABP is intended for only a few days