Chapter 29: Management of Patients With Complications from Heart Disease

The nurse is performing a respiratory assessment for a patient in left-sided heart failure. What does the nurse understand is the best determinant of the patient's ventilation and oxygenation status? Pulse oximetry Listening to breath sounds End-tidal CO2 Arterial blood gases

Arterial blood gases Explanation: In left-sided heart failure, arterial blood gases may be obtained to assess ventilation and oxygenation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Assessment and Diagnostic Findings, p. 834.

Which is a potassium-sparing diuretic used in the treatment of heart failure? Spironolactone Bumetanide Chlorothiazide Ethacrynic acid

Spironolactone Explanation: Spironolactone is a potassium-sparing diuretic. Chlorothiazide is a thiazide diuretic. Bumetanide and ethacrynic acid are loop diuretics. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 825.

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. Explanation: 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.

The nurse is caring for a client with advanced heart failure. What treatment will be considered after all other therapies have failed? heart transplant ventricular access device implantable cardiac defibrillator (ICD) cardiac resynchronization therapy

heart transplant Explanation: Heart transplantation involves replacing a person's diseased heart with a donor heart. This is an option for advanced HF patients when all other therapies have failed. A ventricular access device, ICD, and cardiac resynchronization therapy would be tried prior to a heart transplant. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Other Interventions, p. 828.

The nurse is assessing a client with crackling breath sounds or pulmonary congestion. What is the cause of the congestion? ascites hepatomegaly inadequate cardiac output nocturia

inadequate cardiac output Explanation: Pulmonary congestion occurs and tissue perfusion is compromised and diminished when the heart, primarily the left ventricle, cannot pump blood out of the ventricle effectively into the aorta and the systemic circulation. Ascites is fluid in the abdomen, not a cause of congestion. Hepatomegaly is an enlarged liver, which does not cause crackling breath sounds. Nocturia, or voiding at night, does not cause crackling breath sounds. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Heart Failure, p. 818.

The nurse is developing a plan of care for a client following pericardiocentesis. Which interventions should the nurse implement? Choose all that apply. Assess vital signs every 15 minutes for the first hour. Monitor heart and lung sounds. Record fluid output. Evaluate the cardiac rhythm. Place the client in a supine position.

Assess vital signs every 15 minutes for the first hour. Monitor heart and lung sounds. Record fluid output. Evaluate the cardiac rhythm. Explanation: The nurse should monitor the vital signs for any client who has undergone surgery. Because this procedure requires entering the pericardial sac, assessing heart and lung sounds assists in determining heart failure. The pericardial fluid is recorded as output and assessing the cardiac rhythm allows to assess for cardiac failure. The client should be kept in the semi-Fowler's position, not flat. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Medical Management, p. 814.

Which is a characteristic of right-sided heart failure? Jugular vein distention Dyspnea Pulmonary crackles Cough

Jugular vein distention Explanation: Jugular vein distention is a characteristic of right-sided heart failure. Dyspnea, pulmonary crackles, and cough are manifestations of left-sided heart failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 823.

The client with cardiac failure is taught to report which symptom to the health care provider or clinic immediately? Increased appetite Persistent cough Weight loss Ability to sleep through the night

Persistent cough Explanation: Persistent cough may indicate an onset of left-sided heart failure. Loss of appetite, weight gain, interrupted sleep, unusual shortness of breath, and increased swelling should also be reported immediately. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Chart 29-6, p. 832.

A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which assessment finding for this client? Pulmonary congestion Pedal edema Nausea Jugular venous distention

Pulmonary congestion Explanation: When the left ventricle cannot effectively pump blood out of the ventricle into the aorta, the blood backs up into the pulmonary system and causes congestion, dyspnea, and shortness of breath. All the other choices are symptoms of right-sided heart failure. They are all symptoms of systolic failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Left-Sided Heart Failure, p. 822.

Which is a manifestation of right-sided heart failure? Accumulation of blood in the lungs Systemic venous congestion Increase in forward flow Paroxysmal nocturnal dyspnea

Systemic venous congestion Explanation: Right-sided heart failure causes systemic venous congestion and a reduction in forward flow. Left-sided heart failure causes an accumulation of blood in the lungs and a reduction in forward flow or cardiac output that results in inadequate arterial blood flow to the tissues. Some clients with left-sided heart failure get episodes of dyspnea at night, known as paroxysmal nocturnal dyspnea. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 822.

A client with right-sided heart failure is admitted to the medical-surgical unit. What information obtained from the client may indicate the presence of edema? The client says that he has been urinating less frequently at night. The client says he has been hungry in the evening. The client says his rings have become tight and are difficult to remove. The client says he is short of breath when ambulating.

The client says his rings have become tight and are difficult to remove. Explanation: Clients may observe that rings, shoes, or clothing have become tight. The client would most likely be urinating more frequently in the evening. Accumulation of blood in abdominal organs may cause anorexia, nausea, flatulence, and a decrease in hunger. Shortness of breath with ambulation would occur most often in left-sided heart failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Right-Sided Heart Failure, p. 823.

A client diagnosed with heart failure presents with a temperature of 99.1° F, pulse 100 beats/minute, respirations 42 breaths/minute, BP 110/50 mm Hg; crackles in both lung bases; nausea; and pulse oximeter reading of 89%. Which finding indicates a need for immediate attention? lung congestion nausea temperature blood pressure

lung congestion Explanation: Because pulmonary edema can be fatal, lung congestion needs to be relieved as quickly as possible. Supplemental oxygen or mechanical ventilation is used to support breathing. Inotropic medications, which improve myocardial contractility, are administered to relieve symptoms. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 29: Management of Patients With Complications From Heart Disease, p. 834.

A nurse suspects that a client has digoxin toxicity. The nurse should assess for: hearing loss. vision changes. decreased urine output. gait instability.

vision changes. Explanation: Vision changes, such as halos around objects, are signs of digoxin toxicity. Hearing loss can be detected through hearing assessment; however, it isn't a common sign of digoxin toxicity. Intake and output aren't affected unless there is nephrotoxicity, which is uncommon. Gait changes are also uncommon. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Digitalis, p. 826.

A client with chronic heart failure is receiving digoxin 0.25 mg by mouth daily and furosemide 20 mg by mouth twice daily. The nurse should assess the client for what sign of digoxin toxicity? visual disturbances. taste and smell alterations. dry mouth and urine retention. nocturia and sleep disturbances.

visual disturbances. Explanation: Digoxin toxicity may cause visual disturbances (e.g., flickering flashes of light, colored or halo vision, photophobia, blurring, diplopia, and scotomata), central nervous system abnormalities (e.g., headache, fatigue, lethargy, depression, irritability and, if profound, seizures, delusions, hallucinations, and memory loss), and cardiovascular abnormalities (e.g., abnormal heart rate, arrhythmias). Digoxin toxicity doesn't cause taste and smell alterations. Dry mouth and urine retention typically occur with anticholinergic agents, not inotropic agents such as digoxin. Nocturia and sleep disturbances are adverse effects of furosemide — especially if the client takes the second daily dose in the evening, which may cause diuresis at night. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Digitalis, p. 826.

A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement? "I sleep on three pillows each night." "My feet are bigger than normal." "My pants don't fit around my waist." "I don't have the same appetite I used to."

"I sleep on three pillows each night." Explanation: Orthopnea is a classic sign of left-sided heart failure. The client commonly sleeps on several pillows at night to help facilitate breathing. Swollen feet, ascites, and anorexia are signs of right-sided heart failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Left-Sided Heart Failure, p. 822.

The nurse is admitting a client with heart failure. What client statement indicates that fluid overload was occurring at home? "I eat six small meals a day when I am hungry." "I've stopped eating foods with salt, though I miss the taste." "I'm having trouble going up the steps during the day." "My best time of the day is the morning."

"I'm having trouble going up the steps during the day." Explanation: Difficulty with activities like climbing stairs is an indication of a lessened ability to exercise. Eating small meals and not using salt are usually indicated for clients with heart failure. The client's assertion about morning being the best time of day is a vague statement. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Pathophysiology, p. 829.

The nurse instructs a client with heart failure on restricting sodium in the diet. Which client statement indicates that teaching was effective? "I will add a water softener to my water at home." "Food prepared at home is saltless unless I add it while cooking." "Lemon juice and herbs can be used to replace salt when cooking." "Canned vegetables have low sodium content."

"Lemon juice and herbs can be used to replace salt when cooking." Explanation: For the client on a low-sodium or sodium-restricted diet, a variety of flavorings, such as lemon juice, vinegar, and herbs, may be used to improve the taste of the food and facilitate acceptance of the diet. Sodium is contained in municipal water. Water softeners also increase the sodium content of drinking water. Although the major source of sodium in the average American diet is salt, many types of natural foods contain varying amounts of sodium. Even if no salt is added in cooking and if salty foods are avoided, the daily diet will still contain about 2000 mg of sodium. Fresh fruits and vegetables are low in sodium and should be encouraged.

A client has been diagnosed with systolic heart failure. What percentage will the nurse expect the patient's ejection fraction to be? 5% 30% 55% 65%

30% Explanation: The ejection fraction is normal in diastolic heart failure, but severely reduced in systolic heart failure. The normal EF is 55%-65%. An EF of 5% is not life sustaining and an EF of 30% is about half the normal percentage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Chronic Heart Failure, p. 819.

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 Explanation: Several medications are routinely prescribed for heart failure (HF), including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and diuretics (Table 29-3). Many of these medications, particularly ACE inhibitors and beta-blockers, improve symptoms and extend survival. Others, such as diuretics, improve symptoms but may not affect survival (Fonarow et al., 2010). Calcium channel blockers are no longer recommended for patients with HF because they are associated with worsening failure (ICSI, 2011). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Angiotensin-Converting Enzyme Inhibitors, pp. 824-825.

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 Explanation: Clients with acute pulmonary edema exhibit sudden dyspnea, wheezing, orthopnea, restlessness, cough (often productive of pink, frothy sputum), cyanosis, tachycardia, and severe apprehension. These symptoms do not indicate progressive heart failure, pulmonary hypertension, or cardiogenic shock. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Assessment and Diagnostic Findings, p. 834.

A client in the emergency room is in cardiac arrest and exhibiting pulseless electrical activity (PEA) on the cardiac monitor. What will be the nurse's next action? Administer epinephrine. Change oxygen delivery to a mask. Analyze the arterial blood gas. Stop all emergency measures.

Administer epinephrine. Explanation: PEA can be caused by hypovolemia, hypoxia, hypothermia, hyperkalemia, massive pulmonary embolism, myocardial infarction, and medication overdose (beta blockers, calcium channel blockers). PEA is treated with epinephrine according to advanced life support protocol. Applying oxygen or analyzing an arterial blood gas will not change the client's heart rhythm. PEA is treated until there is no change in the client's rhythm after treatments. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Medications Used in Cardiopulmonary Resuscitation, p. 838.

The nurse is administering sublingual nitroglycerin to a client with chest pain. What action will the nurse take after administering two sublingual tablets if the client continues with chest pain and has a blood pressure of 120/82 mm Hg? Hold any further treatment until the client's blood pressure increases. Notify the health care provider of the chest pain. Administer the third sublingual nitroglycerin tablet. Wait ten minutes after the second tablet to assess pain.

Administer the third sublingual nitroglycerin tablet. Explanation: The nurse will need to administer the third sublingual nitroglycerin tablet. Nitroglycerin is given as three doses for chest pain as the client's blood pressure can tolerate it. The health care provider will be notified after three tablets. The nurse should not hold any further treatment if the client has chest pain. The dosing of nitroglycerin is a five-minute wait. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Pathophysiology, p. 821.

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. Explanation: Elevated blood urea nitrogen indicates impaired renal perfusion in a client with left-sided heart failure. Serum sodium levels may be elevated. Reduced urine output or elevated blood potassium levels do not indicate impaired renal perfusion in a client with left-sided heart failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Left-Sided Heart Failure, p. 822.

A client arrives at the ED with an exacerbation of left-sided heart failure and reports shortness of breath. Which is the priority nursing action? Administer angiotensin II receptor blockers Assess oxygen saturation Administer diuretics Administer angiotensin-converting enzyme inhibitors

Assess oxygen saturation Explanation: The nurse's priority action is to assess oxygen saturation to determine the severity of the exacerbation. It is important to assess the oxygen saturation in a client with heart failure because below-normal oxygen saturation can be life-threatening. Treatment options vary according to the severity of the client's condition and may include supplemental oxygen, oral and IV medications, major lifestyle changes, implantation of cardiac devices, and surgical approaches. The overall goal of treatment of heart failure is to relieve symptoms and reduce the workload on the heart by reducing afterload and preload. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 822.

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 Explanation: Cardiac dysrhythmias such as atrial fibrillation may either cause or result from heart failure; in both instances, the altered electrical stimulation impairs myocardial contraction and decreases the overall efficiency of myocardial function. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 820.

The nurse is teaching a group of clients with heart failure about how to decrease leg edema. What dietary advice will the nurse give to clients with severe heart failure? Avoid the intake of processed and commercially prepared foods. Avoid the intake of canned fruit and fruit juices. Encourage increased intake of vegetables with natural sodium. Encourage increased intake of red meat.

Avoid the intake of processed and commercially prepared foods. Explanation: Until edema resolves, a client with severe heart failure requires restriction of sodium to 500 to 1,000 mg/day. Therefore, processed and commercially prepared foods are eliminated. Vegetables with natural sodium, for example, beets, carrots, and "greens," should be avoided. Fresh, frozen, and canned fruit and fruit juices are not restricted. Increased intake of red meat should not be encouraged; it should be restricted to 6 oz per day. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Chart 29-6, p. 832.

A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client? Intubation of the airway BP and pulse measurements every 15 to 30 minutes Insertion of a central venous catheter Hourly administration of a fluid bolus

BP and pulse measurements every 15 to 30 minutes Explanation: Bedside ECG monitoring is standard, as are continuous pulse oximetry, automatic BP, and pulse measurements approximately every 15 to 30 minutes. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 818.

A client is brought to the emergency department via rescue squad with suspicion of cardiogenic pulmonary edema. What complication should the nurse monitor for? Select all that apply. Nausea and vomiting Pulmonary embolism Cardiac arrhythmias Respiratory arrest Cardiac arrest

Cardiac arrhythmias Respiratory arrest Cardiac arrest Explanation: Pulmonary edema is fluid accumulation in the lungs, which interferes with gas exchange in the alveoli. It represents an acute emergency and is a frequent complication of left-sided heart failure. Cardiac arrhythmias and cardiac or respiratory arrest are associated complications. Nausea and vomiting are not complications but are symptoms of many disorders. The client is not at increased risk for the development of pulmonary embolism with pulmonary edema. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Assessment and Diagnostic Findings, p. 834.

A client has been prescribed furosemide 80 mg twice daily. The asymptomatic client begins to have rare premature ventricular contractions followed by runs of bigeminy with stable signs. What action will the nurse perform next? Notify the health care provider. Check the client's potassium level. Calculate the client's intake and output. Administer potassium.

Check the client's potassium level. Explanation: The client is asymptomatic but has had a change in heart rhythm. More information is needed before calling the health care provider. Because the client is taking furosemide, a potassium-wasting diuretic, the next action would be to check the client's potassium level. The nurse would then call the health care provider with a more complete database. The health care provider will need to be notified after the nurse checks the latest potassium level. The intake and output will not change the heart rhythm. Administering potassium requires a health care provider's order. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Table 29-3, p. 824.

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) Explanation: This client is comfortable at rest, but has "marked limitations" on physical activity. Merely walking down the hall causes fatigue and dyspnea. Therefore, this client is in Class III (moderate). With Class I (mild), ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea, and the client does not experience any limitation of activity. With Class II (mild), the client is comfortable at rest, but the ordinary physical activity of daily living results in fatigue, heart palpitations, or dyspnea; the client's activity is only slightly limited. With Class IV (severe), symptoms of cardiac insufficiency occur at rest, and discomfort increases if any physical activity is undertaken. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Table 29-1: New York Heart Association Classification of Heart Failure, p. 819.

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 (CVP) Explanation: A resulting decrease in CVP and an associated increase in blood pressure after withdrawal of pericardial fluid indicate that the cardiac tamponade has been relieved. An absence of cough would not indicate the absence of cardiac tamponade. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Pericardiocentesis, p. 836.

Which is a cerebrovascular manifestation of heart failure? Tachycardia Ascites Nocturia Dizziness

Dizziness Explanation: Cerebrovascular manifestations of heart failure include dizziness, lightheadedness, confusion, restlessness, and anxiety. Tachycardia is a cardiovascular manifestation. Ascites is a gastrointestinal manifestation. Nocturia is a renal manifestation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 822.

The nurse monitors a client for side effects associated with furosemide, which is newly prescribed for the treatment of heart failure. Complete the following sentence by choosing from the lists of options. Due to the client's high risk for developing Dropdown Item 1 as a result of the prescribed medication, the nurse focuses on monitoring the client for Dropdown Item 2. hypokalemia ventricular arrhythmia hyponatremia nausea hyperuricemia joint swelling

Due to the client's high risk for developing hypokalemia as a result of the prescribed medication, the nurse focuses on monitoring the client forventricular arrhythmia. Correct response: Incorrect response: Your selection: Explanation: Furosemide, a loop diurectic, is often prescribed for clients who experience fluid volume overload due to a diagnosis of heart failure (HF). The client who is newly prescribed furosemide for the treatment of hypervolemia due to HF is at a high risk for developing fluid and electrolyte abnormalites, with a high risk for hypokalemia. Hypokalemia is a potentially life-threatening complication of loop diuretic therapy due to the risk for cardiac arrhythmias. When assessing a client for hypokalemia, the nurse monitors the client for ventricular arrhythmias. This is a priority in the provision of care for a client who is prescribed furosemide for the treatment of heart failure. Although hyponatremia and hyperuricemia are both potential side effects associated with diuretic therapy, they are not high risks for the client who is prescribed furosemide. Although a symptom of hyponatremia is nausea and joint pain is a symptom of hyperuremia, these are not findings that are expected for a client who experiences hypokalemia due to furosemide therapy.

The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure? Decreased urinary output Dyspnea on exertion Hypotension Tachycardia

Dyspnea on exertion Explanation: Left-sided heart failure produces hypoxemia as a result of reduced cardiac output of arterial blood and respiratory symptoms. Many clients notice unusual fatigue with activity. Some find exertional dyspnea to be the first symptom. An increase in urinary output may be seen later as fluid accumulates. Hypotension would be a later sign of decompensating heart failure as well as tachycardia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Left-Sided Heart Failure, p. 822.

Which diagnostic study is usually performed to confirm the diagnosis of heart failure? Electrocardiogram (ECG) Echocardiogram Serum electrolytes Blood urea nitrogen (BUN)

Echocardiogram Explanation: An echocardiogram is usually performed to confirm the diagnosis of heart failure. ECG, serum electrolytes, and a BUN are usually completed during the initial workup. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 819.

The nurse is caring for a client with a history of heart failure and a sudden onset of tachypnea. What is the nurse's priority action? Elevate the head of the bed. Assess pulse oximetry reading. Report a decrease in urine output. Notify the family of a change in condition.

Elevate the head of the bed. Explanation: The nurse's priority action is to elevate the head of bed to help with breathing. The pulse oximetry reading provides more data, but is not the priority intervention. Reporting a decrease urine output is not a priority for the client. Notification of the family is not a priority to help with breathing. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Medical Management, p. 834.

The nurse is teaching a client about lifestyle modifications after a heart failure diagnosis. What will be included in the teaching? Engage in exercise daily. Restrict dietary potassium. Avoid any alcohol. Drink 3 liters of fluid per day.

Engage in exercise daily. Explanation: Lifestyle recommendations after heart failure include restriction of dietary sodium; avoidance of excessive fluid intake, excessive alcohol intake, and smoking; weight reduction when indicated; and regular exercise. The restriction of potassium is not required. Drinking 3 liters of fluid per day would be excessive for a client with heart failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Medical Management, p. 823.

A client with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, and muffled heart sounds. The nurse recognizes these as symptoms of what occurrence? The pericardial space is eliminated with scar tissue and thickened pericardium. Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. The parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction. Fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction.

Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. Explanation: The cardinal signs of cardiac tamponade are falling systolic blood pressure, narrowing pulse pressure, rising venous pressure (increased JVD), and distant (muffled) heart sounds. Increased pericardial pressure, reduced venous return to the heart, and decreased carbon dioxide result in cardiac tamponade (e.g., compression of the heart). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Pathophysiology, p. 836.

The nurse visits the home of a client with heart failure. Which assessment finding indicates to the nurse that the client's tolerance to activity is deteriorating? Weight loss of 0.5 kg (1.1 lbs.) Bilateral lower extremity edema +1 Needs to use a scooter for shopping Fatigue after walking to answer the door

Fatigue after walking to answer the door Explanation: The client's response to activity needs to be monitored. If the client is at home, the degree of fatigue felt after the activity can be used to assess the response. Weight loss is not used to assess activity tolerance but would be helpful to determine the response to medication therapy. Lower extremity edema is not used to assess activity tolerance but would be helpful to determine the response to medication therapy. Tolerance to exercise would be assessed by monitoring heart rate, which should return to baseline within 3 minutes after the activity. Since the client's heart rate returned to baseline in 2 minutes, the activity is being tolerated. Use of a motorized scooter for shopping would not be the best indicator of exercise and/or activity tolerance.

The nurse is caring for a client with suspected right-sided heart failure. What would the nurse know that clients with suspected right-sided heart failure may experience? Increased urine output Gradual unexplained weight gain Increased perspiration Sleeping in a chair or recliner

Gradual unexplained weight gain Explanation: Clients with right-sided heart failure may have a history of gradual, unexplained weight gain from fluid retention. Left-sided heart failure produces paroxysmal nocturnal dyspnea, which may prompt the client to use several pillows in bed or to sleep in a chair or recliner. Right-sided heart failure does not cause increased perspiration or increased urine output. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Right-Sided Heart Failure, p. 823.

A client with congestive heart failure is admitted to the hospital after reporting shortness of breath. How should the nurse position the client in order to decrease preload? Head of the bed elevated 30 degrees and legs elevated on pillows Head of the bed elevated 45 degrees and lower arms supported by pillows Supine with arms elevated on pillows above the level of the heart Prone with legs elevated on pillows

Head of the bed elevated 45 degrees and lower arms supported by pillows Explanation: Preload refers to the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. The client is positioned or taught how to assume a position that facilitates breathing. The number of pillows may be increased, the head of the bed may be elevated, or the client may sit in a recliner. In these positions, the venous return to the heart (preload) is reduced, pulmonary congestion is alleviated, and pressure on the diaphragm is minimized. The lower arms are supported with pillows to eliminate the fatigue caused by the pull of the client's weight on the shoulder muscles. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 830.

A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect? Pulmonary embolism Heart failure Cardiac tamponade Tension pneumothorax

Heart failure Explanation: A client with heart failure has decreased cardiac output caused by the heart's decreased pumping ability. A buildup of fluid occurs, causing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. A client with pulmonary embolism experiences acute shortness of breath, pleuritic chest pain, hemoptysis, and fever. A client with cardiac tamponade experiences muffled heart sounds, hypotension, and elevated central venous pressure. A client with tension pneumothorax has a deviated trachea and absent breath sounds on the affected side as well as dyspnea and jugular vein distention. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Chart 29-1, p. 822.

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 Explanation: Classification II of heart failure is indicated by the patient being comfortable at rest, but experiencing fatigue, palpitation, or dyspnea during ordinary physical activity. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Table 29-1, p. 819.

Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest? I II III IV

IV Explanation: Symptoms of cardiac insufficiency at rest are classified as IV, according to the New York Heart Association Classification of Heart Failure. In class I, ordinary activity does not cause undue fatigue, dyspnea, palpitations, or chest pain. In class II, ADLs are slightly limited. In class III, ADLs are markedly limited. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Table 29-1, p. 819.

Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure? Decreased central venous pressure Increase in the cardiac index Increased pulmonary artery diastolic pressure Decreased mean pulmonary artery pressure

Increased pulmonary artery diastolic pressure Explanation: Increased pulmonary artery diastolic pressure suggests left-sided heart failure. Central venous pressure increases in heart failure rather than decreases. The cardiac index decreases in heart failure. The mean pulmonary artery pressure increases in heart failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Left-Sided Heart Failure, p. 822.

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. Explanation: Venous return is decreased (not increased) with Pericardial effusion because there is an increase in the pericardial fluid, which raises the pressure within the pericardial sac and compresses the heart. Increased right and left ventricular end-diastolic pressures, inability of the ventricles to fill adequately, and atrial compression are all effects of pericardial effusion. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Pathophysiology, p. 836.

A client diagnosed with pulmonary edema has a PaCO2 of 72 mm Hg and an oxygen saturation of 84%. What method of oxygen delivery would best meet the needs of this client? Intubation and mechanical ventilation Face mask with nonrebreather Oxygen cannula at 6 L/minute Venturi mask at 35%

Intubation and mechanical ventilation Explanation: The client's respiratory status is severely compromised and has developed signs of respiratory failure. When respiratory failure occurs, the client is intubated and oxygen is administered under continuous positive airway pressure or with mechanical ventilation with positive end-expiratory pressure. A face mask, cannula, or Venturi mask will not deliver the concentration or ventilatory support that an endotracheal tube with mechanical ventilation will provide. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Oxygen Therapy, p. 834.

A nurse is assessing a client with congestive heart failure for jugular vein distension (JVD). Which observation is important to report to the physician? No JVD is present. JVD is noted at the level of the sternal angle. JVD is noted 2 cm above the sternal angle. JVD is noted 4 cm above the sternal angle.

JVD is noted 4 cm above the sternal angle. Explanation: JVD is assessed with the client sitting at a 45° angle. Jugular vein distention greater than 4 cm above the sternal angle is considered abnormal and is indicative of right ventricular failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 828.

The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following? Left ventricular function Right ventricular function Left atrial function Right atrial function

Left ventricular function Explanation: The signs and symptoms of cardiogenic shock reflect the circular nature of the pathophysiology of HF. The degree of shock is proportional to the extent of left ventricular dysfunction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Cardiogenic Shock, p. 835.

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. Explanation: The nurse should instruct the client, who is to undergo a MUGA scan, to lie very still at intermittent times during the 45-minute test. The client need not drink plenty of fluids, avoid activities before/after the test, or avoid dairy products during the test.

Which feature is the hallmark of systolic heart failure? Low ejection fraction (EF) Pulmonary congestion Limited activities of daily living (ADLs) Basilar crackles

Low ejection fraction (EF) Explanation: A low EF is a hallmark of systolic heart failure (HF); the severity of HF is frequently classified according to the client's symptoms. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 819.

A nurse is assessing a client with suspected cardiac tamponade. How should the nurse assess the client for pulsus paradoxus? Measure blood pressure in the right arm, then in the left arm as the client slows the pace of his inhalations and exhalations. Measure blood pressure in either arm with the client holding his breath, then with the client breathing normally. Measure the blood pressure in either arm as the client slowly exhales and then as the client breathes normally. Measure the blood pressure in right arm as the client inhales slowly, then measure the blood pressure in the left arm as the client exhales slowly.

Measure the blood pressure in either arm as the client slowly exhales and then as the client breathes normally. Explanation: To determine pulsus paradoxus, the nurse should measure blood pressure in either arm as the client slowly exhales and then as the client breathes normally. Unless the client has cardiac tamponade, the two measurements are usually less than 10 points apart. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Clinical Manifestations, p. 836.

The nurse is caring for a client with severe compensated heart failure. What human brain natriuretic peptide (BNP) medication may be used in a critical care unit with hemodynamic monitoring? Natrecor metoprolol captopril enalapril

Natrecor Explanation: Nesiritide (Natrecor) is a preparation of human BNP that mimics the action of endogenous BNP, causing diuresis and vasodilation, reducing blood pressure, and improving cardiac output. Frequently this medication is titrated in a critical care unit for client safety. It is a preload and afterload reducer. Metoprolol is a beta-blocker. Captopril and enalapril are angiotensin-converting enzyme (ACE) inhibitors. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Intravenous Infusions, p. 826.

Which action will the nurse include in the plan of care for a client admitted with acute decompensated heart failure (ADHF) who is receiving milrinone? Monitor blood pressure frequently Encourage the client to ambulate in room Titrate milrinone rate slowly before discontinuing Teach the client about safe home use of the medication

Monitor blood pressure frequently Explanation: Milrinone is a phosphodiesterase inhibitor that delays the release of calcium from intracellular reservoirs and prevents the uptake of extracellular calcium by the cells. This promotes vasodilation, resulting in decreased preload and afterload and reduced cardiac workload. Milrinone is administered intravenously to clients with severe HF, including those who are waiting for a heart transplant. Because the drug causes vasodilation, the client's blood pressure is monitored before administration because if the client is hypovolemic the blood pressure could drop quickly. The major side effects are hypotension and increased ventricular dysrhythmias. Blood pressure and the electrocardiogram (ECG) are monitored closely during and after infusions of milrinone. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 826.

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 Explanation: Myocardial dysfunction and HF can be caused by a number of conditions, including coronary artery disease, hypertension, cardiomyopathy, valvular disorders, and renal dysfunction with volume overload. Atherosclerosis of the coronary arteries is a primary cause of HF, and coronary artery disease is found in the majority of clients with HF. Ischemia causes myocardial dysfunction because it deprives heart cells of oxygen and causes cellular damage. MI causes focal heart muscle necrosis, myocardial cell death, and a loss of contractility; the extent of the infarction correlates with the severity of HF. Left-sided heart failure is caused by myocardial ischemia. Ineffective right ventricular contraction, pulmonary embolus, and cystic fibrosis cause right-sided heart failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 819.

The nurse is working in a long-term care facility with a group of older adults with cardiac disorders. Why would it be important for the nurse to closely monitor an older adult receiving digitalis preparations for cardiac disorders? Older adults are at increased risk for toxicity. Older adults are at increased risk for cardiac arrests. Older adults are at increased risk for hyperthyroidism. Older adults are at increased risk for asthma.

Older adults are at increased risk for toxicity. Explanation: Older adults receiving digitalis preparations are at increased risk for toxicity because of the decreased ability of the kidneys to excrete the drug due to age-related changes. The margin between a therapeutic and toxic effect of digitalis preparations is narrow. Using digitalis preparations does not increase the risk of cardiac arrests, hyperthyroidism, or asthma. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Table 29-3: Common Medication sUsed to Treat Heart Failure, p. 824.

The nurse is caring for a client with heart failure who has been prescribed digoxin. What laboratory value for the client can precipitate digoxin toxicity? Sodium 128 milliequivalents per liter Sodium 155 milliequivalents per liter Potassium 3.0 milliequivalents per liter Potassium 5.6 milliequivalents per liter

Potassium 3.0 milliequivalents per liter Explanation: The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur. A potassium level of potassium 3.0 milliequivalents per liter is low or hypokalemic. A potassium level of 5.6 is high or hyperkalemic. The sodium levels do not precipitate digoxin toxicity. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Digitalis, p. 826.

Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole? Afterload Preload Ejection fraction Stroke volume

Preload Explanation: Preload is the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. Afterload is the amount of resistance to ejection of blood from a ventricle. The ejection fraction is the percentage of blood volume in the ventricles at the end of diastole that is ejected during systole. Stroke volume is the amount of blood pumped out of the ventricle with each contraction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 677.

A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.) Jugular vein distention Ascites Pulmonary crackles Dyspnea Cough

Pulmonary crackles Dyspnea Cough Explanation: The clinical manifestations of pulmonary congestion associated with left-sided heart failure include dyspnea, cough, pulmonary crackles, and low oxygen saturation levels, but not ascites or jugular vein distention. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Left-Sided Heart Failure, p. 822.

A client has been diagnosed with heart failure. What is the major nursing outcome for the client? Reduce the workload on the heart. Walk 30 minutes three times a week. Maintain a healthy diet. Sleep 8 hours per night.

Reduce the workload on the heart. Explanation: Specific objectives of medical management of heart failure include reducing the workload on the heart by reducing preload and afterload. The other choices are objectives that may be supportive of a healthy lifestyle, but are not specific to a client with heart failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Planning and Goals, p. 829.

The nurse observes a client with an onset of heart failure having rapid, shallow breathing at a rate of 32 breaths/minute. What blood gas analysis does the nurse anticipate finding initially? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory alkalosis Explanation: At first, arterial blood gas analysis may reveal respiratory alkalosis as a result of rapid, shallow breathing. Later, there is a shift to metabolic acidosis as gas exchange becomes more impaired. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Pathophysiology, p. 287.

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 Explanation: Signs and symptoms of Right Ventricular Failure include: Weakness; Ascites; Weight gain; Nausea, vomiting; Dysrhythmias; Elevated central venous pressure; Jugular vein distention. The scenario does not indicate whether the heart failure is chronic or acute. Therefore, options A, B, and C are incorrect. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Right-Sided Heart Failure, p. 823.

Assessment of a client on a medical surgical unit finds a regular heart rate of 120 beats per minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 mL over the past hour. What is the reason the nurse anticipates transferring the client to the intensive care unit? The client is experiencing heart failure. The client is going into cardiogenic shock. The client shows signs of aneurysm rupture. The client is in the early stage of right-sided heart failure.

The client is going into cardiogenic shock. Explanation: This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impeding blood supply and oxygen flow to vital organs. Cardiogenic shock also may cause cold, clammy skin and generalized weakness, fatigue, and muscle pain as poor blood flow causes lactic acid to accumulate and prevents waste removal. Left-sided and right-sided heart failure eventually cause venous congestion with jugular vein distention and edema as the heart fails to pump blood forward. A ruptured aneurysm causes severe hypotension and a quickly deteriorating clinical status from blood loss and circulatory collapse; this client has low but not severely decreased blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and full cardiac arrest is common. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Cardiogenic Shock, p. 835.

A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client? The development of chronic obstructive pulmonary disease (COPD) The development of left-sided heart failure The development of right-sided heart failure The development of cor pulmonale

The development of left-sided heart failure Explanation: When the left ventricle fails, the heart muscle cannot contract forcefully enough to expel blood into the systemic circulation. Blood subsequently becomes congested in the left ventricle, left atrium, and finally the pulmonary vasculature. Symptoms of left-sided failure include fatigue; paroxysmal nocturnal dyspnea; orthopnea; hypoxia; crackles; cyanosis; S3 heart sound; cough with pink, frothy sputum; and elevated pulmonary capillary wedge pressure. COPD develops over many years and does not develop after a myocardial infarction. The development of right-sided heart failure would generally occur after a right ventricle myocardial infarction or after the development of left-sided heart failure. Cor pulmonale is a condition in which the heart is affected secondarily by lung damage. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Left-Sided Heart Failure, p. 822.

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. Explanation: Loop diuretics such as furosemide blocks sodium reabsorption in the ascending loop of Henle, which promotes water diuresis. Furosemide also dilate renal vessels. Although loop diuretics block potassium reabsorption, this isn't a therapeutic action. Thiazide diuretics, not loop diuretics, promote sodium secretion into the distal tubule. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Diuretics, p. 825.

The nurse documents pitting edema in the bilateral lower extremities of the client. What does this documentation mean? There is excess fluid volume in the interstitial space in areas affected by gravity. There is excess fluid volume in the venous system of the lower extremities. There is excess fluid volume in the arterial system of the lower extremities. There is excess fluid volume in the hepatic system.

There is excess fluid volume in the interstitial space in areas affected by gravity. Explanation: Dependent pitting edema (excess fluid volume in the interstitial space in body areas affected by gravity) in the feet and ankles can be observed. This type of edema may seem to disappear overnight but really is temporarily redistributed by gravity to other tissues, such as the sacral area. The other options are not descriptive of pitting edema. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Right-Sided Heart Failure, p. 823.

A client with a history of heart failure is returning from the operating room after inguinal hernia repair and the nurse assesses a low pulse oximetry reading. What is the most important nursing intervention? Assess for jugular vein distention. Administer pain medication. Titrate oxygen therapy. Assess the surgical incisional area.

Titrate oxygen therapy. Explanation: The nurse needs to titrate oxygen therapy to increase the client's oxygen levels. Assessing for jugular vein distention and examining the surgical incision area will not meet the oxygen demands. Administering pain medication will not increase oxygenation levels. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Left-Sided Heart Failure, p. 827.

A client taking an ACE inhibitor has developed a dry, hacking cough. Because of this side effect, the client no longer wants to take that medication. What medication that has similar hemodynamic effects does the nurse anticipate the health care provider ordering? Valsartan Furosemide Metoprolol Isosorbide dinitrate

Valsartan Explanation: If the patient cannot continue taking an angiotensin-converting enzyme (ACE) inhibitor because of development of cough, an elevated creatinine level, or hyperkalemia, an angiotensin receptor blocker (ARB) or a combination of hydralazine and isosorbide dinitrate is prescribed (see Table 29-3). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Table 29-3, p. 824.

The physician writes orders for a patient to receive an angiotensin II receptor blocker for treatment of heart failure. What medication does the nurse administer? Digoxin (Lanoxin) Valsartan (Diovan) Metolazone (Zaroxolyn) Carvedilol (Coreg)

Valsartan (Diovan) Explanation: Valsartan (Diovan) is the only angiotensin receptor blocker listed. Digitalis/digoxin (Lanoxin) is a cardiac glycoside. Metolazone (Zaroxolyn) is a thiazide diuretic. Carvedilol (Coreg) is a beta-adrenergic blocking agent (beta-blocker). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Angiotensin Receptor Blockers, p. 825.

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) Explanation: 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 Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Ventricular Assist Devices, p. 805.

A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status? Measuring and recording fluid intake and output Weighing the client daily at the same time each day Assessing the client's vital signs every 4 hours Checking the client's lungs for crackles during every shift

Weighing the client daily at the same time each day Explanation: Increased fluid volume leads to rapid weight gain — 2.2 lb (1 kg) for each liter of fluid retained. Weighing the client daily at the same time and in similar clothing provides more objective data than measuring fluid intake and output, which may be inaccurate because of omitted measurements such as insensible losses. Changes in vital signs are less reliable than daily weight because these changes usually are subtle during early stages of fluid retention. Weight gain is an earlier sign of excess fluid volume than crackles, which represent pulmonary edema. The nurse should plan to detect fluid accumulation before pulmonary edema occurs. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Chart 29-6, p. 832.

While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). How should the nurse document this sound? a first heart sound (S1). a third heart sound (S3). a fourth heart sound (S4). a murmur.

a third heart sound (S3). Explanation: An S3 is heard following an S2, which commonly occurs in clients experiencing heart failure and results from increased filling pressures. An S1 is a normal heart sound made by the closing of the mitral and tricuspid valves. An S4 is heard before an S1 and is caused by resistance to ventricular filling. A murmur is heard when there is turbulent blood flow across the valves. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Physical Examination, p. 828.

A client with left-sided heart failure reports increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of what condition? right-sided heart failure. acute pulmonary edema. pneumonia. cardiogenic shock.

acute pulmonary edema. Explanation: Shortness of breath, agitation, and pink-tinged, foamy sputum signal acute pulmonary edema. This condition results when decreased contractility and increased fluid volume and pressure in clients with heart failure drive fluid from the pulmonary capillary beds into the alveoli. In right-sided heart failure, the client would exhibit hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia, the client would have a temperature spike and sputum that varies in color. Cardiogenic shock is indicated by signs of hypotension and tachycardia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Left-Sided Heart Failure, p. 822.

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

administration of a vasodilating drug (as ordered by a health care provider) Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Pharmacologic Therapy, p. 824.

The nurse is assessing a client with left-sided heart failure. What assessment finding is expected? ascites jugular vein distention air hunger pitting edema of the legs

air hunger Explanation: With left-sided heart failure, the client typically has air hunger and other signs of pulmonary congestion. Ascites, jugular vein distention, and pitting edema of the legs are signs of right-sided heart failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Left-Sided Heart Failure, p. 822.

A client has been diagnosed with congestive heart failure. This client's cardiac function has been compromised since the client suffered a myocardial infarction 3 years ago. Heart failure is classified by: amount of activity restriction the failure imposes. severity of the MI. length of disability post-MI. using the New York Heart Association scale.

amount of activity restriction the failure imposes. Explanation: Chronic heart failure is classified based on the amount of activity restriction it imposes. Although organizations that develop the classifications may have varying stages, they are all based on the level of activity restriction. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 29: Management of Patients With Complications From Heart Disease, p. 819.

The nurse is caring for a client with heart failure. What sign will lead the nurse to suspect right-sided and left-sided heart failure? warm extremities ascites resting bradycardia weight loss

ascites Explanation: Right-sided heart failure is characterized by signs of circulatory congestion, such as leg edema, jugular vein distention, ascites, and hepatomegaly. Left-sided heart failure is characterized by circumoral cyanosis, crackles, and a productive cough. Mixed heart failures can have all symptoms of right and left plus cool extremities, resting tachycardia, and weight gain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Right-Sided Heart Failure, pp. 821-822.

The nurse is caring for a client with heart failure. What sign will lead the nurse to suspect right-sided heart failure? warm extremities ascites resting bradycardia weight loss

ascites Explanation: Right-sided heart failure is characterized by signs of circulatory congestion, such as leg edema, jugular vein distention, ascites, and hepatomegaly. Left-sided heart failure is characterized by circumoral cyanosis, crackles, and a productive cough. Mixed heart failures can have all symptoms of right and left plus cool extremities, resting tachycardia, and weight gain. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Right-Sided Heart Failure, pp. 821-822.

Medical management of cardiac failure uses similar methodology whether it is right-sided or left-sided. Measures such as dietary modification, lifestyle changes, medications to reduce dyspnea and relieve anxiety, etc. are all used with one primary intention. The primary goal in the medical management of heart failure is to reduce: cardiac workload. cardiac output. pulmonary efficacy. oxygenation.

cardiac workload. Explanation: Medical management of both left-sided and right-sided heart failure is directed at reducing the heart's workload and improving cardiac output. There is no reason for reducing pulmonary efficacy. There is no reason for reducing oxygenation. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 29: Management of Patients With Complications From Heart Disease, p. 823.

A nurse caring for a client recently admitted to the ICU observes the client coughing up large amounts of pink, frothy sputum. Lung auscultation reveals coarse crackles in the lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing decompensated heart failure with pulmonary edema. bilateral pneumonia. acute exacerbation of chronic obstructive pulmonary disease. tuberculosis.

decompensated heart failure with pulmonary edema. Explanation: The production of large quantities of frothy sputum, which is sometimes pink or tan (blood tinged), indicates acute decompensated heart failure with pulmonary edema. These signs can be confused with those of pneumonia and tuberculosis. However, auscultation reveals coarse crackles, which indicate pulmonary edema. A patient with acute COPD would have diminished lung sounds bilaterally. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 822.

A client asks the nurse if systolic heart failure will affect any other body function. What body system response correlates with systolic heart failure (HF)? decrease in renal perfusion increased blood volume ejected from ventricle vasodilation of skin dehydration

decrease in renal perfusion Explanation: A decrease in renal perfusion due to low cardiac output (CO) and vasoconstriction causes the release of renin by the kidney. Systolic HF results in decreased blood volume being ejected from the ventricle. Sympathetic stimulation causes vasoconstriction of the skin, gastrointestinal tract, and kidneys. Dehydration does not correlate with systolic heart failure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Chronic Heart Failure, p. 819.

A nurse is caring for a client with left-sided heart failure. What should the nurse anticipate using to reduce fluid volume excess? antiembolism stockings. oxygen. diuretics. anticoagulants.

diuretics. Explanation: Diuretics, such as furosemide, reduce total blood volume and circulatory congestion. Antiembolism stockings prevent venostasis and thromboembolism formation. Oxygen administration increases oxygen delivery to the myocardium and other vital organs. Anticoagulants prevent clot formation but don't decrease fluid volume excess. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Diuretics, p. 825.

The nurse is assessing a client admitted with cardiogenic shock. What medication will the nurse titrate to improve blood flow to vital organs? dopamine enalapril furosemide metoprolol

dopamine Explanation: Dopamine, a sympathomimetic drug, is used to treat cardiogenic shock. It increases perfusion pressure to improve myocardial contractility and blood flow through vital organs. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic blocker that slows heart rate and lowers blood pressure, undesirable effects when treating cardiogenic shock. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Table 29-4, p. 839.

A client has been having cardiac symptoms for several months and is seeing a cardiologist for diagnostics to determine the cause. How will the client's ejection fraction be measured? echocardiogram electrocardiogram cardiac catheterization cardiac ultrasound

echocardiogram Explanation: The heart's ejection fraction is measured using an echocardiogram or multiple gated acquisition scan, not an electrocardiogram or cardiac ultrasound. Cardiac catheterization is not the diagnostic tool for this measurement. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 29: Management of Patients With Complications From Heart Disease, p. 819.

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 Explanation: Fatigue is commonly the earliest symptom of chronic heart failure; it is caused by decreased cardiac output and tissue oxygenation. Pedal edema and nocturia are symptoms of heart failure, but they occur later in the course of the condition. An irregular pulse can be a complication of heart failure, but it is not necessarily an early indication of the condition. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Table 29-1, p. 819.

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 Explanation: The classic signs of cardiogenic shock are related to tissue hypoperfusion and an overall state of shock that is proportional to the extent of left ventricular damage. Reduced cardiac output and stroke volume reduces arterial blood pressure and tissue perfusion. A myocardial infarction may lead to cardiogenic shock, but is not the premise for the intra-aortic balloon pump. Coronary artery stenosis is not related to shock. Right arterial flutter is not indicative of shock. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Cardiogenic Shock, p. 835.

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 Explanation: Counterpulsation with an intra-aortic balloon pump may be indicated for temporary circulatory assistance in clients with cardiogenic shock. The intra-aortic balloon pump increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen consumption in a client with cardiogenic shock. Cardiac pacemakers are used to maintain the heartbeat at a predetermined rate. Hypothermia-hyperthermia machines are used to cool or warm clients with abnormalities in temperature regulation. The defibrillator is commonly used for termination of life-threatening ventricular rhythms. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Mechanical Circulatory Assistive Devices, p. 835.

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 Explanation: Several medications are routinely prescribed for heart failure (HF), including angiotensin-converting enzyme (ACE) inhibitors such as lisinopril, beta-blockers, and diuretics such as bumetanide. Many of these medications, particularly ACE inhibitors and beta-blockers, improve symptoms and extend survival. Others, such as diuretics, improve symptoms but may not affect survival. Calcium channel blockers such as diltiazem are no longer recommended for patients with HF because they are associated with worsening failure. Cholestyramine is used to lower cholesterol. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Angiotensin-Converting Enzyme Inhibitors, pp. 824-825.

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 Explanation: 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. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 29: Management of Patients With Complications From Heart Disease, p. 834.

The nurse is caring for a client with heart failure who is receiving a diuretic medication. What implementation will help the nurse evaluate the client's response of the medication? using mechanical ventilation measuring intake and output obtaining cardiac output with a pulmonary catheter asking the client about comfort level

measuring intake and output Explanation: To evaluate response to a diuretic, intake and output are monitored. Mechanical ventilation helps maintain a normal breathing pattern. A pulmonary artery catheter helps estimate cardiac output. Asking the client about comfort level will not assess urinary output. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 823.

A client has been admitted to the cardiac step-down unit with acute pulmonary edema. Which symptoms would the nurse expect to find during assessment? moist, gurgling respirations drowsiness, numbness increased cardiac output hypertension

moist, gurgling respirations Explanation: Clients with acute pulmonary edema experience sudden dyspnea, wheezing, orthopnea, cough, cyanosis, and tachycardia. Respirations sound moist or gurgling. Drowsiness and numbness are not considered issues. Increased cardiac output is not part of this checklist. Hypertension is not an immediate symptom. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 29: Management of Patients With Complications From Heart Disease, p. 834.

A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client? Vasculitis nausea and vomiting Flexion contractures Enlargement of joints

nausea and vomiting Explanation: Digitalis medications are potent and may cause various toxic effects. The nurse should monitor the client for signs of digitalis toxicity, not just during the initial period of therapy, but throughout care management. The most common signs and symptoms include nausea and vomiting which can lead to dehydration and electrolyte imbalance. Symptoms of toxicity do not include vasculitis, flexion contractures, or enlargement of joints. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 825.

A nurse reviews the client's medical record and reads in the progress notes that the client has decreased left ventricular function. What assessment will validate the diagnosis? increased appetite bibasilar rales cleared with coughing orthopnea resting bradycardia

orthopnea Explanation: Decreased left ventricular function would be characterized by orthopnea, dyspnea, anorexia, bibasilar rales not cleared with coughing, and resting tachycardia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Chronic Heart Failure, p. 819.

When a client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating orthopnea. dyspnea upon exertion. hyperpnea. paroxysmal nocturnal dyspnea.

orthopnea. Explanation: Clients with orthopnea prefer not to lie flat and will need to maintain their beds in a semi- to high Fowler position. Dyspnea upon exertion refers to difficulty breathing with activity. Hyperpnea refers to increased rate and depth of respiration. Paroxysmal nocturnal dyspnea refers to orthopnea that occurs only at night. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 822.

A client is receiving captopril for heart failure. During the nurse's assessment, what sign indicates that the medication therapy is ineffective? skin rash peripheral edema bradycardia postural hypotension

peripheral edema Explanation: Peripheral edema is a sign of fluid volume excess and worsening heart failure. A skin rash and postural hypotension are adverse reactions to captopril, but they don't indicate that therapy is ineffective. The individual will also most like experience trachycardia instead of bradycardia if the heart failure is worsening ang not responding to captopril. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Medical Management, p. 834.

The nurse completes an assessment of a client admitted with a diagnosis of right-sided heart failure. What will be a significant clinical finding related to right-sided heart failure? pitting edema oliguria S4 ventricular gallop sign decreased O2 saturation levels

pitting edema Explanation: The presence of pitting edema is a significant sign of right-sided heart failure because it indicates fluid retention of about 10 lbs. Sodium and water are retained because reduced cardiac output causes a compensatory neurohormonal response. Oliguria is a sign of kidney failure or dehydration. The S4 heart sound is from a thickened left ventricle, seen with aortic stenosis or hypertension. The decreased oxygen saturation levels are from hypoxemia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Right-Sided Heart Failure, p. 823.

The nurse is administering digoxin to a client with heart failure. What laboratory value may predispose the client to digoxin toxicity? magnesium level of 2.5 mg/dL calcium level of 7.5 mg/dL sodium level of 152 mEq/L potassium level of 2.8 mEq/L

potassium level of 2.8 mEq/L Explanation: Conditions that may predispose a client to digoxin toxicity include hypokalemia (evidenced by a potassium level less than 3.5 mEq/L), hypomagnesemia (evidenced by a magnesium level less than 1.5 mEq/L), hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia (evidenced by a magnesium level greater than 2.5 mEq/L), hypercalcemia (evidenced by an ionized calcium level greater than 5.3 mg/dl), and hypernatremia (evidenced by a sodium level greater than 145 mEq/L) aren't associated with a risk of digoxin toxicity. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Digitalis, p. 826.

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 Explanation: High pulmonary artery wedge pressures are diagnostic for left-sided heart failure. With left-sided heart failure, pulmonary edema can develop causing pulmonary crackles. In left-sided heart failure, hypotension may result and urine output will decline. Dry mucous membranes aren't directly associated with elevated pulmonary artery wedge pressures. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, Left-Sided Heart Failure, p. 822.

A client who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly reports chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the client for other signs and symptoms of myocardial infarction. pulmonary embolism. pneumonia. pulmonary edema.

pulmonary embolism. Explanation: Pulmonary embolism is a potentially life-threatening disorder typically caused by blood clots in the lungs. This disorder poses a particular threat to people with cardiovascular disease. Blood clots that form in the deep veins of the legs and embolize to the lungs can cause a pulmonary infarction, whereby emboli mechanically obstruct the pulmonary vessels, cutting off the blood supply to sections of the lung. Clinical indicators of pulmonary embolism can vary but typically include dyspnea, pleuritic chest pain, and tachypnea. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 836.

The nurse finds a client unresponsive in the hospital room and calls a cardiac arrest. Which health care professionals will be responsible for an insertion of the endotracheal tube during the cardiac arrest? Select all that apply. respiratory therapist nurse nurse anesthetist physician paramedic

respiratory therapist nurse anesthetist physician Explanation: Respiratory therapists, physicians, and nurse anesthetists can place an endotracheal airway during cardiac arrest in a hospital. Nurses and paramedics may insert endotracheal tubes in the community setting (field), but not in the hospital. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 29: Management of Patients With Complications from Heart Disease, p. 838.