CH 29: Heart Failure

The nurse is caring for a client with severe compensated heart failure. What human brain natriuretic peptide (BNP) medication may be used in a critical care unit with hemodynamic monitoring? a. Natrecor b. metoprolol c. captopril d. enalapril

a. Natrecor Rationale: Nesiritide (Natrecor) is a preparation of human BNP that mimics the action of endogenous BNP, causing diuresis and vasodilation, reducing blood pressure, and improving cardiac output. Frequently this medication is titrated in a critical care unit for client safety. It is a preload and afterload reducer. Metoprolol is a beta-blocker. Captopril and enalapril are angiotensin-converting enzyme (ACE) inhibitors.

The physician writes orders for a patient to receive an angiotensin II receptor blocker for treatment of heart failure. What medication does the nurse administer? a. Digoxin (Lanoxin) b. Valsartan (Diovan) c. Metolazone (Zaroxolyn) d. Carvedilol (Coreg)

b. Valsartan (diovan) Rationale: Valsartan (Diovan) is the only angiotensin receptor blocker listed. Digitalis/digoxin (Lanoxin) is a cardiac glycoside. Metolazone (Zaroxolyn) is a thiazide diuretic. Carvedilol (Coreg) is a beta-adrenergic blocking agent (beta-blocker).

The pathophysiology of pericardial effusion is associated with all of the following except: a. Increased right and left ventricular end-diastolic pressures. b. Atrial compression. c. Increased venous return. d. Inability of the ventricles to fill adequately.

c. Increased venous return Rationale: Venous return is increased because there is an increase in the pericardial fluid, which raises the pressure within the pericardial sac and compresses the heart.

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.) a. Jugular vein distention b. Ascites c. Pulmonary crackles d. Dyspnea e. Cough

c. Pulmonary crackles d. Dyspnea e. Cough Rationale: The clinical manifestations of pulmonary congestion associated with left-sided heart failure include dyspnea, cough, pulmonary crackles, and low oxygen saturation levels, but not ascites or jugular vein distention.

A nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, what action should the nurse perform? a. administer oxygen b. have the client take deep breaths and cough c. place the client in high Fowler's position d. perform chest physiotherapy

c. place the client in high Fowler's position Rationale: The high Fowler's position will initially promote oxygenation in the client and relieve shortness of breath. Additional measures include administering oxygen to increase oxygen content in the blood. Deep breathing and coughing will improve oxygenation postoperatively but may not immediately relieve shortness of breath. Chest physiotherapy results in expectoration of secretions, which isn't the primary problem in pulmonary edema.

A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion? a. Assess for reduced urine output. b. Assess for reduced blood sodium levels. c. Assess for elevated blood potassium levels. d. Assess for elevated blood urea nitrogen levels.

d. Assess for elevated blood urea nitrogen levels. Rationale: Elevated blood urea nitrogen indicates impaired renal perfusion in a client with left-sided heart failure. Serum sodium levels may be elevated. Reduced urine output or elevated blood potassium levels do not indicate impaired renal perfusion in a client with left-sided heart failure.

The nurse observes a client with an onset of heart failure having rapid, shallow breathing at a rate of 32 breaths/minute. What blood gas analysis does the nurse anticipate finding initially? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

d. Respiratory alkalosis Rationale: At first, arterial blood gas analysis may reveal respiratory alkalosis as a result of rapid, shallow breathing. Later, there is a shift to metabolic acidosis as gas exchange becomes more impaired. Respiratory acidosis and metabolic alkalosis are incorrect distractors.

A client is awaiting the availability of a heart for transplant. What option may be available to the client as a bridge to transplant? a. Implanted cardioverter-defibrillator (ICD) b. Pacemaker c. Intra-aortic balloon pump (IABP) d. Ventricular assist device (VAD)

d. Ventricular assist device (VAD) Rationale: VADs may be used for one of three purposes:(1) a bridge to recovery, (2) a bridge to transport, or (2) destination therapy (mechanical circulatory support when there is no option for a heart transplant). An implanted cardioverter-defibrillator or pacemaker is not a bridge to transplant and will only correct the conduction disturbance and not the pumping efficiency. An IABP is a temporary, secondary mechanical circulatory pump to supplement the ineffectual contraction of the left ventricle. The IABP is intended for only a few days

A client with heart failure must be monitored closely after starting diuretic therapy. What is the best indicator for the nurse to monitor? a. fluid intake and output. b. urine specific gravity. c. vital signs. d. weight.

d. weight Rationale: Heart failure typically causes fluid overload, resulting in weight gain. Therefore, weight is the best indicator of this client's status. One pound gained or lost is equivalent to 500 ml. Fluid intake and output and vital signs are less accurate indicators than weight. Urine specific gravity reflects urine concentration, indicating overhydration or dehydration. Numerous factors can influence urine specific gravity, so it isn't the most accurate indicator of the client's status.