nur 111 - Davis - Left and Right Heart Failure

The nurse is teaching about spironolactone as a treatment for patients with heart failure. Which dietary instruction indicates a need for further teaching? "Avoid alcohol intake." "Limit salt in your diet." "Decrease the intake of foods that are high in fat." "Increase the intake of potassium-containing foods."

"Increase the intake of potassium-containing foods." Rationale: Spironolactone is a potassium-sparing diuretic that helps to prevent further scarring of heart tissue. If dietary potassium intake is increased while the patient is taking spironolactone, it may worsen the condition by increasing serum potassium levels. Test Taking Tips: Look for the incorrect answer.

Fatigue ALTERNATE REST/ACTIVITY or GIVE ANTIDEPRESSANT

ALTERNATE REST/ACTIVITY CORRECT. Fatigue is a common clinical manifestation associated with heart failure. The nurse should alternate rest and activity periods for this patient. An antidepressant may be prescribed for the depression that often accompanies a diagnosis of heart failure.

Which drug classification should the nurse anticipate for a client diagnosed with heart failure to reduce fluid volume and afterload? Diuretic Inotropic Angiotensin-converting-enzyme inhibitor Beta blocker

Angiotensin-converting-enzyme inhibitor

Which are the clinical manifestations of right-sided heart failure? Select all that apply. Ascites Dyspnea Hepatomegaly Generalized edema Weak pulses

Ascites Hepatomegaly Generalized edema

The nurse is assessing a patient who is suspected to have left-sided heart failure. Which assessment provides specific information regarding the left-sided heart function? Auscultating lung sounds Monitoring for hepatomegaly Palpating for peripheral edema Assessing for jugular vein distension

Auscultating lung sounds Rationale: Left-sided heart failure is characterized by shortness of breath (dyspnea), fatigue, and crackles heard on auscultation. Therefore, the nurse should auscultate lung sounds. Test Taking Tips: Differentiate between assessment of left and right failure.

Which medication is prescribed to enhance contractility of the heart muscle in patients suffering from heart failure? Beta blockers Angiotensin receptor blockers (ARB) Cardiac glycosides Venous vasodilators

Cardiac glycosides Rationale: Cardiac glycosides are usually administered to patients to increase contractility of the heart muscle. This medication acts as a positive inotrope agent. Test Taking Tips: Differentiate medications of contractility.

The nurse is reviewing the compensatory mechanisms of heart failure. Place the sequence of events in the correct order. Release of the renin-angiotensin-aldosterone system Brain natriuretic peptide release Increase in venous return to the heart Sympathetic nervous system release of epinephrine and norepinephrine

Correct Position: 1 - Sympathetic nervous system release of epinephrine and norepinephrine Correct Position: 2 - Release of the renin-angiotensin-aldosterone system Correct Position: 3 - Increase in venous return to the heart Correct Position: 4 - Brain natriuretic peptide release Rationale: Compensatory mechanisms are activated in response to decreased stroke volume and cardiac output. The sympathetic nervous system releases epinephrine and norepinephrine, resulting in an increased heart rate, increased myocardial contractility, and increased vasoconstriction in an effort to increase cardiac output. Next, there is activation of the renin-angiotensin-aldosterone system (RAAS). Renin converts angiotensinogen, an inactive peptide released by the liver, to angiotensin I. Angiotensin I is enzymatically converted to angiotensin II by angiotensin-converting enzyme released by the lungs causing vasoconstriction, which helps increase blood pressure and venous return to the heart. Angiotensin II also stimulates the release of aldosterone from the adrenal cortex, which results in sodium and water retention. Brain natriuretic peptide, or B-type natriuretic peptide (BNP), is released in reaction to "overstretching" of the ventricle in response to increased pressure and volume. The result is a natural diuresis as well as arterial and venous dilation. This action decreases both preload and afterload, which decreases the workload on the heart. Test Taking Tips:Answer first and last steps, then fill in the rest.

Which symptoms should the nurse anticipate when providing care to a client who is diagnosed with left-sided heart failure? Select all that apply. Cyanosis Peripheral edema S3 and S4 heart sounds Jugular vein distention Weak peripheral pulses

Cyanosis S3 and S4 heart sounds Weak peripheral pulses

Which drug classification should the nurse anticipate for a client diagnosed with heart failure to increase urine output? Diuretic Inotropic Angiotensin-converting-enzyme inhibitor Beta blocker

Diuretic

Which is a cause for high-output failure for a patient diagnosed with heart failure? Relaxation difficulty Contraction difficulty Elevated demands on the heart Impaired venous return to the heart

Elevated demands on the heart

Which medication is most likely to be prescribed to treat pulmonary edema in a patient with heart failure? Digoxin Nesiritide Furosemide Nitroglycerin

Furosemide Rationale: Furosemide is a diuretic for treating pulmonary edema in patients with heart failure. Test Taking Tips: Differentiate medications.

Acute Exacerbation of Heart Failure HYPERTENSION or HYPOTENSION

HYPOTENSION CORRECT. In severe HF exacerbations, the client has decreased cardiac output and often presents with hypotension, cool extremities, decreased or no urine output, and poor or decreasing mentation. Often, he or she will have both an S3 and S4 heart sound.

Cool Extremities RIGHT-SIDED HF or LEFT-SIDED HF

LEFT-SIDED HF CORRECT. A patient diagnosed with left-sided heart failure experiences weakened cardiac contractions. This results in a backflow of blood that negatively impacts peripheral circulation. Poor peripheral circulation manifests with cool skin and often poor skin color.

Which is a cause for diastolic dysfunction for a patient diagnosed with heart failure? Contraction difficulty Left ventricle hypertrophy Elevated demands on the heart Impaired venous return to the heart

Left ventricle hypertrophy

Fluid Excess and Edema MONITOR I/O or RANGE OF MOTION

MONITOR I/O CORRECT. Generalized edema is a clinical manifestation of heart failure. The patient is prescribed a diuretic and the nurse should monitor intake and output to determine if the prescribed diuretic is working.

Hepatomegaly MONITOR LIVER or MONITOR KIDNEYS

MONITOR LIVER CORRECT. Hepatomegaly indicates an enlarged liver; therefore, the nurse should monitor the patient's liver enzymes. BUN and creatinine should be monitored for clients who are receiving large doses of diuretics.

Daily Weight MORNING or BEFORE VOIDING

MORNING CORRECT. Daily weight should be taken at home at same time each day, preferably morning after voiding. This is important to monitor for possible fluid retention and the need for intervention.

This patient is experiencing right-sided heart failure. Which symptom should the nurse anticipate? Peripheral edema Crackles in the lungs Dyspnea Orthopnea

Peripheral edema Rationale: Edema is commonly seen in right-sided failure. Test Taking Tips: Differentiate between left and right failure.

Low-Sodium Diet REDUCES FLUID or NORMALIZES ELECTROLYTES

REDUCES FLUID CORRECT. Clients who are diagnosed with heart failure will need to be placed on a low-sodium diet to prevent fluid retention and exacerbation of HF. The nurse should teach the patient to avoid adding salt to food and avoid foods with hidden sodium, such as canned vegetables. The nurse should recommend that the patient consume fresh vegetables.

Ascites RIGHT-SIDED HF or LEFT-SIDED HF

RIGHT-SIDED HF CORRECT. The weakened contraction of the right ventricle results in a backflow of blood into the right atrium and venous circulation, resulting in ascites.

A patient is known to have risk factors for heart failure. Diagnostic testing reveals the absence of left ventricular involvement. In which stage of heart failure development, according to the American Heart Association (AHA), is the patient? Stage A Stage B Stage C Stage D

Stage A Rationale: According to the AHA, stage A signifies a patient with risk factors but with no left ventricle impairment. Rationale: According to the AHA, stage B is asymptomatic with left ventricle hypertrophy and/or impaired left ventricle function. Rationale: According to the AHA, stage C signifies current or past symptoms of heart failure. Rationale: According to the AHA, stage D signifies refractory heart failure eligible for heart transplant along with inotropic and/or mechanical support. Test Taking Tips: Learn the pathophysiology of each stage.

A patient tells the nurse, "I have labored breathing and chest pain while doing vigorous physical activities, but feel comfortable at rest." Which stage of heart failure does the patient fall under according to the New York Heart Association's classification of functional status? Stage A Stage B Stage C Stage D

Stage C Rationale: In stage C, a patient experiences marked limitations with physical activity but is comfortable at rest. Since the patient feels pain and difficulty in breathing while doing physical activities, but is comfortable at rest, he or she is classified as stage C. Rationale: A patient in stage D will have severe limitations and distress while doing any physical activity and also when he or she is at rest. Rationale: In stage A, no symptoms such as dyspnea or chest pain are experienced while performing physical activity. Rationale: Mild symptoms while performing ordinary activities are associated with stage B. Test Taking Tips: Differentiate between the stages.

Pulmonary Edema BETA BLOCKER or DIURETIC

DIURETIC CORRECT. Pulmonary edema is often a medical emergency requiring the administration of a prescribed intravenous diuretic, such as furosemide, and the initiation of supplementary oxygen. Some clients may even require intubation and mechanical ventilation.

The patient asks the nurse what it means to be in "stage B" of heart failure? Which statement by the nurse is accurate? It signifies current or past symptoms of heart failure. It signifies refractory heart failure eligible for heart transplant, inotropic and/or mechanical support. It signifies hypertrophy and/or impaired function of the left ventricle with asymptomatic conditions. It signifies risk factors but no left ventricle impairment.

It signifies hypertrophy and/or impaired function of the left ventricle with asymptomatic conditions. Rationale: Stage C means current or past symptoms of heart failure according to the AHA. Rationale: Stage A indicates risk factors for a patient but no impairment of the left ventricle, according to the AHA classification. Rationale: A patient in stage B of heart failure development will be asymptomatic, with hypertrophy and/or impaired function of the left ventricle, according to the AHA classification. Rationale: Stage D signifies refractory heart failure eligible for a heart transplant and inotropic and/or mechanical support, according to the AHA. Test Taking Tips: Differentiate the stages.