Chapter 25 Prepu: Management of Patients with Complications of Heart Disease
The nurse is admitting a client with heart failure. What client statement indicates that fluid overload was occurring at home? a. "I cut back on going up the steps during the day." b. "My best time of the day is the morning." c. "My food tastes bland without salt." d. "I eat six small meals a day when I am hungry."
"I cut back on going up the steps during the day." Cutting back on activities like climbing stairs is an indication of a lessened ability to exercise. Eating small meals and not using salt are usually indicated for clients with heart failure. The client's assertion about morning being the best time of day is a vague statement.
A client has been diagnosed with systolic heart failure. What percentage will the nurse expect the patient's ejection fraction to be? a. 55% b. 5% c. 30% d. 65%
30% The ejection fraction is normal in diastolic heart failure, but severely reduced in systolic heart failure. The normal EF is 55-65%. The 5% is not life-sustaining and the 30 % is about half the normal percentage.
A nurse is caring for a client with left-sided heart failure. During the nurse's assessment, the client is wheezing, restless, tachycardic, and has severe apprehension. The client reports that these symptoms came on suddenly. The nurse knows that these are symptoms of what condition? a. Progressive heart failure b. Pulmonary hypertension c. Acute pulmonary edema d. Cardiogenic shock
Acute pulmonary edema
The nurse is administering sublingual nitroglycerin to a client with chest pain. What action will the nurse take after administering two sublingual tablets if the client continues with chest pain and has a blood pressure of 120/82 mm Hg? a. Hold any further treatment until the client's blood pressure increases. b. Notify the health care provider of the chest pain. c. Wait ten minutes after the second tablet to assess pain. d. Administer the third sublingual nitroglycerin tablet.
Administer the third sublingual nitroglycerin tablet. The nurse will need to administer the third sublingual nitroglycerin tablet. Nitroglycerin is given in three doses for chest pain as the client's blood pressure can tolerate it. The healthcare provider will be notified after three tablets. The nurse should not hold any further treatment if the client has chest pain. The dosing of nitroglycerin is a five-minute wait.
The nurse discusses basic cardiac hemodynamics and explains preload to the client. What nursing intervention will decrease preload? a. application of antiembolic stockings b. sustained elevation of the client's legs c. increasing activity d. administration of a vasodilating drug (as ordered by a health care provider)
Administration of a vasodilating drug (as ordered by a health care provider) Preload is the amount of blood presented to the ventricles just before systole. Anything that decreases the amount of blood returning to the heart will decrease preload, such as vasodilation or blood pooling in the extremities. Anything that assists in returning blood to the heart (antiembolic stockings) or preventing blood from pooling in the extremities will increase preload.
The nurse is performing a respiratory assessment for a patient with left-sided heart failure. What does the nurse understand is the best determinant of the patient's ventilation and oxygenation status? a. Arterial blood gases b. Pulse oximetry c. End-tidal CO2 d. Listening to breath sounds
Arterial blood gases In left-sided heart failure, arterial blood gases may be obtained to assess ventilation and oxygenation.
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 elevated blood potassium levels. b. Assess for reduced blood sodium levels. c. Assess for reduced urine output. d. Assess for elevated blood urea nitrogen levels.
Assess for elevated blood urea nitrogen levels. 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.
A patient is seen in the emergency department (ED) with heart failure secondary to dilated cardiomyopathy. What key diagnostic test does the nurse assess to determine the severity of the patient's heart failure? a B-type natriuretic peptide (BNP) b. Blood urea nitrogen (BUN) c. Complete blood count (CBC) d. Serum electrolytes
B-type natriuretic peptide (BNP)
A patient with severe pulmonary edema is being intubated by the respiratory therapist. What priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea? a. Listen for breath sounds over the epigastrium. b. Observe for mist in the endotracheal tube. c. Attach a pulse oximeter probe and obtain values. d. Call for a chest x-ray.
Call for a chest x-ray.
A client who has developed congestive heart failure must learn to make dietary adaptations. The client should avoid: a. canned peas. b. angel food cake. c. ready-to-eat cereals. d. dried peas.
Canned peas. There is a wide variety of foods that the client can still eat; the key is to have low salt content.
The nurse is caring for a client in the hospital with chronic heart failure who has marked limitations in his physical activity. The client is comfortable when resting in the bed or chair, but when ambulating in the room or hall, the client becomes short of breath and fatigued easily. What type of heart failure is this considered according to the New York Heart Association (NYHA)? a. Class IV (Severe) b. Class III (Moderate) c. Class I (Mild) d. Class II (Mild)
Class III (Moderate) Class III is when there is a marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitations, or dyspnea. Class I is ordinary physical activity that does not cause undue fatigue, palpitations, or dyspnea. The client does not experience any limitation of activity. Class II (Mild) is when the client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea. Class IV (Severe), The client is unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.
A patient is undergoing a pericardiocentesis. After the withdrawal of pericardial fluid, which assessment by the nurse indicates that cardiac tamponade has been relieved? a. Decrease in blood pressure b. Decrease in central venous pressure (CVP) c. Absence of cough d. Increase in CVP
Decrease in central venous pressure (CVP) A resulting decrease in CVP and an associated increase in blood pressure after withdrawal of pericardial fluid indicate that the cardiac tamponade has been relieved. An absence of cough would not indicate the absence of cardiac tamponade.)
The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema? a. decreased right ventricular elasticity b. increased left atrial contractility c. decreased left ventricular pumping d. increased right atrial resistance
Decreased left ventricular pumping Pulmonary edema is an acute event that results from heart failure. Myocardial scarring, resulting from ischemia, limits the distensibility of the ventricle, making it vulnerable to demands for increased workload. When the demand on the heart increases, there is resistance to left ventricular filling and blood backs up into the pulmonary circulation. Pulmonary edema quickly develops.
The nurse is providing care to a client with cardiogenic shock requiring an intra-aortic balloon pump (IABP). What is the therapeutic effect of the IABP therapy? a. decreased renal perfusion b. decreased left ventricular workload c. decreased peripheral perfusion to the extremities d. decreased right ventricular workload
Decreased left ventricular workload The signs and symptoms of cardiogenic shock reflect the circular nature of the pathophysiology of HF. The therapeutic effect is decreased left ventricular workload. The IABP increases perfusion to the coronary and peripheral arteries.
A nurse is caring for a client with a cardiac disorder who is prescribed diuretics. What important factor should the nurse include in this client's teaching plan? a. A discussion of the required room temperature conditions in the home environment. b. A discussion of the signs and symptoms of electrolyte and water loss. c. A discussion on how to avoid direct sunlight when outdoors. d. A discussion of the signs and symptoms of anemia.
Discussion of the signs and symptoms of electrolyte and water loss. Instructions for clients taking diuretics should include a discussion of the signs and symptoms of electrolyte and water loss and the importance of adhering to the prescribed medication schedule. The client need not be informed about the symptoms of anemia or be advised to maintain any particular room temperature or avoid sunlight; use of diuretics does not increase risk for developing photosensitivity or anemia.
The nurse assessing a client with an exacerbation of heart failure identifies which symptom as a cerebrovascular manifestation of heart failure (HF)? a. Ascites b. Dizziness c. Tachycardia d. Nocturia
Dizziness Cerebrovascular manifestations of heart failure include dizziness, lightheadedness, confusion, restlessness, and anxiety. Tachycardia is a cardiovascular manifestation. Ascites is a gastrointestinal manifestation. Nocturia is a renal manifestation.
The nurse is assessing a client admitted with cardiogenic shock. What medication will the nurse titrate to improve blood flow to vital organs? a. enalapril b. dopamine c. furosemide d. metoprolol
Dopamine (Dopamine, a sympathomimetic drug, is used to treat cardiogenic shock. It increases perfusion pressure to improve myocardial contractility and blood flow through vital organs. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic blocker that slows heart rate and lowers blood pressure, undesirable effects when treating cardiogenic shock.)
The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure? a. Dyspnea on exertion b. Tachycardia c. Decreased urinary output d. Hypotension
Dyspnea on exertion Left-sided heart failure produces hypoxemia as a result of reduced cardiac output of arterial blood and respiratory symptoms. Many clients notice unusual fatigue with activity. Some find exertional dyspnea to be the first symptom. An increase in urinary output may be seen later as fluid accumulates. Hypotension would be a later sign of decompensating heart failure as well as tachycardia.
Which diagnostic study is usually performed to confirm the diagnosis of heart failure? a. Serum electrolytes b. Electrocardiogram (ECG) c. Blood urea nitrogen (BUN) d. Echocardiogram
Echocardiogram
The nurse is caring for a client with heart failure. What procedure should the nurse prepare the client for in order to determine the ejection fraction to measure the efficiency of the heart as a pump? a. A pulmonary arteriography b. Electrocardiogram c. A chest radiograph d. Echocardiogram
Echocardiogram An echocardiogram assesses the heart's structure. This test is used to identify ejection fraction (EF), a percentage that measures how well the ventricles pump blood
The nurse is caring for a client with a history of heart failure and a sudden onset of tachypnea. What is the nurse's priority action? a. Assess pulse oximetry reading. b. Notify the family of a change in condition. c. Elevate the head of the bed. d. Report a decrease in urine output.
Elevate the head of the bed. The nurse's priority action is to elevate the head of the bed to help with breathing. The pulse oximetry reading provides more data but is not the priority intervention
The nurse is interviewing a client during an initial visit to a cardiologist's office. What symptom will the nurse expect to find as an early symptom of chronic heart failure? a. nocturia b. pedal edema c. fatigue d. irregular pulse
Fatigue Fatigue is commonly the earliest symptom of chronic heart failure; it is caused by decreased cardiac output and tissue oxygenation. Pedal edema and nocturia are symptoms of heart failure, but they occur later in the course of the condition. An irregular pulse can be a complication of heart failure, but it is not necessarily an early indication of the condition.
The nurse visits the home of a client with heart failure. Which assessment finding indicates to the nurse that the client's tolerance to activity is deteriorating? a. Fatigue after walking to answer the door b. Weight loss of 0.5 kg (1.1 lbs.) c. Needs to use a scooter for shopping d. Bilateral lower extremity edema +1
Fatigue after walking to answer the door The client's response to activity needs to be monitored. If the client is at home, the degree of fatigue felt after the activity can be used to assess the response. Weight loss is not used to assess activity tolerance but would be helpful to determine the response to medication therapy. Lower extremity edema is not used to assess activity tolerance but would be helpful to determine the response to medication therapy. Tolerance to exercise would be assessed by monitoring heart rate, which should return to baseline within 3 minutes after the activity. Since the client's heart rate returned to baseline in 2 minutes, the activity is being tolerated. Use of a motorized scooter for shopping would not be the best indicator of exercise and/or activity tolerance.
A client with congestive heart failure is admitted to the hospital after reporting shortness of breath. How should the nurse position the client in order to decrease preload? a. Head of the bed elevated 30 degrees and legs elevated on pillows b. Head of the bed elevated 45 degrees and lower arms supported by pillows c. Supine with arms elevated on pillows above the level of the heart d. Prone with legs elevated on pillows
Head of the bed elevated 45 degrees and lower arms supported by pillows Preload refers to the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. The client is positioned or taught how to assume a position that facilitates breathing. The number of pillows may be increased, the head of the bed may be elevated, or the client may sit in a recliner. In these positions, the venous return to the heart (preload) is reduced, pulmonary congestion is alleviated, and pressure on the diaphragm is minimized. The lower arms are supported with pillows to eliminate the fatigue caused by the pull of the client's weight on the shoulder muscles.
The nurse is performing an initial assessment of a client diagnosed with heart failure (HF), including the client's sensorium and level of consciousness (LOC). Why is the assessment of the client's sensorium and LOC important in clients with HF? a. Decreased LOC causes an exacerbation of the signs and symptoms of HF. b. HF ultimately affects oxygen transportation to the brain. c. Clients with HF are susceptible to overstimulation of the sympathetic nervous system. d. The most significant adverse effect of medications used for HF treatment is altered LOC.
Heart failure ultimately affects oxygen transportation to the brain. As the volume of blood ejected by the heart decreases, so does the amount of oxygen transported to the brain. Sympathetic stimulation is not a primary concern in clients with HF, although it is a possibility. HF affects LOC but the reverse is not usually true. Medications used to treat HF carry many adverse effects, but the most common and significant effects are cardiovascular (CV).
A client is already being treated for hypertension. The doctor is concerned about the potential for heart failure and has the client return for regular check-ups. What does hypertension have to do with heart failure? a. Heart failure occurs when blood pressure drops. b. Hypertension causes the heart's chambers to enlarge and weaken. c. Hypertension causes the heart's chambers to shrink. d. Hypertension in older males regularly leads to heart failure.
Hypertension causes the heart's chambers to enlarge and weaken, making it impossible for the ventricles to eject all the blood they receive.
The nurse is assessing a patient who reports no symptoms of heart failure at rest but is symptomatic with ordinary physical activity. Under what classification does the nurse understand this patient would be categorized? a. I b. III c. IV d. II
II Classification II of heart failure is indicated by the patient being comfortable at rest, but experiencing fatigue, palpitation, or dyspnea during ordinary physical activity.
The critical care nurse is caring for a client with cardiogenic shock. What is the premise for inserting an intra-aortic balloon pump? a. right atrial flutter b. inadequate tissue perfusion c. myocardial ischemia d. coronary artery stenosis
Inadequate tissue perfusion The classic signs of cardiogenic shock are related to tissue hypoperfusion and an overall state of shock that is proportional to the extent of left ventricular damage
Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure? a. Increased pulmonary artery diastolic pressure b. Decreased mean pulmonary artery pressure c. Increase in the cardiac index d. Decreased central venous pressure
Increased pulmonary artery diastolic pressure Central venous pressure increases in heart failure rather than decreases. The cardiac index decreases in heart failure. The mean pulmonary artery pressure increases in heart failure.
A nurse is assessing a client with congestive heart failure for jugular vein distension (JVD). Which observation is important to report to the physician? a. No JVD is present. b. JVD is noted at the level of the sternal angle. c. JVD is noted 2 cm above the sternal angle. d. JVD is noted 4 cm above the sternal angle.
JVD is noted 4 cm above the sternal angle. JVD is assessed with the client sitting at a 45° angle. Jugular vein distention greater than 4 cm above the sternal angle is considered abnormal and is indicative of right ventricular failure.
Which is a characteristic of right-sided heart failure?
Jugular vein distention Jugular vein distention is a characteristic of right-sided heart failure. Dyspnea, pulmonary crackles, and cough are manifestations of left-sided heart failure.
A new client has been admitted with right-sided heart failure. When assessing this client, the nurse knows to look for which finding? a. Pulmonary congestion b. Dyspnea c. Jugular venous distention d. Cough
Jugular venous distention When the right ventricle cannot effectively pump blood from the ventricle into the pulmonary artery, the blood backs up into the venous system and causes jugular venous distention and congestion in the peripheral tissues and viscera. All the other choices are symptoms of left-sided heart failure.
The nurse is preparing a client for a multiple gated acquisition (MUGA) scan. What would be an important instruction for the nurse to give a client who is to undergo a MUGA scan? a. Drink plenty of fluids during the test. b. Avoid dairy products a day before and a day after the test. c. Avoid any activity at least 2 hours before the test. d. Lie very still at intermittent times during the test.
Lie very still at intermittent times during the test. The nurse should instruct the client, who is to undergo a MUGA scan, to lie very still at intermittent times during the 45-minute test. The client need not drink plenty of fluids, avoid activities before/after the test, or avoid dairy products during the test.
Which feature is the hallmark of systolic heart failure? a. Pulmonary congestion b. Limited activities of daily living (ADLs) c. Basilar crackles d. Low ejection fraction (EF)
Low ejection fraction (EF) A low EF is a hallmark of systolic heart failure (HF); the severity of HF is frequently classified according to the client's symptoms.
Which is the hallmark of heart failure? a. Low ejection fraction (EF) b. Basilar crackles c. Limited ADLs d. Pulmonary congestion
Low ejection fraction (EF) Although a low EF is a hallmark of heart failure (HF), the severity of HF is frequently classified according to the client's symptoms. Pulmonary congestion, limitation of ADLs, and basilar crackles are all symptoms of HF.
A client has been admitted to the cardiac step-down unit with acute pulmonary edema. Which symptoms would the nurse expect to find during the assessment? a. drowsiness, numbness b. increased cardiac output c. moist, gurgling respirations d. hypertension
Moist, gurgling respirations Clients with acute pulmonary edema experience sudden dyspnea, wheezing, orthopnea, cough, cyanosis, and tachycardia. Respirations sound moist or gurgling. Drowsiness and numbness are not considered issues. Increased cardiac output is not part of this checklist. Hypertension is not an immediate symptom
A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client? a. Vasculitis b. Flexion contractures c. Enlargement of joints d. nausea and vomiting
Nausea and vomiting Digitalis medications are potent and may cause various toxic effects. The nurse should monitor the client for signs of digitalis toxicity, not just during the initial period of therapy, but throughout care management. The most common signs and symptoms include nausea and vomiting which can lead to dehydration and electrolyte imbalance. Symptoms of toxicity do not include vasculitis, flexion contractures, or enlargement of joints. Also: Potassium levels A key concern associated with digoxin therapy is digitalis toxicity. Clinical manifestations of toxicity include anorexia, nausea, visual disturbances, confusion, and bradycardia. The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur.
Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole? a. Afterload b. Preload c. Stroke volume d. Ejection fraction
Preload Preload is the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. Afterload is the amount of resistance to ejection of blood from a ventricle. The ejection fraction is the percentage of blood volume in the ventricles at the end of diastole that is ejected during systole. Stroke volume is the amount of blood pumped out of the ventricle with each contraction.
A client has been diagnosed with congestive heart failure. Which is a cause of crackles heard in the bases of the lungs? a. Pulmonary hypertension b. Mitral valve stenosis c. Aortic valve stenosis d. Pulmonary congestion
Pulmonary congestion Crackles heard in the bases of the lungs are a sign of pulmonary congestion. Heart palpitations are caused by tachydysrhythmias. Crackles heard in the bases of the lungs are not signs of pulmonary hypertension and mitral valve stenosis.
A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." What additional assessment information would be important for the CSU nurse to obtain? a. high urine output b. dry mucous membranes c. hypertension d. pulmonary crackles
Pulmonary crackles High pulmonary artery wedge pressures are diagnostic for left-sided heart failure. With left-sided heart failure, pulmonary edema can develop causing pulmonary crackles. In left-sided heart failure, hypotension may result and urine output will decline. Dry mucous membranes aren't directly associated with elevated pulmonary artery wedge pressures.
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. Pulmonary crackles b. Jugular vein distention c. Dyspnea d. Ascites e. Cough
Pulmonary crackles Dyspnea Cough 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 client who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly reports chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the client for other signs and symptoms of: a. pulmonary edema. b. pulmonary embolism. c. pneumonia. d. myocardial infarction.
Pulmonary embolism. Pulmonary embolism is a potentially life-threatening disorder typically caused by blood clots in the lungs. This disorder poses a particular threat to people with cardiovascular disease. Blood clots that form in the deep veins of the legs and embolize to the lungs can cause a pulmonary infarction, whereby emboli mechanically obstruct the pulmonary vessels, cutting off the blood supply to sections of the lung. Clinical indicators of pulmonary embolism can vary but typically include dyspnea, pleuritic chest pain, and tachypnea.
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. Respiratory alkalosis c. Respiratory acidosis d. Metabolic alkalosis
Respiratory alkalosis 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.
The nurse recognizes which symptom as a classic sign of cardiogenic shock? a. Hyperactive bowel sounds b. Restlessness and confusion c. High blood pressure d. Increased urinary output
Restlessness and confusion
The nurse recognizes which symptom as a classic sign of cardiogenic shock? a. High blood pressure b. Increased urinary output c. Hyperactive bowel sounds d. Restlessness and confusion
Restlessness and confusion Cardiogenic shock occurs when decreased cardiac output leads to inadequate tissue perfusion and initiation of the shock syndrome. Inadequate tissue perfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation).
Which is a manifestation of right-sided heart failure? a. Increase in forward flow b. Systemic venous congestion c. Paroxysmal nocturnal dyspnea d. Accumulation of blood in the lungs
Systemic venous congestion Right-sided heart failure causes systemic venous congestion and a reduction in forward flow. Left-sided heart failure causes an accumulation of blood in the lungs and a reduction in forward flow or cardiac output that results in inadequate arterial blood flow to the tissues. Some clients with left-sided heart failure get episodes of dyspnea at night, known as paroxysmal nocturnal dyspnea.
Assessment of a client on a medical-surgical unit finds a regular heart rate of 120 beats per minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 mL over the past hour. What is the reason the nurse anticipates transferring the client to the intensive care unit? a. The client shows signs of aneurysm rupture. b. The client is going into cardiogenic shock. c. The client is in the early stage of right-sided heart failure. d. The client is experiencing heart failure.
The client is going into cardiogenic shock. This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impeding blood supply and oxygen flow to vital organs. Cardiogenic shock also may cause cold, clammy skin and generalized weakness, fatigue, and muscle pain as poor blood flow causes lactic acid to accumulate and prevents waste removal. Left-sided and right-sided heart failure eventually cause venous congestion with jugular vein distention and edema as the heart fails to pump blood forward. A ruptured aneurysm causes severe hypotension and a quickly deteriorating clinical status from blood loss and circulatory collapse; this client has low but not severely decreased blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and full cardiac arrest is common.
A nurse is teaching a client about heart failure. What will the nurse explain is causing the heart to fail? a. The heart cannot pump sufficient blood to meet the body's metabolic needs. b. The heart is fibrillating. c. The heart is pumping too slowly to disseminate nutrients to the body. d. The heart is pumping too fast to adequately meet the body's metabolic needs.
The heart cannot pump sufficient blood to meet the body's metabolic needs. Heart failure is the inability of the heart to pump sufficient blood to meet the body's metabolic needs. Heart failure does not mean the heart pumps too fast or to slow; it means it cannot contract effectively to eject the blood in the ventricles. A fibrillating heart involves a problem with conduction, not failure.
The nurse is administering furosemide to a client with heart failure. What best describes the therapeutic action of the medication? a. Furosemide promotes sodium secretion into the distal tubule. b. The medication promotes potassium secretion into the distal tubule and constricts renal vessels. c. Furosemide blocks the reabsorption of potassium on the collecting tubule. d. The medication blocks sodium reabsorption in the ascending loop and dilates renal vessels.
The medication blocks sodium reabsorption in the ascending loop and dilates renal vessels.
A client with a history of heart failure is returning from the operating room after inguinal hernia repair and the nurse assesses a low pulse oximetry reading. What is the most important nursing intervention? a. Titrate oxygen therapy. b. Assess the surgical incisional area. c. Administer pain medication. d. Assess for jugular vein distention.
Titrate oxygen therapy. The nurse needs to titrate oxygen therapy to increase the client's oxygen levels. Assessing for jugular vein distention and examining the surgical incision area will not meet the oxygen demands. Administering pain medication will not increase oxygenation levels.
The nurse is assisting in the care of a client who is receiving cardiopulmonary resuscitation (CPR). Why will the client be prescribed amiodarone during the resuscitation efforts? a. Reduce the development of torsade de pointes. b. Treat pulseless ventricular tachycardia. c. Prevent the development of hypotension. d. Correct metabolic acidosis.
Treat pulseless ventricular tachycardia. During CPR, the medications provided will depend upon the client's condition and response to therapy. Amiodarone is used to treat pulseless ventricular tachycardia. Sodium bicarbonate is used to correct metabolic acidosis. Norepinephrine and dopamine are used to prevent the development of hypotension. Magnesium sulfate is used for the client with torsade de pointes.
The student nurse is caring for a client with heart failure. Diuretics have been prescribed. What method might be used with a debilitated client to help the nurse evaluate the client's response to diuretics? a. Using mechanical ventilation b. Using a pulmonary artery catheter c. Using a biventricular pacemaker d. Using a urinary catheter
Using a urinary catheter To evaluate response to diuretics, a urinary catheter is used. Mechanical ventilation helps maintain a normal breathing pattern. A pulmonary artery catheter helps estimate cardiac output. A biventricular pacemaker is used to sustain life.
A client taking an ACE inhibitor has developed a dry, hacking cough. Because of this side effect, the client no longer wants to take that medication. What medication that has similar hemodynamic effects does the nurse anticipate the health care provider ordering? a. Isosorbide dinitrate b. Valsartan c. Furosemide d. Metoprolol
Valsartan If the patient cannot continue taking an angiotensin-converting enzyme (ACE) inhibitor because of development of cough, an elevated creatinine level, or hyperkalemia, an angiotensin receptor blocker (ARB) or a combination of hydralazine and isosorbide dinitrate is prescribed (see Table 29-3).
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. Metolazone (Zaroxolyn) b. Digoxin (Lanoxin) c. Valsartan (Diovan) d. Carvedilol (Coreg)
Valsartan (Diovan) 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).
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. Intra-aortic balloon pump (IABP) b. Implanted cardioverter-defibrillator (ICD) c. Pacemaker d. Ventricular assist device (VAD)
Ventricular assist device (VAD)
A client with chronic heart failure is receiving digoxin 0.25 mg by mouth daily and furosemide 20 mg by mouth twice daily. The nurse should assess the client for which signs of digoxin toxicity? a. dry mouth and urine retention. b. visual disturbances. c. taste and smell alterations. d. nocturia and sleep disturbances.
Visual disturbances.
While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). How should the nurse document this sound? a third heart sound (S3). a murmur. a first heart sound (S1). a fourth heart sound (S4).
a third heart sound (S3). An S3 is heard following an S2, which commonly occurs in clients experiencing heart failure and results from increased filling pressures. An S1 is a normal heart sound made by the closing of the mitral and tricuspid valves. An S4 is heard before an S1 and is caused by resistance to ventricular filling. A murmur is heard when there is turbulent blood flow across the valves.
A client with left-sided heart failure reports increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of what condition? a. acute pulmonary edema. b. right-sided heart failure. c. pneumonia. d. cardiogenic shock.
acute pulmonary edema. Shortness of breath, agitation, and pink-tinged, foamy sputum signal acute pulmonary edema. This condition results when decreased contractility and increased fluid volume and pressure in clients with heart failure drive fluid from the pulmonary capillary beds into the alveoli. In right-sided heart failure, the client would exhibit hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia, the client would have a temperature spike and sputum that varies in color. Cardiogenic shock is indicated by signs of hypotension and tachycardia.
The nurse discusses basic cardiac hemodynamics and explains preload to the client. What nursing intervention will decrease preload? a. administration of a vasodilating drug (as ordered by a healthcare provider) b. increasing activity c. application of anti-embolic stockings d. sustained elevation of the client's legs
administration of a vasodilating drug (as ordered by a health care provider) Preload is the amount of blood presented to the ventricles just before systole. Anything that decreases the amount of blood returning to the heart will decrease preload, such as vasodilation or blood pooling in the extremities. Anything that assists in returning blood to the heart (antiembolic stockings) or preventing blood from pooling in the extremities will increase preload.
A client has been having cardiac symptoms for several months and is seeing a cardiologist for diagnostics to determine the cause. How will the client's ejection fraction be measured? a. echocardiogram b. cardiac ultrasound c. cardiac catheterization d. electrocardiogram
echocardiogram The heart's ejection fraction is measured using an echocardiogram or multiple gated acquisition scan, not an electrocardiogram or cardiac ultrasound. Cardiac catheterization is not the diagnostic tool for this measurement.
The nurse is assessing a newly admitted client with chest pain. What medical disorder is most likely causing the client to have jugular vein distention? a. myocardial infarction (MI) b. heart failure c. abdominal aortic aneurysm d. pneumothorax
heart failure
A nurse is administering digoxin. What client parameter would cause the nurse to hold the digoxin and notify the health care prescriber? a. atrial fibrillation rhythm b. heart rate of 55 beats per minute c. urine output of 300 mL in eight hours d. blood pressure of 125/80
heart rate of 55 beats per minute Digoxin therapy slows conduction through the AV node. A heart rate of 55 is slow and the digoxin therapy may slow the heart rate further. Blood pressure of 125/80 is normal. Urine output of 300 mL is adequate, so the kidneys are functioning. Atrial fibrillation is not a parameter to hold medication.
The nurse is assessing a client with crackling breath sounds or pulmonary congestion. What is the cause of the congestion? a. inadequate cardiac output b. hepatomegaly c. nocturia d. ascites
inadequate cardiac output Pulmonary congestion occurs and tissue perfusion is compromised and diminished when the heart, primarily the left ventricle, cannot pump blood out of the ventricle effectively into the aorta and the systemic circulation. Ascites is fluid in the abdomen, not a cause of congestion. Hepatomegaly is an enlarged liver, which does not cause crackling breath sounds. Nocturia, or voiding at night, does not cause crackling breath sounds.
The nurse is assigned to care for a client with heart failure. What medication does the nurse anticipate administering that will improve client symptoms as well as increase survival? a. lisinopril b. diltiazem c. bumetanide d. cholestyramine
lisinopril Several medications are routinely prescribed for heart failure (HF), including angiotensin-converting enzyme (ACE) inhibitors such as lisinopril, beta-blockers, and diuretics such as bumetanide. Many of these medications, particularly ACE inhibitors and beta-blockers, improve symptoms and extend survival. Others, such as diuretics, improve symptoms but may not affect survival. Calcium channel blockers such as diltiazem are no longer recommended for patients with HF because they are associated with worsening failure. Cholestyramine is used to lower cholesterol.
A nurse reviews the client's medical record and reads in the progress notes that the client has decreased left ventricular function. What assessment will validate the diagnosis? a. increased appetite b. orthopnea c. resting bradycardia d. Bibasilar rales cleared with coughing
orthopnea Decreased left ventricular function would be characterized by orthopnea, dyspnea, anorexia, bibasilar rales not cleared with coughing, and resting tachycardia.
The nurse is administering digoxin to a client with heart failure. What laboratory value may predispose the client to digoxin toxicity? a. potassium level of 2.8 mEq/L b. sodium level of 152 mEq/L c. magnesium level of 2.5 mg/dL d. calcium level of 7.5 mg/dL
potassium level of 2.8 mEq/L Conditions that may predispose a client to digoxin toxicity include hypokalemia (evidenced by a potassium level less than 3.5 mEq/L), hypomagnesemia (evidenced by a magnesium level less than 1.5 mEq/L), hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia (evidenced by a magnesium level greater than 2.5 mEq/L), hypercalcemia (evidenced by an ionized calcium level greater than 5.3 mg/dl), and hypernatremia (evidenced by a sodium level greater than 145 mEq/L) aren't associated with a risk of digoxin toxicity.
