Chapter 32: Concepts of Care for Patients with Cardiac Problems

A nurse assesses a client who has a history of heart failure. Which question would the nurse ask to assess the extent of the client's heart failure?

"Are you still able to walk upstairs without fatigue?"

A nurse teaches a client who has a history of heart failure. Which statement would the nurse include in this client's discharge teaching?

"Weigh yourself daily while wearing the same amount of clothing."

A nurse prepares to discharge a client who has heart failure. Based on national quality measures, what actions would the nurse complete prior to discharging this client? (Select all that apply.)

- Ensure that the client is prescribed a beta blocker. - Document a discussion about advanced directives. - Confirm that a postdischarge nurse visit has been scheduled. - Care transition record transmitted to next level of care within 7 days of discharge.

A nurse evaluates laboratory results for a client with heart failure. Which results would the nurse expect? (Select all that apply.)

- Hematocrit: 32.8% - Serum sodium: 130 mEq/L (130 mmol/L) - Proteinuria - Microalbuminuria

A nurse is assessing a client with left-sided heart failure. For which clinical manifestations would the nurse assess? (Select all that apply.)

- Pulmonary crackles - Confusion - Cough that worsens at night

A nurse assesses a client who is recovering from a heart transplant. Which assessment findings would alert the nurse to the possibility of heart transplant rejection? (Select all that apply.)

- Shortness of breath - Abdominal bloating - New-onset bradycardia - Fatigue

A nurse assesses clients on a cardiac unit. Which client would the nurse identify as being at greatest risk for the development of left-sided heart failure?

A 36-year-old woman with aortic stenosis

A nurse assesses a client after administering the first dose of a nitrate. The client reports a headache. What action would the nurse take?

Administer PRN acetaminophen.

A nurse is providing discharge teaching to a client recovering from a heart transplant. Which statement would the nurse include?

"Avoid large crowds and people who are sick."

A nurse is teaching a client with heart failure who has been prescribed enalapril. Which statement would the nurse include in this client's teaching?

"Avoid using salt substitutes."

A nurse teaches a client with heart failure about energy conservation. Which statement would the nurse include in this client's teaching?

"Begin walking 200 feet a day three times a week."

A nurse cares for a client recovering from prosthetic valve replacement surgery. The client asks, "Why will I need to take anticoagulants for the rest of my life?" What is the best response by the nurse?

"Blood clots form more easily in artificial replacement valves."

A nurse teaches a client who is prescribed digoxin therapy. Which statement would the nurse include in this client's teaching?

"Do not take this medication within 1 hour of taking an antacid."

A nurse cares for an older adult client with heart failure. The client states, "I don't know what to do. I don't want to be a burden to my daughter, but I can't do it alone. Maybe I should die." What is the best response by the nurse?

"I can stay if you would you like to talk more about this."

A nurse assesses a client in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure?

"I must stop halfway up the stairs to catch my breath."

After teaching a client who is being discharged home after mitral valve replacement surgery, the nurse assesses the client's understanding. Which client statement indicates a need for additional teaching?

"I will have my teeth cleaned by my dentist in 2 weeks."

A nurse assesses a client admitted to the cardiac unit. Which statement by the client alerts the nurse to the possibility of right-sided heart failure?

"My shoes fit really tight lately."

A nurse cares for a client with right-sided heart failure. The client asks, "Why do I need to weigh myself every day?" How would the nurse respond?

"Weight is the best indication that you are gaining or losing fluid."

A nurse cares for a client with end-stage heart failure who is awaiting a transplant. The client appears depressed and states, "I know a transplant is my last chance, but I don't want to become a vegetable." How would the nurse respond?

"Would you like information about advance directives?"

After teaching a client who is recovering from a heart transplant to change positions slowly, the client asks, "Why is this important?" How would the nurse respond?

"Your new heart is not connected to the nervous system and is unable to respond to decreases in blood pressure caused by position changes."

A nurse prepares to discharge a client who has heart failure. Which questions would the nurse ask to ensure this client's safety prior to discharging home? (Select all that apply.)

- "Are your bedroom and bathroom on the first floor?" - "What social support do you have at home?" - "What spiritual beliefs may impact your recovery?"

After teaching a client with congestive heart failure (CHF), the nurse assesses the client's understanding. Which client statements indicate a correct understanding of the teaching related to nutritional intake? (Select all that apply.)

- "I'll read the nutritional labels on food items for salt content." - "I will eat oatmeal for breakfast instead of ham and eggs." - "Substituting fresh vegetables for canned ones will lower my salt intake."

A nurse collaborates with assistive personnel (AP) to provide care for a client with congestive heart failure. Which instructions would the nurse provide to the AP when delegating care for this client? (Select all that apply.)

- "Reposition the client every 2 hours." - "Accurately record intake and output." - "Use the same scale to weigh the client each morning."

A nurse assesses clients on a cardiac unit. Which clients would the nurse identify as at greatest risk for the development of acute pericarditis? (Select all that apply.)

- A 36-year-old woman with systemic lupus erythematosus (SLE) - A 42-year-old man recovering from coronary artery bypass graft surgery - An 80-year-old man with a bacterial infection of the respiratory tract

A nurse is caring for a client who was admitted with hypertrophic cardiomyopathy (HCM). What interprofessional care does the nurse anticipate providing? (Select all that apply.)

- Administering beta blockers - Preparing for a cardiac catheterization - Instructing the client to avoid strenuous exercise

While assessing a client on a cardiac unit, a nurse identifies the presence of an S3 gallop. What action would the nurse take next?

Assess for symptoms of left-sided heart failure.

A nurse admits a client who is experiencing an exacerbation of heart failure. What action would the nurse take first?

Assess the client's respiratory status.

A nurse assesses a client who has mitral valve regurgitation. For which cardiac dysrhythmia would the nurse assess?

Atrial fibrillation

A nurse assesses a client with mitral valve stenosis. What clinical sign or symptom would alert the nurse to the possibility that the client's stenosis has progressed?

Dyspnea on exertion

A nurse assesses a client with pericarditis. Which assessment finding would the nurse expect to find?

Friction rub at the left lower sternal border.

After administering the first dose of captopril to a client with heart failure, the nurse implements interventions to decrease complications. Which intervention is most important for the nurse to implement?

Instruct the client to ask for assistance when rising from bed.

A nurse is caring for a client with acute pericarditis who reports substernal precordial pain that radiates to the left side of the neck. Which nonpharmacologic comfort measure would the nurse implement?

Sit the client up with a pillow to lean forward on.

A nurse cares for a client with infective endocarditis. Which infection control precautions would the nurse use?

Standard Precautions