Chapter 29

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? A) "I sleep on three pillows each night." B) "My feet are bigger than normal." C) "My pants don't fit around my waist." D) "I don't have the same appetite I used to."

"I sleep on three pillows each night."

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

"I'm having trouble going up the steps during the day."

A client has had an echocardiogram to measure ejection fraction. The nurse explains that ejection fraction is the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects? A) 55% B) 50% C) 45% D) 40%

55%

A client has been experiencing increasing shortness of breath and fatigue. The health care provider has ordered a diagnostic test in order to determine what type of heart failure the client is having. What diagnostic test does the nurse anticipate being ordered? A) A chest x-ray B) An echocardiogram C) An electrocardiogram D) A ventriculogram

An echocardiogram

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

Atrial fibrillation

A client with chronic heart failure is able to continue with his regular physical activity and does not have any limitations as to what he can do. According to the New York Heart Association (NYHA), what classification of chronic heart failure does this client have? A) Class I (Mild) B) Class II (Mild) C) Class III (Moderate) D) Class IV (Severe)

Class I (Mild)

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

Decrease in central venous pressure (CVP)

A client is exhibiting digitalis toxicity. Which of the following medications would the nurse expect to be ordered for this client? A) Digoxin immune FAB B) Ibuprofen C) Warfarin D) Amlodipine

Digoxin immune FAB

Which medication reverses digitalis toxicity? A) Ibuprofen B) Warfarin C) Amlodipine D) Digoxin immune FAB

Digoxin immune FAB

The nurse assessing a client with an exacerbation of heart failure identifies which symptom as a cerebrovascular manifestation of heart failure (HF)? A) Tachycardia B) Ascites C) Nocturia D) Dizziness

Dizziness

Which is a cerebrovascular manifestation of heart failure? A) Tachycardia B) Ascites C) Nocturia D) Dizziness

Dizziness

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

Dyspnea on exertion

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

Echocardiogram

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? A) The pericardial space is eliminated with scar tissue and thickened pericardium. B) Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. C) The parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction. D) 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.

Which medication is categorized as a loop diuretic? A) Chlorothiazide B) Chlorthalidone C) Spironolactone D) Furosemide

Furosemide

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? A) Increased urine output B) Gradual unexplained weight gain C) Increased perspiration D) Sleeping in a chair or recliner

Gradual unexplained weight gain

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? A) Head of the bed elevated 30 degrees and legs elevated on pillows B) Head of the bed elevated 45 degrees and lower arms supported by pillows C) Supine with arms elevated on pillows above the level of the heart D) Prone with legs elevated on pillows

Head of the bed elevated 45 degrees and lower arms supported by pillows

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

IV

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

JVD is noted 4 cm above the sternal angle.

The nurse identifies which symptom as a characteristic of right-sided heart failure? A) Jugular vein distention (JVD) B) Dyspnea C) Pulmonary crackles D) Cough

Jugular vein distention (JVD)

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

Low ejection fraction (EF)

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? A) Monitor blood pressure frequently B) Encourage the client to ambulate in room C) Titrate milrinone rate slowly before discontinuing D) Teach the client about safe home use of the medication

Monitor blood pressure frequently

Which describes difficulty breathing when a client is lying flat? A) Paroxysmal nocturnal dyspnea (PND) B) Orthopnea C) Tachypnea D) Bradypnea

Orthopnea

The nurse is preparing to administer furosemide to a client with severe heart failure. What lab study should be of most concern for this client while taking furosemide? A) BNP of 100 B) Sodium level of 135 C) Hemoglobin of 12 D) Potassium level of 3.1

Potassium level of 3.1

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

Preload

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

The nurse recognizes which symptom as a classic sign of cardiogenic shock? A) Restlessness and confusion B) Hyperactive bowel sounds C) High blood pressure D) Increased urinary output

Restlessness and confusion

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? A) The client is experiencing heart failure. B) The client is going into cardiogenic shock. C) The client shows signs of aneurysm rupture. D) The client is in the early stage of right-sided heart failure.

The client is going into cardiogenic shock.

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? A) The development of chronic obstructive pulmonary disease (COPD) B) The development of left-sided heart failure C) The development of right-sided heart failure D) The development of cor pulmonale

The development of left-sided heart failure

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? A) Valsartan B) Furosemide C) Metoprolol D) Isosorbide dinitrate

Valsartan

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

Weighing the client daily at the same time each day

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? A) warm extremities B) ascites C) resting bradycardia D) weight loss

ascites

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

ascites

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

canned peas.

The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema? A) decreased left ventricular pumping B) decreased right ventricular elasticity C) increased left atrial contractility D) increased right atrial resistance

decreased left ventricular pumping

The nurse is providing care to a client with cardiogenic shock requiring a intra-aortic balloon pump (IABP). What is the therapeutic effect of the IABP therapy? A) decreased left ventricular workload B) decreased right ventricular workload C) decreased peripheral perfusion to the extremities D) decreased renal perfusion

decreased left ventricular workload

Frequently, what is the earliest symptom of left-sided heart failure? A) dyspnea on exertion B) anxiety C) confusion D) chest pain

dyspnea on exertion

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? A) echocardiogram B) electrocardiogram C) cardiac catheterization D) cardiac ultrasound

echocardiogram

The nurse is teaching a client with heart failure about the ability for the heart to pump out blood. What diagnostic test will measure the ejection fraction of the heart? A) MRI B) pulmonary arterial pressure C) echocardiogram D) nuclear angiography

echocardiogram

The nurse is assessing a newly admitted client with chest pain. What medical disorder is most likely causing the client to have jugular vein distention? A) abdominal aortic aneurysm B) heart failure C) myocardial infarction (MI) D) pneumothorax

heart failure

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

inadequate cardiac output

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

nausea and vomiting

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

peripheral edema

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? A) pitting edema B) oliguria C) S4 ventricular gallop sign D) decreased O2 saturation levels

pitting edema

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

potassium level of 2.8 mEq/L

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 A) myocardial infarction. B) pulmonary embolism. C) pneumonia. D) pulmonary edema.

pulmonary embolism.

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

vision changes.

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? A) visual disturbances. B) taste and smell alterations. C) dry mouth and urine retention. D) nocturia and sleep disturbances.

visual disturbances.