Perfusion
Right-Sided Heart Failure
"AW HEAD" Congestion of the viscera and peripheral tissues Edema of the lower extremities Enlargement of the liver (hepatomegaly) Ascites Anorexia, nausea Weakness Weight gain (fluid retention) JVD oliguria
Left-sided heart failure
"DO CHAP" Dyspnea on exertion Pulmonary congestion, pulmonary crackles Cough that is initially dry and nonproductive Frothy sputum that is sometimes blood-tinged Inadequate tissue perfusion Weak, thready pulse Tachycardia Oliguria, nocturia Fatigue
PDA is characterized by:
-increased pulmonary blood flow -failure for the opening between the pulmonary artery and the aorta to close after birth -may be treated with indomethacin -at risk for L side heart failure and cyanosis -Loud, machinery-like murmur.
Stage 1 hypertension is defined as persistent blood pressure levels in which the systolic pressure is ____ and the diastolic is ____. A 120/80 mm Hg B 130/80 mm Hg. C 140/90 mm Hg. D 150/90 mm Hg.
130/80 mm Hg.
An older client receiving medication for hypertension had a recent fall at home. What should the nurse include in this client's plan of care? A) Monitor serum sodium levels. B) Assess postural blood pressures. C) Monitor serum creatinine levels. D) Monitor blood pressure every 2 hours.
Answer: B Explanation: Baroreceptors are less efficient with aging. Therefore, orthostatic hypotension is more likely to occur. Also, clients treated for hypertension could have an increase in sensitivity to the medications. Postural blood pressure assessment allows the nurse to prevent orthostatic hypotension and falls. Every 2 hours is too frequent for assessments of a noncritical client. Sodium intake and creatinine levels assess renal function.
A client has a blood pressure of 142/92. The nurse recognizes this as: A) Normal. B) Hypertension Stage I. C) Prehypertension. D) Hypertension Stage II.
Answer: B Explanation: Blood pressure values in the adult are classified as either normal (<120/<80 mmHg), prehypertension (120-139/80-89), hypertension stage I (140-159/90-99), or hypertension stage II (> or =160/> or =100).
The nurse is instructing a client on lifestyle changes to prevent the onset of heart disease. What should be included in this teaching? Select all that apply. A) Limit exercise to 15 minutes a day. B) Reduce saturated fats in the diet. C) Avoid cigarette smoking. D) Wear elastic hose. E) Limit fluid intake.
Answer: B, C Explanation: Interventions that would help the client prevent the onset of cardiovascular disease would be to avoid cigarette smoking and reduce saturated fats in the diet. Limiting fluids and wearing elastic hose are not known to prevent the onset of cardiovascular disease. Fifteen minutes of exercise a day may not be enough exercise to prevent the onset of cardiovascular disease.
A client is admitted to determine the cause of secondary hypertension. Which diagnostic tests should the nurse suspect the client will be prescribed and need teaching? Select all that apply. A) Cerebral angiogram B) Intravenous pyelogram C) Renal angiogram D) Cardiac catheterization E) Myelogram
Answer: B, C Explanation: When secondary hypertension is suspected, diagnostic tests include an intravenous pyelogram and renal ultrasound to determine if the renal system is the cause of the hypertension. Cerebral angiogram, cardiac catheterization, and myelogram are not diagnostic tests to determine the cause for secondary hypertension.
A nurse is caring for a client with heart failure secondary to an acute non-cardiac condition. Which condition would be excluded from the client's cause of heart failure? A) Massive pulmonary embolus B) Hyperthyroidism C) Rheumatic fever D) Volume overload
Answer: C Explanation: Heart failure is caused by either impaired myocardial function, increased cardiac workload, or acute non-cardiac conditions. Acute non-cardiac conditions include massive pulmonary embolus, hyperthyroidism, and volume overload. Rheumatic fever is a condition that causes impaired myocardial function.
A client is prescribed metoprolol for a heart disorder. What should the nurse teach the client about this medication? A) Expect a rapid heart rate. B) Change positions slowly. C) Reduce protein intake. D) Increase fluids.
B) Change positions slowly. Explanation: Metoprolol is a beta blocker. The client should be instructed to use care when ambulating and to change positions slowly since this medication causes orthostatic hypotension. This medication does not cause a rapid heart rate. The client should not be instructed to increase fluids. Protein restriction is not indicated with this medication.
Which of the following patients is not a candidate for a beta blocker medication? A 45 year old male with angina. A 39 year old female with asthma. A 25 year old female with migraines. A 55 year old male with a history of two heart attacks.
A 39 year old female with asthma. Remember Beta Blocker stands for "Brady & Breathing", it is not recommended for patients with breathing issues
An older client is diagnosed with cardiomyopathy and a cardiac dysrhythmia. What would the nurse expect to be indicated for this client? A) Beta blocker B) Digoxin C) Nitrate medications D) Fluids
A) Beta blocker Explanation: Treatment for cardiomyopathy includes calcium channel blockers, beta blockers, and antiarrhythmics. Nitrates should be avoided because they increase blood pressure. Digoxin should be avoided because it increases the force of contractions. The client should be on a sodium and fluid restriction and not be encouraged to drink fluids.
A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation? A. "I've noticed that I've gain 6 lbs in one week." B. "While I sleep I have to prop myself up with a pillow so I can breathe." C. "I haven't noticed any swelling in my feet or hands lately." D. Options B and C are correct. E. Options A and B are correct.
A. "I've noticed that I've gain 6 lbs in one week." B. "While I sleep I have to prop myself up with a pillow so I can breathe." Options A and B are correct.
Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply: A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.
A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.
Which of the following terms describes the force against which the ventricle must expel blood? A. Afterload B. Cardiac output C. Overload D. Preload
A. Afterload
When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol hydrochloride: A. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. B. Increases norepinephrine secretion and thus decreases blood pressure and heart rate. C. Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. D. Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II
A. Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.
Hypertension is known as the silent killer. This phrase is associated with the fact that hypertension often goes undetected until symptoms of other system failures occur. This may occur in the form of: A. Cerebrovascular accident B. Liver disease C. Myocardial infarction D. Pulmonary disease
A. Cerebrovascular accident
The nurse is planning care for several clients. Which client has the greatest risk of developing heart failure? A) A 69-year-old African-American male with hypertension B) A 50-year-old African-American female who smokes C) A 75-year-old Caucasian male who is overweight D) A 52-year-old Caucasian female with asthma
Answer: A Explanation: Age, race, and hypertension lead to an increased risk for developing heart failure. Race and smoking are risk factors, but being female and younger decreases the overall risk. Age and obesity are risk factors, but not as much as age, being African-American, and having hypertension. Asthma is not considered a significant risk factor in the development of heart failure.
The nurse is caring for an infant diagnosed with patent ductus arteriosus. Which medication should the nurse plan to provide this client? A) Indomethacin B) NSAIDS C) Antidepressant D) Insulin
Answer: A Explanation: Intravenous indomethacin often stimulates the closure of the ductus arteriosus in premature infants. The infant will most likely not be prescribed an NSAID or an antidepressant. The infant would be prescribed insulin if diabetes were diagnosed.
A nurse working in the Intensive Care Unit (ICU) is caring for a client in a hypertensive emergency due to acute nephritis. The nurse understands that the client's renal system affects blood pressure by: A) Releasing the catecholamines epinephrine and norepinephrine. B) Stimulating the release of renin. C) Stimulating the release of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). D) Synthesizing and releasing adrenomedullin.
Answer: B Explanation: A drop in renal perfusion stimulates renin release. Renin converts angiotensinogen to angiotensin I, which is then converted to angiotensin II in the lungs. ANP and BNP are released from the atrial cells, not the renal system. The catecholamines epinephrine and norepinephrine are released from the adrenal cortex, not from the kidneys.
You're working on a unit that provides specialized cardiac care to the pediatric population. Which patient below would be the best candidate for Indomethacin from the treatment of patent ductus arteriosus? A. A 25-year-old adult B. A premature infant C. An 8 month old child D. A 12 year old child
The answer is B. A medication (NSAIDs) can be used to close the ductus arteriosus. Indomethacin is a prostaglandin inhibitor. It is used in premature babies or sometimes in very young infant's days old. It won't work for older infants, children, or adults.
Which of the following is a common side effect of Spironolactone? A. Renal failure B. Hyperkalemia C. Hypokalemia D. Dry cough
The answer is B. Hyperkalemia Spironolactone is potassium-sparing. Therefore, it can increase the potassium level (hyperkalemia).
A patient is scheduled to take Lisinopril. When is the best time to administer this medication? 30 minutes after a meal At bedtime In the morning 1 hour before a meal
1 hour before a meal
The mother of a baby born with a congenital heart defect is upset, as no one else in the family has been born with this condition. About what should the nurse ask the mother during the assessment? A) Use of alcohol during the pregnancy B) Maternal father's history of diabetes C) Father's exposure to toxins in the work environment D) History of hypertension
Answer: A Explanation: Most congenital heart defects occur during the first 8 weeks of pregnancy and are a combination of environmental and genetic factors. Fetal exposure to alcohol is one of the greatest factors for the development of these defects. A history of hypertension will not cause a fetus to develop a congenital heart defect. The father's exposure to toxins in the work environment is not known to cause congenital heart defects of children. The maternal father's history of diabetes also is not known to cause congenital heart defects in children.
The nurse instructs a client about the medication nifedipine (Procardia) for hypertension. Which client statement indicates that additional teaching is needed? A) "This medication will cause my ankles to swell, which is normal." B) "I need to drink 6-8 glasses of water each day." C) "I will call my doctor if I gain weight or become short of breath." D) "I need to eat foods high in fiber when taking this medication."
Answer: A Explanation: Swelling in the feet or ankles when taking this medication should be reported to the healthcare provider. This medication can cause constipation, so drinking 6-8 glasses of water each day and increasing fiber in the diet are appropriate interventions cited by the client. The client should notify the healthcare provider with weight gain or shortness of breath.
The nurse is planning care for a pediatric client recovering from surgery to repair a congenital heart defect. Which intervention should the nurse include to support the client's fluid status? A) Encourage fluids. B) Limit fluids. C) Monitor output. D) Maintain intravenous therapy until day before discharge.
Answer: A Explanation: The child should be encouraged to begin oral fluids and nutrition when permitted. Although oral fluids are rarely limited, intake and output should be carefully assessed. Fluids and antibiotics should be provided as ordered until the child's oral intake is normal. Once normal, the line can be converted to a heparin or saline lock. Both intake and output should be monitored.
During an assessment, a client with congestive heart failure and severe shortness of breath tells the nurse about not having enough money to purchase medications. What nursing diagnosis is of the greatest initial importance when planning care? A) Excess Fluid Volume related to shortness of breath B) Ineffective Family Management of Therapeutic Regime related to inability to purchase medications C) Fatigue related to shortness of breath D) Activity Intolerance related to shortness of breath
Answer: A Explanation: The client is experiencing acute shortness of breath because of the excess fluid. Excess Fluid Volume is the nursing diagnosis that is the priority at this time. Activity Intolerance and Fatigue will improve once the Excess Fluid Volume is addressed. Ineffective Family Management of Therapeutic Regime related to inability to purchase medications should be addressed after the client's physiological problems are resolved.
The nurse is positioning a client with left-sided heart failure in bed. Which sleeping position would the client find the most comfortable? A) Seated in a recliner with 2-3 pillows under feet B) Lying on the left side with the head of the bed elevated 30° C) Seated in a recliner with 2-3 pillows under head D) Lying on either side with the head of the bed elevated 30°
Answer: A Explanation: The client with left-sided cardiac failure could develop orthopnea. This is a result of the pulmonary congestion and decreased cardiac output. Being in an upright position will ease the work of breathing. Side-lying positions will not help alleviate or prevent the development of orthopnea. Propping the lower legs up while in a sitting position can help decrease dependent edema, but 2-3 pillows are not needed for sleep.
A client reports morning headache that extends into the neck and goes away as the day wears on. What should the nurse suspect this client is describing? A) A symptom of hypertension B) A sinus headache C) A migraine headache D) Spinal stenosis
Answer: A Explanation: When symptoms of hypertension do appear, they are usually vague. Headache, generally in the back of the head and neck, may be present on awakening, subsiding during the day. The client is not describing a migraine or sinus headache. There is not enough information to determine whether the client has spinal stenosis.
The nurse is assessing a toddler diagnosed with tetralogy of Fallot. Which assessment findings should the nurse determine as being consistent with this child's diagnosis? Select all that apply. A) Palpable thrill in the pulmonic area B) Nail clubbing C) Cough D) Apneic periods E) Knee e-chest position
Answer: A, B, E Explanation: Manifestations of tetralogy of Fallot include a palpable thrill in the pulmonic area, clubbing of the fingers due to reduce oxygenation, and the knee-chest position, which the child will perform to decrease the return of systemic venous blood to the heart. A cough and apneic periods are not manifestations of this congenital heart defect.
The nurse is caring for a child with heart failure. What will the nurse most likely assess in this child? Select all that apply. A) Shortness of breath B) Weight loss C) Bradycardia D) Tachycardia E) Increased blood pressure
Answer: A, D Explanation: Tachycardia is a sign of CHF because the heart attempts to improve cardiac output by beating faster. Shortness of breath is caused by pulmonary congestion. Bradycardia is a serious sign and can indicate impending cardiac arrest, but is not a typical assessment finding in a client with CHF. Blood pressure does not increase in CHF, and the weight, instead of decreasing, increases because of retention of fluids.
The nurse is assessing a client being treated for congestive heart failure. What physical findings would indicate that the client's condition is not improving? Select all that apply. A) Urine output 160 ml over 8 hours B) Pulse oximetry reading of 96% C) Temperature of 98.6°F (37°C) D) Wheezing of breath sounds in all lobes E) Moderate amount of clear, thin mucus
Answer: A, D Explanation: Wheezing heard when assessing breath sounds is indicative of abnormal breath sounds, which are characteristic in congestive heart failure. These sounds would indicate that the client's condition is not improving. A urine output of less than 30 ml/hour should be reported to the healthcare provider and is an indication of a worsening of congestive heart failure. A temperature reading of 98.6°F, moderate clear mucus, and a pulse oximetry reading of 96% are all normal findings.
The home care nurse assesses an older client's blood pressure as being 150/100 mmHg. When reviewing medications, the client reports taking the blood pressure medication only when feeling tense. What should the nurse instruct this client to do? A) Continue to take medication when feeling tense. B) Take the blood pressure medication as prescribed regardless of feeling tense. C) Take the blood pressure medication at twice the prescribed dosage for 1 day and then resume the daily schedule. D) Contact the physician for an increase in blood pressure medication.
Answer: B Explanation: Clients sometimes mistakenly take blood pressure medication only on an as-needed basis. This is incorrect; the client should take the medication as prescribed on a daily basis. The dosage prescribed may be appropriate if taken daily; therefore, it would not need to be increased. To advise the client to increase the medication without a physician consultation would be out of the scope of nursing practice.
A nurse working in the Neonatal Intensive Care Unit (NICU) is caring for a preterm infant with a congenital heart defect. The nurse knows that these conditions are categorized by: A) Severity of defect. B) Pathophysiology and hemodynamics of defect. C) Location of defect. D) Age when defect diagnosed.
Answer: B Explanation: Congenital heart defects are categorized by their pathophysiology and hemodynamics.
A nurse is caring for a pregnant client who is hypertensive. What additional symptom likely indicates this client has early preeclampsia? A) Persistent headache B) Excessive protein in the urine C) Right-sided abdominal pain D) Severe epigastric pain
Answer: B Explanation: Early signs of preeclampsia include high blood pressure and evidence of protein in the urine. Later symptoms include persistent headache and right-sided abdominal pain. Severe epigastric pain is a symptom of HELLP syndrome.
The nurse is planning care for an infant with congestive heart failure. What should the nurse include in this child's care? A) Give larger feedings less often to conserve energy. B) Organize activities to allow for uninterrupted sleep. C) Monitor respirations during active periods. D) Force fluids appropriate for age.
Answer: B Explanation: It is important to allow for uninterrupted sleep in order to decrease metabolic demands on the heart. Fluids should be restricted to those that are high in calories and low in volume in order to avoid overloading the lungs with fluid. Respirations are difficult to monitor during active periods, making this an unrealistic goal. Small-volume, high-calorie feedings should be given.
The nurse teaches a client about lifestyle modifications to help manage hypertension. Which client statement indicates teaching has been effective? A) "I won't be able to run in marathons anymore." B) "I know I need to give up my cigarettes and alcohol." C) "I need to get started on my medications right away." D) "My father had hypertension, did nothing, and lived to be 90 years old."
Answer: B Explanation: Limiting intake of alcohol and discontinuing tobacco products are important nonpharmacological methods for controlling hypertension. Implementing lifestyle modifications may eliminate the need for pharmacotherapy, so the client may not have to take medication right away. Increasing physical activity is an important lifestyle modification for controlling hypertension. The fact that the client's father had hypertension and lived to be 90 years old does not mean that the client will have the same experience; the client is in denial.
During hospitalization for congestive heart failure, a client awakens during the night frightened and short of breath. What is this client most likely experiencing? A) Cardiomyopathy B) Paroxysmal nocturnal dyspnea C) High-output failure D) Multisystem heart failure
Answer: B Explanation: Paroxysmal nocturnal dyspnea occurs when edema fluid that has accumulated during the day is reabsorbed into the circulation at night. This causes fluid overload and pulmonary congestion. The client awakens at night short of breath and frightened. The client is not experiencing multisystem heart failure, cardiomyopathy, or high-output failure.
A baby will be having surgery to correct a congenital heart defect. On which topic should the parents be instructed regarding the care of the child before surgery? A) Restricting immunizations until after the surgery B) Preventing exposure to infection C) Implementing no particular precautions D) Restricting fluids
Answer: B Explanation: Preoperative care of a baby having surgery to correct a congenital heart defect should include prevention from infection with good hand washing. There are precautions that the parents should take to ensure the child is in optimal health prior to the surgery. Fluids are not to be restricted but encouraged. Immunizations should be continued.
A client has a nighttime cough related to taking enalapril (Vasotec). What is the best nursing intervention to promote rest in this client? A) Have the client sit up at an 80° angle in a comfortable chair at night. B) Have the client sleep on 2 or 3 pillows at night. C) Contact the physician for an order for a cough-suppressant medication. D) Contact the physician for an order for a sedative-hypnotic medication.
Answer: B Explanation: The client should sleep with the head elevated if a cough becomes troublesome when in supine position. A cough induced by an angiotensin-converting enzyme inhibitor will not be relieved by cough medication. Sitting up at an 80° angle would be effective but would be too uncomfortable for the client. A sedative-hypnotic medication would put the client to sleep, but it does nothing to address the client's cough.
The nurse is concerned that a client with an alteration in perfusion is at risk for inadequate oxygenation. What should the nurse consider when planning for this client's potential health problem? A) Cluster activities. B) Instruct on deep breathing. C) Medications appropriate to increase heart rate D) Positioning to increase blood return
Answer: B) Instruct on deep breathing. Explanation: The client is at risk for inadequate oxygenation. The nurse should consider teaching the client the importance of deep breathing to increase the amount of oxygen in the body tissues. Clustering activities would negatively impact oxygenation. Periods of rest should occur between activities. The client with oxygenation issues will have tachycardia. The nurse should consider medications that would reduce instead of increase the heart rate. The client should be in the high-Fowler position to improve oxygenation. Positions to increase blood flow to the heart would include Trendelenburg, which would negatively impact oxygenation.
The nurse is analyzing data collected after assessing a child with a congenital heart defect that decreases pulmonary blood flow. Which nursing diagnosis would be applicable for this client? A) Risk for Infection related to engorged pulmonary vasculature B) Interrupted Family Processes C) Decreased Cardiac Output D) Excess Fluid Volume
Answer: C Explanation: Nursing diagnoses for clients with congenital heart defects that decrease pulmonary blood flow include Decreased Cardiac Output, Risk for Infection related to unfiltered bacteria in the blood, Caregiver Role Strain, Activity Intolerance, and Delayed Growth and Development. Excess Fluid Volume, Risk for Infection related to engorged pulmonary vasculature, and Interrupted Family Processes are nursing diagnoses seen in the care of a client with a congenital heart defect that increases pulmonary blood flow.
A client is prescribed enalapril (Vasotec) for treatment of heart failure. What assessment finding should cause the nurse concern following the initial administration of this drug? A) Serious rash B) Ototoxicity C) Low blood pressure D) Irregular pulse
Answer: C Explanation: Severe hypotension can occur after the initial administration of enalapril (Vasotec). Ototoxicity is an adverse effect of loop diuretics. Stevens-Johnson syndrome, a serious rash, and an irregular pulse are adverse effects of beta blockers.
The nurse is caring for a client with hypertension. The nurse understands that the client's blood pressure is determined by all the following factors except: A) Pumping action of the heart. B) Peripheral vascular resistance. C) Heart rate. D) Blood volume.
Answer: C Explanation: The factors which determine blood pressure include the pumping action of the heart; peripheral vascular resistance; and blood volume and viscosity. Heart rate by itself does not determine blood pressure.
What will the nurse most likely assess in a client with right heart failure? A) Leg cramps B) Indigestion C) Reduced circulation to the pulmonary structures D) Reduced urine output
Answer: C) Reduced circulation to the pulmonary structures Explanation: Circulation to the pulmonary structures begins with the right side of the heart. The client with right heart failure will have reduced circulation to these structures. There is no evidence to suggest that right heart failure will cause indigestion or reduced urine output. Not all clients with right heart failure experience leg cramps.
A nurse working in Labor and Delivery is assessing a term newborn for congenital heart defects. The nurse understands that manifestations of an atrial septal defect (ASD) may include: A) Pulmonary artery hypotension and congestive heart failure. B) Midsystolic murmur at lower right sternal border, due to increased blood flow across the tricuspid valve. C) Mitral valve regurgitation with cleft on mitral valve. D) S1 heart tone may be split due to forceful left ventricular contraction.
Answer: C, D Explanation: An atrial septal defect (ASD) occurs when there is an opening in the atrial septum permitting left-to-right shunting of blood. Midsystolic murmur may be auscultated at the lower left sternal border, due to increased blood flow across the tricuspid valve. Mitral valve regurgitation may occur with a cleft on the mitral valve. S1 heart tones may be split due to forceful right ventricular contraction. Finally, pulmonary artery hypertension and congestive heart failure may occur.
A client with primary hypertension is prescribed terazosin (Hytrin) to treat this condition. The nurse caring for this client understands that the mechanism of action for this medication is: A) Prevents conversion of angiotensin I to angiotensin II. B) Prevents beta-receptor stimulation in the heart. C) Inhibits the flow of calcium ions across the cell membrane of vascular tissue and cardiac cells. D) Blocks alpha-receptors in the vascular smooth muscle.
Answer: D Explanation: Terazosin (Hytrin), an alpha-adrenergic blocker, acts by blocking alpha-receptors in the vascular smooth muscle. ACE inhibitor medications prevent conversion of angiotensin I to angiotensin II. Beta-adrenergic blockers prevent beta-receptor stimulation in the heart. Calcium channel blockers inhibit the flow of calcium ions across the cell membrane of vascular tissue and cardiac cells.
A nurse is educating the parents of a child born with tetralogy of Fallot. Which statement will the nurse include regarding this defect? A) "Increased pulmonary blood flow causes symptoms with this disease." B) "This disease consists of pulmonic stenosis, left ventricular hypertrophy, ventricular septal defect, and an overriding aorta." C) "Your child has a decreased amount of red blood cells because of this disease." D) "This disease consists of pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and an overriding aorta."
Answer: D Explanation: Tetralogy of Fallot consists of four defects—pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and an overriding aorta. This disease is also characterized by decreased pulmonary blood flow, and polycythemia (increased red blood cells due to hypoxia).
Select all the correct statements about educating the patient with heart failure: A. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week. B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias. E. Patients with heart failure should limit exercise because of the risks.
B. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine. C. Heart failure patients should limit sodium intake to 2-3 grams per day. D. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias.
Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply: A. Jugular venous distention B. Persistent cough C. Weight gain D. Crackles E. Nocturia F. Orthopnea
B. Persistent cough D. Crackles F. Orthopnea
A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention? A. Encourage the patient to cough and deep breathe. B. Place the patient in Semi-Fowler's position. C. Assist the patient into High Fowler's position. D. Perform chest percussion therapy.
C. Assist the patient into High Fowler's position.
One hour after administering IV furosemide (Lasix) to a client with heart failure, a short burst of ventricular tachycardia appears on the cardiac monitor. Which of the following electrolyte imbalances should the nurse suspect? A. Hypocalcemia B. Hypermagnesemia C. Hypokalemia D. Hypernatremia
C. Hypokalemia
Which of the following factors can cause blood pressure to drop to normal levels? A. Kidneys' excretion of sodium only B. Kidneys' retention of sodium and water C. Kidneys' excretion of sodium and water D. Kidneys' retention of sodium and excretion of water
C. Kidneys' excretion of sodium and water
Which family of drugs are the following medications considered: Amlodipine, Verapamil, Diltiazem? Beta blockers (BB) ACE Inhibitors (ACEI) Angiotension Receptor Blockers (ARBs) Calcium Channel Blockers (CCBs)
Calcium Channel Blockers (CCBs)
Which of the following systems of the body are affected by hypertension? Cardiovascular, brain, kidney, eyes Cardiovascular, gastrointestinal, reproductive, and kidney Brain, respiratory, kidney, cardiovascular None of the options are correct
Cardiovascular, brain, kidney, eyes
TOF is characterized by:
TET spells(Squatting or knee-chest position) cyanosis(blue baby) pulmonary stenosis at risk for congestive heart failure nail clubbing due to hypoxia 4 components "PROV" risk for FTT and Activity Intolerance prostaglandin E
The structure that connects the aorta to the pulmonary artery in utero is known as the: A Pulmonary vein. B Left ventricle. C Ligamentam arteriosum. D Ductus arteriosus.
D Ductus arteriosus.
A client is receiving spironolactone to treat hypertension. Which of the following instructions should the nurse provide? A. "Eat foods high in potassium." B. "Take daily potassium supplements." C. "Discontinue sodium restrictions." D. "Avoid salt substitutes."
D. "Avoid salt substitutes."
You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching? A. "I will limit my sodium intake to 5-6 grams a day." B. "I will be sure to incorporate canned vegetables and fish into my diet." C. "I'm glad I can still eat sandwiches because I love bologna and cheese sandwiches." D. "I will limit my consumption of frozen meals."
D. "I will limit my consumption of frozen meals."
These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes? A. Beta-blockers B. Vasodilators C. Angiotensin II receptor blockers D. Angiotensin-converting-enzyme inhibitors
D. Angiotensin-converting-enzyme inhibitors ACE inhib=meds ending with "pril"
Which of the following is a late sign of heart failure? A. Shortness of breath B. Orthopnea C. Edema D. Frothy-blood tinged sputum
D. Frothy-blood tinged sputum The answer is D. Shortness of breath, orthopnea, and edema are EARLY signs and symptoms. Frothy-blood tinged sputum is a late sign.
Which of the following terms is used to describe the amount of stretch on the myocardium at the end of diastole? A. Afterload B. Cardiac index C. Cardiac output D. Preload
D. Preload
Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine output? A. Angina pectoris B. Cardiomyopathy C. Left-sided heart failure D. Right-sided heart failure
D. Right-sided heart failure
What should the nurse assess post-cardiac catheterization at the right femoral site?
Frequent vital signs ensure legs are flat assess dressing site assess right pedal and tibial pulses hourly monitor for urine output hourly(strict i&o's)
A patient is being discharged home on Hydrochlorothiazide (HCTZ) for treatment of hypertension. Which of the following statements by the patient indicates they understood your discharge teaching about this medication? I will make sure I consume foods high in potassium. I will only take this medication if my blood pressure is high. I understand a dry cough is a common side effect with this medication. I will monitor my glucose levels closely because this medication may mask symptoms of hypoglycemia.
I will make sure I consume foods high in potassium.
A patient with hypertension is started on a new medication for treatment and is reporting a continuous dry cough. Which of the following medications do you suspect is causing this problem? Lisinopril Labetalol Losartan Hydrochlorothiazide
Lisinopril
You're caring for a 2-day-old infant with a large patent ductus arteriosus. The mother of the infant is anxious and asks you to explain her child's condition to her again. Which statement below BEST describes this condition? A. "The vessel connecting the aorta and pulmonary vein has closed prematurely, which is leading to increased blood flow to the lungs." B. "The vessel connecting the aorta and pulmonary artery has failed to close at birth, which is leading to a left-to-right shunt of blood." C. The vessel connecting the aorta and pulmonary vein has failed to close at birth, which is leading to a right-to-left shunt of blood." D. "The vessel connecting the aorta and pulmonary artery has closed prematurely, which is leading to a left-to-right shunt of blood."
The answer is B. Patent ductus arteriosus (PDA) occurs when the vessel that normally connects the aorta and pulmonary artery in utero has failed to close at birth, which leads to a left-to-right shunting of blood. This shunting of blood will increase blood flow to the lungs and can cause pulmonary hypertension and eventually heart failure (left-sided), especially if the PDA is large.
A two-month-old is showing signs and symptoms of heart failure. An echocardiogram is ordered. The test shows the infant has a ventricular septal defect (VSD). Which statement below best describes the blood flow in the heart due to this congenital heart defect? A. "The blood in the heart is shunting from the right ventricle to the left ventricle, which is increasing pulmonary blood flow." B. "The blood in the heart is shunting from the left ventricle to the right ventricle, which is decreasing pulmonary blood flow." C. "The blood in the heart is shunting from the left ventricle to the right ventricle, which is increasing pulmonary blood flow." D. "The blood in the heart is bypassing the left ventricle and is being shunted to the right ventricle, which is decreasing lung blood flow."
The answer is C. In this condition, the blood in the heart is shunting from the LEFT ventricle to the RIGHT ventricle, which is INCREASING pulmonary blood flow."
You're working in the NICU providing care to a neonate who has a large patent ductus arteriosus. Which finding during your head-to-toe assessment would require you to immediately notify the physician? A. Loud, harsh continuous murmur B. Abnormal pulse pressure C. Crackles D. Diaphoresis when feeding
The answer is C. Options A, B, and D (although are abnormal findings) is expected to be found in a large PDA. However, option C is a sign and symptoms that the patient is entering into left-sided heart failure (a life-threatening complication of this condition in a neonate), which would require immediate intervention. PDA can lead to heart failure when the left-to-right shunt is severe enough.
As noted in the previous question, a loud murmur was noted during assessment of a newborn with patent ductus arteriosus. As the nurse you know that what type of murmur is a hallmark sign of this condition? A. harsh, loud systolic murmur B. soft, blowing diastolic murmur C. systolic and diastolic machinery-like murmur D. machinery-like murmur present on only diastole
The answer is C. The hallmark murmur with PDA is a continuous (heard both during diastole and systole) that is harsh and machinery-like. It can be noted at the left upper sternal border.
While feeding a 3-month-old infant, who has Tetralogy of Fallot, you notice the infant's skin begins to have a bluish tint and the breathing rate has increased. Your immediate nursing action is to? A. Continue feeding the infant and place the infant on oxygen. B. Stop feeding the infant and provide suction. C. Stop feeding the infant and place the infant in the knee-to-chest position and administer oxygen. D. Assess the infant's heart rate and rhythm.
The answer is C. The patient is experiencing a "tet spell". This is where during any type of activity like feeding, crying, playing etc. the child's heart (due to Tetralogy of Fallot) is unable to maintain proper oxygen levels in the blood (these activities place extra work on the heart and it can't keep up). Therefore, there are low amounts of oxygen in the blood, and the skin will become cyanotic (bluish tint) and the respiratory rate will increase (this is the body's way of trying to increase the oxygen levels in the body but it doesn't work because it's not a gas exchange problem in the lungs but a heart problem). The nurse would want to place the infant in the knee-to-chest position. WHY? This increases systemic vascular resistance (which will help decrease the right to left shunt that is occurring in the heart...hence helps replenish the body with oxygenated blood). In addition, the nurse would want to place the patient on oxygen.
As the nurse you know which statements below are correct about the ductus arteriosus? Select all that apply: A. "The ductus arteriosus is a structure that should be present in all babies in utero." B. "The ductus arteriosus normally closes about 3 days after birth or sooner." C. "The purpose of the ductus arteriosus is to help carry blood that is entering the left side of the heart to the rest of the body, hence bypassing the lungs." D. "The ductus arteriosus connects the aorta to the pulmonary vein."
The answers are A and B. These are correct statements about the ductus arteriosus. Option A is correct because every newborn should have this structure, but it will close shortly after birth. Option C is wrong because the purpose of this structure is to help carry blood that is entering the RIGHT side (not left) of the heart to the rest of the body, hence bypassing the lungs. Option D is wrong because this structure connects the aorta to the pulmonary ARTERY (not vein).
You're providing education to the parents of a child who has a patent ductus arteriosus. The parents want to know the complications of this condition. In your education, you will include which of the following complications of PDA? Select all that apply: A. Heart failure B. Pulmonary hypertension C. Recurrent lung infections D. Clubbing of the fingernails E. Endocarditis F. Pulmonary stenosis
The answers are A, B, C, and E. These are complications that can occur with PDA. Clubbing of the nails can be seen in tetralogy of fallot.
A child with INCREASED pulmonary blood flow would most likely have: PDA VSD
increased pulmonary blood flow= PDA & VSD decreased pulmonary blood flow= TOF
