Chapter 35 2040
After receiving a change-of-shift report about these four clients, which client should the nurse assess first? A 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset frequent premature ventricular contractions B 55-year-old admitted with pulmonary edema who received furosemide (Lasix) and whose current O2 saturation is 94% C 68-year-old with pericarditis who is reporting sharp, stabbing chest pain when taking deep breaths D 79-year-old admitted for possible rejection of a heart transplant who has sinus tachycardia, heart rate 104 beats/min
A
Before administering furosemide (Lasix) to a client with heart failure, it is most important for the nurse to assess which diagnostic test result? A Serum electrolytes B Arterial blood gases C Hemoglobin and hematocrit D B-type natriuretic peptide
A
For which heart condition is it most important for the home health nurse to discuss an advance directive with the client and family? A Heart failure B Valvular heart disease C Infective endocarditis D Rheumatic carditis
A
One hour after administering enalapril (Vasotec) to a client with heart failure (HF), the client reports dizziness and the nurse notes a blood pressure of 82/46 mm Hg. Which is the nurse's priority action? A Place the client flat in bed. B Initiate cardiac monitoring. C Notify the health care provider. D Obtain an order for dopamine (Intropin).
A
The nurse discusses the importance of restricting sodium in the diet of a client with heart failure. Which statement made by the client indicates that the client needs further teaching? A "I should avoid eating hamburgers." B "I must cut out bacon and canned foods." C "I shouldn't put the salt shaker on the table anymore." D "I should avoid lunchmeats but may cook my own turkey."
A
The nurse is caring for an 82-year-old client admitted for exacerbation of heart failure (HF). The nurse questions the client about the use of which medication because it raises an index of suspicion as to the worsening of the client's HF? A Ibuprofen (Motrin) B Hydrochlorothiazide (HydroDIURIL) C NPH insulin D Levothyroxine (Synthroid)
A
The nurse is providing discharge teaching to a client with heart failure, focusing on when to seek medical attention. Which statement by the client indicates a correct understanding of the teaching? A "I will call the provider if I have a cough lasting 3 or more days." B "I will report to the provider weight loss of 2-3 pounds in a day." C "I will try walking for 1 hour each day." D "I should expect occasional chest pain."
A
The nurse is providing education to a client with heart failure (HF) based on the Heart Failure Core Measure Set. Which point is essential for the nurse to include? A Encouraging the client to stop smoking B Ensuring oxygen is available for home use C Assisting the client in completing an advance directive D Instructing to notify the provider of weight loss greater than 3 lbs in 3 days
A
Which factor is the most common etiology of heart failure? A Hypertension B Hyperkinetic conditions C Obesity D Structural heart changes
A
Which factor reflects the most common etiology of heart failure? A Myocardial infarction (MI) B Valvular disorders C Fluid volume excess D Ventricular dilation
A
Which specific type of heart failure (HF) is most likely to occur at the beginning of chronic HF? A Left-sided B Right-sided C High-output D Bilateral
A
For which cardiac conditions is antimicrobial therapy most likely to be used? Select all that apply. A Infective endocarditis B Rheumatic carditis C Valvular heart disease D Cardiomyopathy E Heart failure
A,B,C
Which drugs are contraindicated in hypertrophic cardiomyopathy? Select all that apply. A Diuretics B Nitrates C Cardiac glycosides D Calcium antagonists E Beta-adrenergic blockers
A,B,C
Which are major compensatory mechanisms when cardiac output is insufficient to meet the demands of the body? Select all that apply. A Sympathetic nervous system stimulation B Renin-angiotensin system activation C Chemical responses D Myocardial hypertrophy E Pulmonary hypertension
A,B,C,D
What are common signs and symptoms of right-sided heart failure? Select all that apply. A Nausea and vomiting B Increase in weight C A hacking cough D Dependent edema E Oliguria during the day
A,B,E
Which conditions can cause high-output heart failure? Select all that apply. A High fever B Septicemia C Valvular disease D Hyperthyroidism E Coronary artery disease
A,B,E
Which drugs are contraindicated in hypertrophic cardiomyopathy? Select all that apply. A Diuretics B Nitrates C Cardiac glycosides D Calcium antagonists E Beta-adrenergic blockers
A,B.C
What are the symptoms of left-sided heart failure? Select all that apply. A Hacking cough B Dependent edema C Distended abdomen D Oliguria during the day E Frothy, pink-tinged sputum
A,D,E
What are common symptoms of hypokalemia? Select all that apply. A Weakness B Cool extremities C Dependent edema D Depressed reflexes E Irregular heart rate
A,D.E
Which factors are associated with the development of infective endocarditis? Select all that apply. A Sepsis B Heart failure C Pulmonary embolism D Myocardial infarction E Cystoscopy 2 days ago F Intravenous heroin use
A,E,F
A client begins therapy with lisinopril (Prinivil, Zestril). What does the nurse consider at the start of therapy with this medication? A The client's ability to understand medication teaching B The risk for hypotension C The potential for bradycardia D Liver function tests
B
A client with heart failure is taking furosemide (Lasix). Which finding concerns the nurse with this new prescription? A Serum sodium level of 135 mEq/L B Serum potassium level of 2.8 mEq/L C Serum creatinine of 1.0 mg/dL D Serum magnesium level of 1.9 mEq/L
B
How does the nurse in the cardiac clinic recognize that the client with heart failure has demonstrated a positive outcome related to the addition of metoprolol (Lopressor) to the medication regimen? A Ejection fraction is 25%. B Client states that she is able to sleep on one pillow. C Client was hospitalized five times last year with pulmonary edema. D Client reports that she experiences palpitations.
B
The home health nurse visits a client with heart failure who has gained 5 pounds in the past 3 days. The client states, "I feel so tired and short of breath." Which action does the nurse take first? A Assess the client for peripheral edema. B Listen to the client's posterior breath sounds. C Notify the health care provider about the client's weight gain. D Remind the client about dietary sodium restrictions.
B
The nurse is providing education to a client with heart failure (HF) about an appropriate diet. Which information is most important for the nurse to emphasize? A "Avoid grapefruit juice." B "Do not add any salt to your food." C "Increase fluids to 100 ounces daily." D "Try to increase the amount of green leafy vegetables you eat.
B
Which client is best to assign to an LPN/LVN working on the telemetry unit? A Client with heart failure who is receiving dobutamine (Dobutrex) B Client with restrictive cardiomyopathy who uses oxygen for exertional dyspnea C Client with pericarditis who has a paradoxical pulse and distended jugular veins D Client with rheumatic fever who has a new systolic murmur
B
Which medication when given in heart failure may reduce the incidence of morbidity and mortality? A Dobutamine (Dobutrex) B Carvedilol (Coreg) C Digoxin (Lanoxin) D Bumetamide (Bumex)
B
Which parameter, determined through laboratory testing, is known as the "early warning detector" for heart failure? A Hematocrit B Microalbuminuria C Electrocardiogram D B-type natriuretic peptide
B
What finding does the nurse expect when assessing a client with long-standing heart failure? Select all that apply. A Weight loss B Swollen abdomen C Third heart sound D Shortness of breath with activity E Awakening with breathlessness F Productive cough with yellow sputum
B,C,D,E
The nurse caring for a client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider? Select all that apply. A Hypokalemia B Sinus bradycardia C Fatigue D Serum digoxin level of 1.5 E Anorexia
B,C,E
What are symptoms of aortic stenosis? Select all that apply. A Polyuria B Debilitation C Marked fatigue D Nocturnal angina E Peripheral cyanosis
B,C,E
The client, a college athlete who collapsed during soccer practice, has been diagnosed with hypertrophic cardiomyopathy. The client says, "How can this be? I am in great shape. I eat right and exercise." What is the nurse's best response? A "How does this make you feel?" B "This can be caused by taking performance-enhancing drugs." C "This may be caused by a genetic trait." D "Just imagine how bad it would be if you weren't in good shape."
C
The nurse is assessing a client with a cardiac infection. Which symptoms support the diagnosis of infective endocarditis instead of pericarditis or rheumatic carditis? A Friction rub auscultated at the left lower sternal border B Pain aggravated by breathing, coughing, and swallowing C Splinter hemorrhages D Thickening of the endocardium
C
The nurse teaches a client with heart failure to begin exercising when permitted by the health care provider. Which beginning activity does the nurse suggest as appropriate? A Knitting B Jogging C Walking D Weightlifting
C
The use of which drug may pose a risk for the development of heart failure, especially in older adults? A Insulin B Digoxin (Lanoxin) C Ibuprofen (Advil) D Potassium chloride
C
When following up in the clinic with a client with heart failure, how does the nurse recognize that the client has been compliant with fluid restrictions? A Auscultation of crackles B Pedal edema C Weight loss of 6 pounds since the last visit D Reports sucking on ice chips all day for dry mouth
C
Which intervention best assists the client with acute pulmonary edema in reducing anxiety and dyspnea? A Monitor pulse oximetry and cardiac rate and rhythm. B Reassure the client that his distress can be relieved with proper intervention. C Place the client in high Fowler's position with the legs down. D Ask a family member to remain with the client.
C
Which nursing action should the nurse delegate to a nursing assistant working on the medical unit? A Determine the usual alcohol intake for a client with cardiomyopathy. B Monitor the pain level for a client with acute pericarditis. C Obtain daily weights for several clients with class IV heart failure. D Check for peripheral edema in a client with endocarditis.
C
Which nursing intervention for a client admitted today with heart failure will assist the client to conserve energy? A Client ambulates around the nursing unit with a walker. B The nurse monitors the client's pulse and blood pressure frequently. C The nurse obtains a bedside commode before administering furosemide. D The nurse returns the client to bed when he becomes tachycardic.
C
While caring for a client receiving digoxin (Lanoxin) for heart failure, the nurse becomes concerned when the client demonstrates which sign/symptom? A Weight loss B Increased urine output C Sinus bradycardia, rate of 48 beats/min D Dry tongue and tented skin
C
What are the intended outcomes of ultrafiltration when performed in a client with renal dysfunction? Select all that apply. A Increase in aldosterone B Decrease in cardiac index C Decrease in filling pressures D Reduction in norepinephrine E Decrease in pulmonary arterial pressure
C,D,E
A client admitted for heart failure has a priority problem of hypervolemia related to compromised regulatory mechanisms. Which assessment data obtained the day after admission is the best indicator that the treatment has been effective? A The client has diuresis of 400 mL in 24 hours. B The client's blood pressure is 122/84 mm Hg. C The client has an apical pulse of 82 beats/min. D The client's weight decreases by 2.5 kg.
D
A client has a history of acute dyspnea. Which test is used for diagnosing diastolic heart failure in this client? A Chest x-rays B Electrocardiogram C Multigated angiographic D B-type natriuretic peptide
D
A client has refractory end-stage heart failure. In which class of the New York Heart Association (NYHA) functional classification system is the client categorized? A Class I NYHA B Class II NYHA C Class III NYHA D Class IV NYHA
D
A client reports waking with a feeling of breathlessness 2 to 5 hours after falling asleep. What condition may this indicate? A Orthopnea B Exertional dyspnea C High-output heart failure D Paroxysmal nocturnal dyspnea
D
An older adult client with type 2 diabetes mellitus is being treated with rosiglitazone (Avandia). Which condition is the client susceptible to? A Difficulty in breathing B Obstructive sleep apnea C Cardiac infection D Acute myocardial infarction
D
In testing arterial blood gas values which condition can be a probable cause of metabolic acidosis? A Hyperventilation B Potassium retention C Carbon dioxide retention D Accumulation of lactic acid
D
The nurse prepares to administer digoxin to a client with heart failure and notes the following information: temperature: 99.8° F; pulse: 48; irregular respirations: 20; potassium level: 3.2 mEq/L. What action does the nurse take? A Give digoxin; reassess the heart rate in 30 minutes. B Give the digoxin; document assessment findings in the medical record. C Hold the digoxin and obtain a prescription for an additional dose of furosemide. D Hold the digoxin and obtain a prescription for a potassium supplement.
D
Which assessment or test is used to confirm a diagnosis of infective endocarditis? A Presence of third heart sound B Echocardiogram C Complete blood count D Positive blood cultures
D
Which diagnostic reading does the nurse anticipate may be elevated in a client with heart failure? A Sodium B Calcium C Cardiac output D B-type natriuretic peptide
D
Which finding is consistent with digoxin toxicity? A Weight gain B Worsening heart failure C Orthostatic hypotension D Blurred vision
D
Which ventricular reconstructive procedure involves the removal of portions of the cardiac septum and left ventricular wall? A Myosplint B Partial left ventriculectomy C Acorn cardiac support device D Endoventricular circular patch cardioplasty
D
The nurse is providing community education on the risks for heart failure. Which topics does the nurse include in the discussion? Select all that apply. A Hypothyroidism B Hypotension C Use of anxiolytic medications D Cocaine use E Aortic stenosis F Sinus arrhythmia
D,E