Client with Heart Failure (final)

c ( Feedback Rationale: All cardiomyopathies have similar symptoms, but only dilated cardiomyopathy presents with orthopnea, nocturnal dyspnea, peripheral edema, and ascites. Hypertrophic and restrictive cardiomyopathy usually present with dyspnea on exertion. Hypotrophic cardiomyopathy is not a cardiomyopathy classification. )

A client presents to the emergency department with symptoms of orthopnea, paroxysmal nocturnal dyspnea, peripheral edema, and ascites. The physician suspects cardiomyopathy. The nurse suspects the client is experiencing which type of myopathy? a Hypertrophic cardiomyopathy b Hypotrophic cardiomyopathy c Dilated cardiomyopathy d Restrictive cardiomyopathy

2 (LPN/LVN education and scope of practice include data collection such as listening to lung sounds and checking for peripheral edema when caring for stable clients. Weighing the residents should be delegated to a UAP. Reviewing medications with residents and planning appropriate activity levels are nursing actions that require RN-level education and scope of practice. Focus: Delegation)

As the charge nurse in a long-term care facility that employs RNs, LPNs/LVNs, and UAPs, you have developed a plan for the ongoing assessment of all residents with a diagnosis of heart failure. Which activity included in the plan is most appropriate to delegate to an LPN/LVN team member? 1. Weighing all residents with heart failure each morning 2. Listening to lung sounds and checking for edema each week 3. Reviewing all heart failure medications with residents every month 4. Updating activity plans for residents with heart failure every quarter

a (Cardiac output is determined by the amount of blood pumped from the ventricles in 60​ seconds, or 1 minute)

Cardiac output is determined by the amount of blood that pumps through the ventricles in what time​ frame? a 60 seconds b 30 seconds c 15 seconds d 45 seconds

a

Mae​ Jones, an​ 83-year-old woman with a history of​ hypertension, is admitted with reports of dyspnea on exertion. When you perform a physical assessment on Ms.​ Jones, you auscultate S3​ and S4​ heart sounds over her left sternal border and fine crackles over the bottom half of her lung fields. Her breathing is​ labored, and her oxygen saturation is​ 88% while breathing room air. Which intervention would you include for Ms.​ Jones's nursing plan of​ care? a Administer oxygen as prescribed. b Give foods high in sodium. c Instruct her to stop taking diuretics. d Encourage liberal fluid intake.

1.5-2.5

The normal adult value for magnesium is___-____ mEq/L

b

The nurse is caring for a client newly diagnosed with heart failure. Which medication order does the nurse anticipate receiving from the healthcare​ provider? a Benzodiazepine b Diuretic c Proton pump inhibitor d Selective serotonin reuptake inhibitor

1,2,4 (If the client will call the HCP when there is increasing SOB, weight gain over 2 lbs in 1 day, and need to sleep sitting up, this indicates an understanding of the teaching because the S/S suggest worsening of client condition HF. Althought the client most likely will be on a Na restricted diet, the client would not need to notify the HCP if they had consumed a high Na breakfast. Instead the client would need to be alert for possible S/S of worsening HF and work to reduce Na intake the rest of the day and in the future)

The nurse is teaching a client with HF how to avoid complications and future hospitalizations. The nurse is confident that the client has understood the teaching when the client identifies which potential complication? Select all that apply 1. becoming increasingly SOB at rest 2. weight gain of 2 lbs or more in 1 day 3. high intake of Na for breakfast 4. having to sleep sitting up in a reclining chair 5. weigh loss of 2 lbs in 1 day

4 ( a low serum K level predisposes the client to digoxin toxicity. Because K inhibits cardiac excitability, a low serum K level would mean the client would be prone to increased cardiac excitability. Na, glucose, and Ca levels do not affect digoxin or contribute to digoxin toxicity)

The nurse should assess the client for digoxin toxicity if serum levels indicate the client has a : 1. low Na level 2. high glucose level 3. high Ca level 4. low K level

a,b,c,e (Common manifestations of heart failure include paroxysmal nocturnal​ dyspnea, which is when the client awakes at night short of breath. Other manifestations include​ edema, nocturia​ (voiding two or more times a​ night), and dyspnea at rest. A client with heart failure will experience weight​ gain, not weight loss.)

What are common manifestations of heart​ failure? ​(Select all that​ apply.) a Paroxysmal nocturnal dyspnea b Nocturia c Edema d Weight loss e Dyspnea at rest

1 (increasing cardiac output is the main goal of therapy for a client with HF or pulmonary edema. Pulmonary edema is an acute medical emergency requiring immediate intervention. Respiratory status and comfort will be improved when cardiac output increases to the acceptable level. Peripheral edema is not typically associated with pulmonary edema.)

What is the major goal of nursing care for a client with HF and pulmonary edema? 1. increase cardiac output 2. Improve respiratory status 3. decrease peripheral edema 4. enchance comfort

a

When assessing a patient with chronic heart failure, the healthcare provider would expect to identify which of these clinical manifestations? Choose 1 answer: a Inspiratory crackles b Asymmetrical chest expansion c Expiratory wheezing d Subcutaneous crepitus

a (Thiamin, which may be prescribed to a client with heart​ failure, will convert carbohydrates into glucose and metabolize fats and proteins. Magnesium is a supplement necessary to maintain normal heart rhythm. Coenzyme Q10 improves mitochondrial function and energy production. Vitamin D3 promotes the intestinal absorption of dietary calcium.)

Which supplement that may be prescribed to a client with heart failure will convert carbohydrates into glucose and metabolize fats and​ protein? a Thiamin b Magnesium c Vitamin D3 d Coenzyme Q10

2,3,4 (Hypokalemia is a side effect of loop diuretics. Bananas, dried fruit, and oranges are examples of foods high in K. Angel food cake and peppers are low in K)

A client recieving a loop diuretic should be encouraged to eat which foods? Select all that apply: 1. angel food cake 2. banana 3. dried fruit 4. orange juice 5. peppers

1 (It is a priority to assess the BP first because people with pulmonary edema typically experience severe HTN that requires early intervention. The client probably does not have skin breakdown, but when the client is stable and when the nurse obtains a complete health history, the nurse should inspect the clients skin for any signs of breakdown; however when the client is stable, the nurse should inspect the skin. K levels are not the first priority. The nurse should monitor urine output after the client is stable)

An older adult with a history of HF is admitted to the ER with pulmonary edema. On admission, what should the nurse assess first? 1. BP 2. skin breakdown 3. serum K level 4. urine output

b (Pulmonary edema develops as a consequence of​ left-sided heart failure. Symptoms include shortness of​ breath, pink, frothy​ sputum, labored breathing increased respiratory​ rate, fine​ crackles, and wheezes.​ Right-sided failure involves failure of the right​ ventricle, causing blood to accumulate in the systemic venous system.)

Barry​ Marks, a​ 56-year-old man with a history of coronary artery​ disease, is admitted with reports of dyspnea and fatigue. Upon physical​ examination, you auscultate crackles halfway up Mr.​ Marks's lung fields. An echocardiogram reveals reduced cardiac output. Which response should you provide to Mr. Marks when he asks you to explain why a heart problem makes it is hard for him to​ breathe? ​a "The right side of your heart is too weak to pump enough blood to your​ lungs." ​b "Your heart is too weak to pump blood​ effectively, so the blood is backing up and congesting your​ lungs." c ​"The right ventricle of your heart is not pumping​ properly." d ​"The right side of your heart is too weak to pump blood​ effectively, so the blood is backing up and congesting your​ lungs."

3 (The nurse should withhold the dose of captopril; captopril is an ACE inhibitor, and a side effect of the medication is hyperkalemia. The BUN and creatinine which are normal, should be viewed prior to administration since renal insufficiency is another potential side effect of an ACE-1. The HR is within normal limits. The nurse should question the dose of metoprolol if the clients HR is bradycardic. The hbg and hct are normal for a female. The nurse should report the high K level and that the captopril was withheld.)

Captopril, furosemide, and metoprolol are prescribed for a client with systolic hear failure. The clients BP is 136/82 and the HR is 65 bpm. Prior to medication administration at 0900, the nurse reviews the following lab tests: NA 140 K 6.8 BUN 18 Creat 1.0 Hgb 12 Hct 37% What should the nurse do first? 1. Administer the medications 2. Call the HCP 3. Withhold the captopril 4. Question the metoprolol dose

3 (The client's visual disturbances may be a sign of digoxin toxicity. The nurse should notify the health care provider and obtain an order to measure the digoxin level. An irregularly irregular pulse is expected with atrial fibrillation; there are no contraindications to taking digoxin with food; and crackles that clear with coughing are indicative of atelectasis, not worsening of heart failure. Focus: Prioritization)

During a home visit to an 88-year-old client who is taking digoxin (Lanoxin) 0.25 mg daily to treat heart failure and atrial fibrillation, you obtain this assessment information. Which finding is most important to communicate to the health care provider? 1. Apical pulse of 68 beats/min and irregularly irregular 2. Digoxin taken with meals 3. Vision that is becoming "fuzzy" 4. Lung crackles that clear after coughing

1 (After IV injection of furosemide, diuresis normally begins in about 5 min. and reaches its peak within about 30 mins. Medication effects last 2-4 hrs. When furosemide is given IM or orally , drug action begins more slowly and lasts longer than when given IV)

Furosemide is administered IV to a client with HF. How soon after administration should the nurse begin to see evidence of the drugs desired effect? 1. 5-10 min 2. 30-60 min 3. 2-4 hrs 4. 6-8 hrs

a,b,d,e,f

The healthcare provider is teaching a group of senior citizens about risk factors for heart failure. Which of these factors will the healthcare provider include in the teaching? Choose all answers that apply: A Sleep apnea B History of preeclampsia C Increased high density lipoproteins (HDL) D Hypertension E Obesity F High sodium intake

1,3,5,6 (Dyspnea, crackles, oliguria and decreased O2 sat are S/S related to pulmonary congestion and inadequate tissue perfusion associated with left-sided HF. JVD and RUQ pain along with ascites and edema are usually associated with congestion of the peripheral tissues and viscera in right-sided HF)

The nurse should assess the client with left sided HF for which findings? Select all that apply 1. dyspnea 2. JVD 3. crackles 4. RUQ pain 5. oliguria 6. decreased O2 sat

a

Which is the sodium limit for a client diagnosed with heart​ failure? a 1.5 -2 ​g/day b 3.5 -4 ​g/day c 0.5 -1 ​g/day d 2.5 -3 ​g/day

2 4 3 1 (The primary goal is to decrease the cardiac ischemia that may be causing the client's tachycardia. This would be most rapidly accomplished by decreasing the workload of the heart and administering supplemental oxygen. Changes in blood pressure indicate the impact of the tachycardia on cardiac output and tissue perfusion. Finally, the physician should be notified about the client's response to activity, because changes in therapy may be indicated. Focus: Prioritization)

You are ambulating a cardiac surgery client who has a telemetry cardiac monitor when another staff member tells you that the client has developed supraventricular tachycardia at a rate of 146 beats/min. In which order will you take the following actions? 1. Call the client's physician. 2. Have the client sit down. 3. Check the client's blood pressure. 4. Administer PRN oxygen by nasal cannula. _____, _____, _____, _____

2 (early signs of digoxin toxicity include anorexia, N/V. Visual disturbances can also occur, including double or blurred vision and visual halos. Hypokalemia is a common cause of digoxin toxicity associated with arrhythmias because low serum K can enhance ectopic pacemaker activity. Although vomiting can lead to fluid deficit, given the clients history, the vomiting is likely due to the adverse effects of digoxin toxicity. Pulmonary edema is manifested by dyspnea and coughing)

A client has a history of HF and has been prescribed furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first degree atrioventricular block. The nurse should assess the client for signs of : 1. hyperkalemia 2. digoxin toxicity 3. fluid deficit 4. pulmonary edema

a (​Rationale: ​Weakness, fatigue, and decreased exercise tolerance are clinical manifestations of systolic heart failure.​ Diastolic, left-sided, and​ right-sided heart failure have different manifestations than those reported by the client.)

A client reports​ weakness, fatigue, and decreased exercise tolerance. Based on the reported​ symptoms, the nurse anticipates that the healthcare provider will diagnose the client as having which classification of heart​ failure? a Systolic ​b Right-sided ​c Left-sided d Diastolic

2 (Research indicates that B-type natriuretic peptide levels increase in clients with poor left ventricular function and symptomatic heart failure and can be used to differentiate heart failure from other causes of dyspnea and fatigue such as pneumonia. The other values should also be monitored, but do not indicate whether the client has heart failure. Focus: Prioritization)

A client seen in the clinic with shortness of breath and fatigue is being evaluated for a possible diagnosis of heart failure. Which laboratory result will be most useful to monitor? 1. Serum potassium 2. B-type natriuretic peptide 3. Blood urea nitrogen 4. Hematocrit

c (Rationale Acute heart failure is a sudden decrease in cardiac function and is caused by myocardial infarction. Chronic heart failure is a gradual decrease in cardiac function. Cardiac disorders that lead to chronic heart failure include​ cardiomyopathy, valvular​ disease, and coronary heart disease.)

A client was recently diagnosed with acute heart failure. The nurse anticipates that which cardiac disorder led to this ​diagnosis? a Cardiomyopathy b Valvular disease c Myocardial infarction d Coronary heart disease

3 (The client's history and symptoms indicate that acute arterial occlusion has occurred. Because it is important to return blood flow to the foot rapidly, the physician should be notified immediately so that interventions such as balloon angioplasty or surgery can be initiated. Changing the position of the foot and improving blood oxygen saturation will not improve oxygen delivery to the foot. Telling the client that embolization is a common complication of endocarditis will not reassure a client who is experiencing acute pain. Focus: Prioritization)

A client who has endocarditis with vegetation on the mitral valve suddenly reports severe left foot pain. You note that no pulse is palpable in the left foot and that it is cold and pale. Which action should you take next? 1. Lower the client's left foot below heart level. 2. Administer oxygen at 4 L/min to the client. 3. Notify the client's physician about the change in status. 4. Reassure the client that embolization is common in endocarditis.

2 (Digoxin is a cardiac glycoside with positive inotropic activity. This inotropic activity causes increased strength of myocardial contractions and thereby increases output of blood from the left ventricle. Digoxin does not dilate coronary arteries. Although Digoxin can be used to treat arrhythmias and does decrease the electrical conductivity of the myocardium, these are not primary reasons for its use in clients with HF and pulmonary edema.)

A client with HF is receiving digoxin IV. The nurse should determine the effectiveness of the drug by assessing: 1. dilated coronary arteries 2. increased myocardial contractility 3. decreased cardiac arrhythmias 4. decreased electrical conductivity in the heart

3 (Warfarin is an anticoagulant which is used in the treatment of atrial fibrillation and decrease ventricular ejection fraction (<20%) to preven thrombus formation and release of emboli into the circulation. The client may also take other medications as needed to manage heart failure. Warfarin does not reduce circulatory load or improve myocardial workload. Warfarin does not affect cardiac rhythm.)

A client with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction of 15 %. The client is taking warfarin. The expected outcome of this drug is to: 1. decrease circulatory overload 2 improve the myocardial workload 3. prevent thrombus formation 4. regulate cardiac rhythm

c ( Feedback Rationale: Nausea and anorexia are symptoms of digoxin toxicity. Abnormal sodium or potassium levels or abnormal PT/INR would not explain the client's symptoms and, therefore, are not priorities to assess before notifying the physician.)

A client with coronary artery disease (CAD) has had bypass surgery and is about to be discharged home on several new medications, including digoxin (Lanoxin) and furosemide (Lasix). The client complains of nausea and anorexia. Which action will the nurse do first? a Check the sodium level. b Call the physician. c Check the digoxin level. d Check the PT/INR.

a,c,e (Rationale: Urinary output of less than 30​ mL/hr for 2 hours suggests decreased renal tissue perfusion. A blood pressure of​ 126/72 mmHg is within normal limits and indicates adequate tissue perfusion. An increased capillary refill time can indicate decreased cardiac​ output, which can cause poor tissue perfusion. A decreased level of consciousness indicates that the brain tissue is not being adequately perfused. An oxygen saturation of​ 93% is within normal limits.​ Therefore, there is sufficient oxygen for tissue perfusion.)

A nurse is assessing a client with heart failure. The nurse is concerned the client is experiencing poor tissue perfusion based on which assessment​ findings? ​(Select all that​ apply.) a Capillary refill time is increasing. b Blood pressure is​ 126/72 mmHg. c Urinary output is 20​ mL/hr for the past 2 hours. d Oxygen saturation is​ 93% on room air. e Level of consciousness is decreasing.

a,d,e (Rationale Venous pressure monitoring includes right heart filling pressures and can be used to monitor fluid status. The normal central venous pressure is 2-6 mm Hg.​ Intra-arterial pressure monitoring provides direct and continuous arterial blood pressures. Pulmonary artery pressure monitoring is used to evaluate left ventricular and cardiac functioning.)

A nurse is caring for a client newly diagnosed with heart failure. The client is placed on venous pressure monitoring. Which information about the heart function does venous pressure monitoring​ provide? ​(Select all that​ apply.) a Fluid status b Direct and continuous arterial blood pressures c Left ventricular and cardiac functioning d Normal​ range, 2 to 6 mmHg e Right heart filling pressures

b,c,d,e (Rationale: ​Initially, cardiac output is increased because the cardiac muscles are able to accommodate the additional workload. This situation cannot last. Over​ time, the cardiac muscle will​ weaken, and cardiac output will begin to decrease. Decreased cardiac output causes the aortic baroreceptors to stimulate the sympathetic nervous system. The heart develops structural changes to accommodate additional fluid volume. The heart chambers and heart muscles enlarge to accommodate the additional fluid. As the cardiac output​ decreases, perfusion to the kidneys decreases. The kidneys respond by releasing renin to increase the vascular volume and venous return. Atrial natriuretic peptide is released by the cardiac cells to help delay cardiac decompensation. Atrial natriuretic peptide is a hormone that helps balance the effects of other hormones.)

A nurse is describing the pathophysiology of heart failure to a client. Which changes caused by compensatory mechanisms in the development of heart failure should the nurse​ describe? ​(Select all that​ apply.) a Increased cardiac output causes the aortic baroreceptors to stimulate the sympathetic nervous system. b The kidneys release renin to retain sodium and water in an attempt to maintain cardiac output. c Atrial natriuretic peptide is released by the cardiac cells to help delay cardiac decompensation. d The ventricles in the heart remodel and develop hypertrophy because of the chronic increase in fluid volume. e Hypertension causes the cardiac muscles to overstretch and cause temporarily increased cardiac output.

a

A nurse is preparing discharge teaching for a client newly diagnosed with heart failure. Which information should the nurse include in this​ teaching? a Allow rest periods throughout the day. b Strenuous exercise is encouraged as manifestations improve. c Eat three large meals daily. d Restrict sodium intake to 3​ g/day.

c (Rationale Digitalis glycosides increase contractility by improving systolic​ contractions, which improves cardiac output and perfusion. Nitrates are​ vasodilators, both venous and arterial. They will not improve contractility. Loop diuretics cause the kidneys to release water through the loop of Henle. They reduce​ volume, but will not improve contractility.​ Alpha-blockers are typically not used in the treatment of heart failure.)

A nurse is providing care for a client with heart failure. The client has weakened ventricular contractions and deceased cardiac output. The nurse anticipates an order for which medication to improve ​contractility? a Nitrates b Loop diuretics c Digitalis glycosides ​d Alpha-blockers

a

A nurse is providing care for a client with pulmonary edema subsequent to heart failure. Which finding indicates that the interventions implemented have resolved the gas exchange​ problem? a Oxygen saturation is​ 94% with oxygen supplementation. b Lung sounds indicate bilateral crackles and a cough productive of​ frothy, pink sputum. ​c Client's respirations are 26​ breaths/min with intercostal retractions. d Client is restless and sitting upright to breathe.

a,b,d,e (Rationale: When caring for a client diagnosed with heart​ failure, the nurse should auscultate lung sounds every 4​ hours, weigh the client​ daily, monitor intake and​ output, and record hourly urine outputs. These interventions will assist in monitoring the​ client's fluid volume status. Allowing for rest periods will assist with the​ client's activity. It is not used to monitor the​ client's fluid volume.)

A nurse is providing care to a client diagnosed with heart failure. Which interventions should the nurse implement when monitoring the​ client's fluid​ volume? ​(Select all that​ apply.) a Monitor intake and output. b Auscultate lung sounds every 4 hours. c Allow for rest periods. d Weigh the client daily. e Record hourly urine outputs.

a,b,c,e (​Rationale: When providing education to a community​ group, the nurse needs to include the following risk factors for heart​ failure: coronary heart​ disease, hypertension, diabetes​ mellitus, and sleep apnea. Pituitary adenoma is not a risk factor for heart failure.)

A nurse is providing education about heart failure to a community group. Which risk factors should the nurse include in the​ presentation? ​(Select all that​ apply.) a Coronary heart disease b Hypertension c Sleep apnea d Pituitary adenoma e Diabetes mellitus

a,b,d (Rationale: High urine pH and red blood cells are associated with renal disease. A high specific gravity can be associated with concentrated​ urine, which is found in clients who are retaining fluid. Creatinine is excreted by the kidneys. Serum creatinine is a better indicator of renal function than BUN. Elevated BUN can be a sign of dehydration. If the client is not​ dehydrated, then elevated blood urea nitrogen can be a sign of renal function. Creatinine does not elevate with dehydration. Creatinine rises when the kidneys are unable to excrete it. The chest​ x-ray will show enlarged heart and fluid in the lung. A chest​ x-ray is not diagnostic for renal problems. BNP is produced in the cardiac ventricles. It rises in response to stretch and overload. It is related to heart failure but not renal function.)

A nurse is reviewing diagnostic tests for a client newly diagnosed with heart failure. The nurse is concerned that the client is experiencing renal issues in addition to the heart failure. Which diagnostic tests would the nurse focus on to help determine renal​ function? ​(Select all that​ apply.) a Serum creatinine b Urinalysis ​c B-type natriuretic​ peptide(BNP) d Blood urea nitrogen​ (BUN) e Chest​ x-ray

d (Hydrochlorothiazide inhibits sodium reabsorption, causing sodium and water (along with potassium and hydrogen ions) to be excreted. The diuretic effect and decrease in fluid volume may cause orthostatic (postural) hypotension. Position changes should be made slowly to prevent falls.)

A patient diagnosed with mild heart failure is prescribed hydrochlorothiazide (Microzide). The healthcare provider should determine the teaching about the medication has been successful if the patient makes which of these statements? Choose 1 answer: A "I should not worry if I experience a dry cough when taking this medication." B "I might experience swelling in my legs when taking this medication." C . "This medication might cause me to have a decrease in my appetite." D "It is important for me to change positions slowly because I might become dizzy.

c

A patient has been admitted to the cardiac unit with a diagnosis of right ventricular failure. Which of the following assessment findings would the healthcare provider expect to observe? is most likely to be observed by the healthcare provider? Choose 1 answer: Choose 1 answer: A Fatigue and hemoptysis B Bradycardia and circumoral cyanosis C Peripheral edema and jugular vein distension D Dyspnea and pulmonary crackles

d

A patient is being assessed for possible heart failure. Which of these laboratory results will provide support this diagnosis? Choose 1 answer: Choose 1 answer: a Decreased C-reactive protein b Increased creatine kinase c Decreased serum sodium d Increased brain natriuretic peptide (BNP)

a (Furosemide may cause hypokalemia, which increases the risk of digoxin toxicity.)

A patient is diagnosed with heart failure and is prescribed digoxin (Lanoxin) and furosemide (Lasix). Before administering the furosemide to the patient, which laboratory result should the healthcare provider to review? Choose 1 answer: Choose 1 answer: A Serum potassium B Serum troponin C Serum sodium D Blood urea nitrogen (BUN)

4 (Pulmonary valve dysfunction decreases blood flow to the lungs. Pulmonary valve dysfunction increases the workload of the right ventricle. A sign of right ventricular failure is peripheral edema.)

A patient who has a history of pulmonary valve stenosis tells the healthcare provider, "I don't have a lot of energy anymore, and both of my feet get swollen in the late afternoon." Which of these problems does the healthcare provider conclude is the likely cause of these clinical findings? Choose 1 answer: 1 Acute pericarditis 2 Deep vein thrombosis (DVT) 3 Peripheral artery disease 4 Right ventricular failure

c (Rationale: In hypertrophic cardiomyopathy, symptoms may not develop until the demand for oxygen increases as with exercising. This type of cardiomyopathy is not a problem with filling the heart, but rather an obstruction of blood being ejected from the heart to meet the body's oxygen demand. It is not likely that the child had symptoms. The ventricle does not rupture due to scarring. )

A young athlete collapsed and died due to hypertrophic cardiomyopathy. The parents ask the nurse how it is possible that their child had no symptoms of this disorder before experiencing sudden cardiac death. What is the most appropriate response made by the nurse? a "It is likely that your child had symptoms of the disorder but may not have thought them important." b "During exercise, the heart may not be able to meet the body's demands for blood and oxygen." c "Exercise causes the heart to contract more forcefully and can lead to changes in the heart's rhythm or outflow of blood." d "Cardiomyopathy results in destruction and scarring of cardiac muscle cells. As a result, the ventricle may rupture, causing sudden death."

2 (Since proton pump inhibitors such as omeprazole affect the metabolism of clopidogrel and decrease its effectiveness, the health care provider may want to discontinue the omeprazole in this client with unstable angina. The other medications should also be verified, but current national guidelines for clients with unstable angina indicate that providers should consider avoiding proton pump inhibitors in those who require clopidogrel. Focus: Prioritization)

The health care provider telephones you with new prescriptions for a client with unstable angina who is already taking clopidogrel (Plavix). Which medication is most important to clarify further with the health care provider? 1. Aspirin (Ecotrin) 162 mg daily 2. Omeprazole (Prilosec) 20 mg daily 3. Metoprolol (Lopressor) 50 mg daily 4. Nitroglycerin patch (Nitrodur) 0.4 mg/hr

1 (the ankle edema suggests fluid volume overload. The nurse should assess respiratory rate, lung sounds, and 02 sat to identify any signs of respiratory symptoms of HF requiring immediate attention. The nurse can then draw blood for lab studies, insert the foley cath, and weigh the client)

The nurse is admitting an older adult to the hospital. The ECG report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed. Based on this finding, what should the nurse do first? 1. assess respiratory status 2. draw blood for a laboratory study 3. insert a foley catheter 4. weigh the client

4,5 (Signs of pulmonary edema are identical to those of acute HF. S/S are generally apparent in the respiratory system and include coarse crackle, severe dyspnea, and tachycardia. Severe tachycardia occurs due to sympathetic stimulation in the presence of hypoxemia. BP may be decreased OR elevated, depending on the severity of the edema. JVD, dependent edema, and anorexia are symptoms of RIGHT sided HF.)

Which are indications that a client with a history of left-sided HF is developing pulmonary edema? Select all that apply 1. distended jugular veins 2. dependent edema 3. anorexia 4. course crackles 5. tachycardia

2 (canned foods always have higher sodium levels)

Which food should the nurse teach a client with heart failure to limit when following a 2-Gram sodium diet? 1. apples 2. canned tomatoe juice 3. whole wheat bread 4. beef tenderloin

1,2,3,5 (HF can be a result of several cardiovascular conditions, which will affect the hearts ability to pump effectively. The bodys attempts to compensate through several neurohormonal mechanisms. Decrease cardiac output stimulates the aortic and carotid baroreceptors which activates the sympathetic nervous system to release norepinephrine and epinephrine. This early response increases the HR and contractility. It also has some negative effects, including vasoconstriction of the skin, GI tract, and kidneys.. Decreased renal perfusion (due to low CO and vasoconstriction) activates the renin-angiotensin-aldosterone process resulting in the release of ADH. This causes fluid retention in an attempt to increase BP and, therefore, cardiac output. In the damaged heart, this causes fluid overload. There is no parasympathetic response. Decreased pulmonary perfusion can be a result of fluid overload or concomitant pulmonary disease)

The nurse is assessing a client with chronic HF who is demonstrating neurohormonal compensatory mechanisms. Which are expected findings on assessment? Select all that apply 1. decreased cardiac output 2. increased heart rate 3. vasoconstriction in skin, GI tract and kidneys. 4. decreased pulmonary perfusion 5. fluid overload

1,4,6 (It is not unusual for the elderly client to become somewhat confused when "relocated" to the hospital, and this may be more difficult for those with known dementia. Frequent reorientation delivered patiently and calmly along with placing familiar items nearby so the client can see them may help reduce confusion related to hospitalization. Establishing a trusting relationship is important with every client but moreso with this client. Putting the client in a room further from the nursing station may decrease extra noise for the client but will also make it more difficult to observe this client and maintain a safe environment. Procedures should be explained to the client prior to proceeding and should not be rushed. Visits by the family and friends may help keep the client oriented.)

The nurse is caring for an older client with mild dementia admitted with HF. What nursing care will be helpful for this client in reducing potential confusion related to hospitalization and change in routine? select all that apply 1. reorient freq to time, place and situation 2. Put the client in a quiet room furthest from the nursing station 3. Perform necessary procedures quickly 4. Arrange for familiar pictures or special items at bedside 5. Limit the clients visitors 6. Spend time with the client, establishing a trusting relationship

c,d (Rationale: Any type of cardiomyopathy has a very poor prognosis, so the client and family will likely experience anticipatory grieving of the loss of a loved one. The client will likely experience fear in confronting death. Risk for bleeding, decisional conflict, and risk for electrolyte imbalance are not priorities for this client. )

The nurse is planning care for a client with cardiomyopathy. Which nursing diagnoses are appropriate for the client? (Select all that apply.) a Risk for Electrolyte Imbalance b Risk for Bleeding c Anticipatory Grieving d Fear e Decisional Conflict

3 (colored vision and seeing yellow spots are symptoms of digoxin toxicity. Abd pain, anorexia, N/V are other common symptoms of digoxin toxicity. Additional signs of toxicity include arrythmias, such as atrial fibrillation or bradycardia. Rash, increase appetite and elevated BP are not associated with digoxin toxicity.)

The nurse should teach the client that signs of digoxin toxicity include: 1. rash over the chest and back 2. increased appetitie 3. visual disturbances such as seeing yellow spots 4. elevated BP

4

The nurse teaches the client with HF to take oral furosemide in the morning. The primary reason for this is to prevent: 1. electrolyte imbalance 2. N/V 3. excretion of excess fluids accumulated during the night 4. sleep disturbances during the night

3 (HF is a complex chronic condition. Education should focus on health promotion and preventative care at home. S/S can be monitored by the client. Instructing the client to obtain daily weights at the same time each day is very important. The client should be told to call the HCP if there has been a weight gain of 2 lb or more. This may indicate fluid overload, and treatment can be prescribed early and on an outpatient basis, rather than waiting until the symptoms become life threatening. Following a high fiber diet is beneficial but it is not relevant to the teaching needs of a client with HF. Excercise would need to be planned in consultation with the HCP and based on condition and history of the client. Althouth the nurse doesnt plan excercise a sedendary lifestyle should not be recommended.)

The nurse's discharge teaching plan for the client with HF should emphasize the importance of: 1. maintaining a high fiber diet 2. walking 2 miles every day 3. obtaining daily weights at the same time each day 4. remaining sedentary for most of the day

3 (Research indicates that mortality is decreased when clients with heart failure use beta-blocking medications such as carvedilol. When beta-blocker therapy is started for clients with heart failure, heart failure symptoms may initially become worse for a few weeks, so increased fatigue, activity intolerance, weight gain, and edema are not indicative of a need to discontinue the medication at this time. However, the slow heart rate does require further follow-up, because bradycardia may progress to more serious dysrhythmias such as heart block. Focus: Prioritization)

Two weeks ago, a 63-year-old client with heart failure received a new prescription for carvedilol (Coreg) 3.125 mg orally. When evaluating the client in the cardiology clinic, you obtain the following data. Which finding is of most concern? 1. Reports of increased fatigue and activity intolerance 2. Weight increase of 0.5 kg over a 1-week period 3. Sinus bradycardia at a rate of 48 beats/min 4. Traces of edema noted over both ankles

2 (A normal apical impulse is found over the apex of the heart and is typically located and auscultated in the left 5th intercostal space in the midclavicular line. An apical impulse located or auscultated below the 5th intercostal space or lateral to the midclavicular line may indicate left ventricular enlargement)

When assessing an older adult, the nurse finds the apical pulse below the 5th intercostal space. The nurse should further assess the client for: 1. Left atrial enlargement 2. Left ventricular enlargement 3. Right atrial enlargement 4. Right ventrical enlargement

d

When obtaining a health history of a patient admitted with a diagnosis of heart failure, which statement made by the patient supports the diagnosis of heart failure? Choose 1 answer: a "I often feel pain in my lower legs when I take my walk." . b "I sometimes feel pain in the middle of my chest during exercise." c "I get hot and break out in a sweat during the night." d "I get out of breath when I go up a flight of stairs."

3 (Sitting almost upright in bed with the feet and legs resting on the mattress decreased venous return to the heart, thus reducing myocardial work-load. Also, the sitting position allows maximum space for lung expansion. Low fowlers position would be used if the client could not tolerate high fowlers for some reason. Lying on the right side would not be a good position for the client in HF. The client in HF would not tolerate Trendlenberg.)

Which position is best for a client with HF who has orthopnea? 1. semi sitting (low fowlers position) with legs elevated on pillows. 2. lying on the right side (Sims position) with a pillow between the legs 3. sitting upright (High fowlers) with legs resting on the mattress 4. lying on the back with the head lowered (Trendlenberg) and legs elevated.

2 (The new RN's education and hospital orientation would have included safe administration of IV medications. The preceptor will be responsible for the supervision of the new graduate in assessments and client care. The other clients require more complex assessment or client teaching by an RN with experience in caring for clients with these diagnoses. Focus: Assignment)

While working on the cardiac step-down unit, you are serving as preceptor to a newly graduated RN who has been in a 6-week orientation program. Which client will be best to assign to the new graduate? 1. 19-year-old with rheumatic fever who needs discharge teaching before going home with a roommate today 2. 33-year-old admitted a week ago with endocarditis who will be receiving ceftriaxone (Rocephin) 2 g IV 3. 50-year-old with newly diagnosed stable angina who has many questions about medications and nursing care 4. 75-year-old who has just been transferred to the unit after undergoing coronary artery bypass grafting yesterday

3 (Hyperkalemia is a common adverse effect of both ACE inhibitors and potassium-sparing diuretics. The other laboratory values may be affected by these medications but are not as likely or as potentially life threatening. Focus: Prioritization)

You are caring for a hospitalized client with heart failure who is receiving captopril (Capoten) and spironolactone (Aldactone). Which laboratory value will be most important to monitor? 1. Sodium level 2. Blood urea nitrogen level 3. Potassium level 4. Alkaline phosphatase level

3 (Premature ventricular contractions occurring in the setting of acute myocardial injury or infarction can lead to ventricular tachycardia and/or ventricular fibrillation (cardiac arrest), so rapid treatment is necessary. The other clients also have dysrhythmias that will require further assessment, but these are not as immediately life threatening as the premature ventricular contractions in the setting of MI. Focus: Prioritization)

You are monitoring the cardiac rhythms of clients in the coronary care unit. Which client will need immediate intervention? 1. Client admitted with heart failure who has atrial fibrillation with a rate of 88 beats/min while at rest 2. Client with a newly implanted demand ventricular pacemaker who has occasional periods of sinus rhythm at a rate of 90 to 100 beats/min 3. Client who has just arrived on the unit with an acute MI and has sinus rhythm at a rate of 76 beats/min with frequent premature ventricular contractions 4. Client who recently started taking atenolol (Tenormin) and has a first-degree heart block, with a rate of 58 beats/min

4 (Anticoagulant medications are high-alert medications and require special safeguards, such as double-checking of medications by two nurses before administration. Although the other medications require the usual medication safety procedures, double-checking is not needed. Focus: Prioritization)

You are preparing to administer the following medications to a client with multiple health problems who has been hospitalized with deep vein thrombosis. Which medication is most important to double-check with another licensed nurse? 1. Famotidine (Pepcid) 20 mg IV 2. Furosemide (Lasix) 40 mg IV 3. Digoxin (Lanoxin) 0.25 mg PO 4. Warfarin (Coumadin) 2.5 mg PO

1 (Measurement of ankle and brachial blood pressures for ankle-brachial index calculation is within the UAP's scope of practice. Calculating the ankle-brachial index and any referrals or discussion with the client are the responsibility of the supervising RN. The other clients require more complex assessments or client teaching, which should be done by an experienced RN. Focus: Delegation)

You are working in an outpatient clinic where many vascular diagnostic tests are performed. Which task associated with vascular testing is most appropriate to delegate to an experienced UAP? 1. Measuring ankle and brachial pressures in a client for whom the ankle-brachial index is to be calculated 2. Checking blood pressure and pulse every 10 minutes in a client who is undergoing exercise testing 3. Obtaining information about allergies from a client who is scheduled for left leg contrast venography 4. Providing brief client teaching for a client who will undergo a right subclavian vein Doppler study

4 (The most common complication after coronary arteriography is hemorrhage, and the earliest indication of hemorrhage is an increase in heart rate. The other data may also indicate a need for ongoing assessment, but the increase in heart rate is of most concern. Focus: Prioritization)

You assess a client who has just returned to the recovery area after undergoing coronary arteriography. Which information is of most concern? 1. Blood pressure is 144/78 mm Hg 2. Pedal pulses are palpable at +1 3. Left groin has a 3-cm bruised area 4. Apical pulse is 122 beats/min and regular

2 (The client's symptoms indicate acute hypoxia, so immediate further assessments (such as assessment of oxygen saturation, neurologic status, and breath sounds) are indicated. The other clients also should be assessed soon, because they are likely to require nursing actions such as medication administration and teaching, but they are not as acutely ill as the dyspneic client. Focus: Prioritization)

You have just received a change-of-shift report about these clients on the coronary step-down unit. Which one will you assess first? 1. 26-year-old with heart failure caused by congenital mitral stenosis who is scheduled for balloon valvuloplasty later today 2. 45-year-old with constrictive cardiomyopathy who developed acute dyspnea and agitation about 1 hour before the shift change 3. 56-year-old who underwent coronary angioplasty and stent placement yesterday and has reported occasional chest pain since the procedure 4. 77-year-old who was transferred from the intensive care unit 2 days ago after coronary artery bypass grafting and has a temperature of 100.6° F (38.1° C)

right

_______ sided Edema in the feet and legs or, if the client is bedridden, in the sacrum Anorexia and nausea Right upper quadrant pain may result from liver engorgement Neck veins distend and become visible, even when the client is upright

left

_______ sided Fatigue and activity intolerance are common early manifestations Dizziness and syncope Dyspnea, shortness of breath, cough Orthopnea (difficulty breathing when supine) Cyanosis Inspiratory crackles (rales) and wheezes may be heard in lung bases S3 gallop