Davis-Ch.26 Heart failure

6. Which of the following is the most common cause of left-sided heart failure? 1.Hypertension 2.Kidney failure 3.Mitral stenosis 4.Aortic regurgitation

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8. The nurse notes a client's chest tube drainage is 200 mL/hr. For which of the following should the nurse monitor the client? 1.Hypovolemia 2.Increase in cardiac output 3.Fluid volume excess 4.Bounding pulses

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29. The nurse is caring for a client with right-sided heart failure. Which clinical manifestations can the nurse expect to find? Select all that apply. 1.Cyanosis 2.Weight gain 3.Paroxysmal nocturnal dyspnea 4.Crackles 5.Dependent peripheral edema

25 Rationales Option 1:Cyanosis is seen with left-sided heart failure. Option 2:Weight gain is seen in right-sided heart failure. Option 3:Paroxysmal nocturnal dyspnea is seen in clients with left-sided heart failure. Option 4:Crackles are heard in clients with left-sided heart failure. Option 5:Dependent peripheral edema is seen in clients with right-sided heart failure.

27. Which of the following is shown here? 1.Tricuspid valve 2.Pulmonary semilunar valve 3.Aortic semilunar valve 4.Mitral valve

3

9. In heart failure, which part of the heart fails first? 1.Left atrium 2.Left ventricle 3.Right atrium 4.Right ventricle

2 The left ventricle fails first because the left ventricle has the greatest workload.

22. The nurse is providing teaching to a client undergoing a heart transplant. Which statement made by the client indicates the need for further teaching? 1."I am only at risk for rejection right after surgery." 2."The doses of immunosuppressive medication will decrease over time." 3."I will need to take cyclosporine (Neoral) for life." 4."Immunosuppressive drugs decrease the risk for rejecting the heart."

1 Q-which one is incorrect? Rationales Option 1:This statement requires correction; the client is always at risk for rejection, but the highest risk is right after surgery. Option 2:This statement is correct; over time, the doses of immunosuppressant drugs won't be as high. Option 3:This statement is correct; immunosuppressive drugs will be taken for life. Option 4:This statement is correct; the risk for organ rejection decreases when taking immunosuppressive therapy.

16. The nurse is teaching a client about monitoring fluid status at home. How often should the nurse encourage the client to weigh? 1.Daily 2.Weekly 3.Biweekly 4.Monthly

1 Rationales Option 1:Clients with altered fluid status should weigh daily. Option 2:The client should weigh more frequently. Option 3:The client needs to weigh daily. Option 4:Monthly weights will not provide an accurate assessment of fluid status.

26. Which of the following is the most common cause of right-sided heart failure? 1.Left-sided heart failure 2.Hypertension 3.Infective endocarditis (IE) 4.Aortic regurgitation

1 Rationales Option 1:The most common cause of right-sided heart failure is left-sided heart failure. Option 2:Hypertension is not the most common cause of right-sided heart failure. Option 3:IE is not the most common cause of right-sided heart failure. Option 4:Aortic regurgitation is not the most common cause of right-sided heart failure.

20. The nurse is preparing to administer digoxin (Lanoxin). Which of the following interventions should the nurse implement? 1.Monitor apical heart rate for 1 minute. 2.Assess for symptoms of hyperkalemia. 3.Take the client's blood pressure. 4.Weight the client.

1 Rationales Option 1:The nurse should assess the apical heart rate for 1 minute and notify the health-care provider if it is less than 60. Option 2:The nurse should assess for hypokalemia. Option 3:Blood pressure does not need to be assessed before administering Lanoxin. Option 4:Weight is not typically affected by Lanoxin.

40. The nurse is providing teaching to a client undergoing a heart transplant. Which statement made by the client indicates the need for further teaching? 1."I am only at risk for rejection right after surgery." 2."The doses of immunosuppressive medication will decrease over time." 3."I will need to take cyclosporine (Neoral) for life." 4."Immunosuppressive drugs decrease the risk for rejecting the heart."

1 Rationales Option 1:This statement requires correction; the client is always at risk for rejection, but the highest risk is right after surgery. Option 2:This statement is correct; over time, the doses of immunosuppressant drugs won't be as high. Option 3:This statement is correct; immunosuppressive drugs will be taken for life. Option 4:This statement is correct; the risk for organ rejection decreases when taking immunosuppressive therapy.

41. The nurse is teaching a client with heart failure about ways to prevent orthopnea. Which statement made by the client indicates an understanding of the teaching? 1."I should sleep with two or three pillows so I can breathe easier." 2."I should lie in a flat position as long as I am able to." 3."I can lie flat as long as my legs are elevated." 4."I should only use one pillow to sleep at night."

1 Rationales Option 1:Two or more pillows should be used for sleeping when orthopnea is present. Option 2:Dyspnea occurs in clients with orthopnea when lying flat. Option 3:A client with orthopnea has dyspnea that worsens when lying flat. Option 4:A client with orthopnea should sleep with two or more pillows.

18. The nurse is caring for a client who underwent a heart transplant. Which of the following would be of most concern to the nurse? 1.Yellow-green sputum 2.Chest tube drainage of 50 mL/hr 3.Incision pain 4.Clear yellow urine

1 Rationales Option 1:Yellow-green sputum can be indicative of infection. Option 2:This is a normal amount of drainage. Option 3:Incision pain is normal after surgery. Option 4:This is normal; cloudy urine indicates infection.

3. Which of the following are the earliest symptoms of chronic heart failure? Select all that apply. 1.Fatigue 2.Clammy, cold skin 3.Weakness 4.Crackles 5.Pink, frothy sputum

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21. Which of the following are clinical manifestations related to a decrease in oxygenation? Select all that apply. 1.Fatigue 2.Dyspnea 3.Jaundice 4.Sleepiness 5.Confusion

125 Rationales Option 1:Fatigue is noted in clients with decreased oxygenation. Option 2:Dyspnea is observed in clients with decreased oxygenation. Option 3:Cyanosis is seen in clients with decreased oxygenation. Option 4:Insomnia is seen in clients with decreased oxygenation. Option 5:Confusion is seen with decreased oxygenation.

35. The nurse is caring for a client about to undergo cardiac catheterization. Which of the following statements made by the client indicate an understanding of the procedure? Select all that apply. 1."I need to inform the health-care provider that I am allergic to contrast dye." 2."I will be put to sleep for the test." 3."It may feel warm when they inject the dye." 4."The procedure is quick. It may only take 30 minutes." 5."They will check my vital signs and electrocardiogram (ECG) during the procedure."

135 Rationales Option 1:The client cannot have contrast if they are allergic to contrast dye. Option 2:The client will be awake during the test. Option 3:The client may experience a warm, flushing sensation when the dye is injected. Option 4:The procedure will take 2 to 3 hours. Option 5:The nurse will monitor vital signs and ECG during the procedure.

5. The nurse is caring for a client with left-sided heart failure. Which clinical manifestations should the nurse expect to see? Select all that apply. 1.Crackles 2.Ascites 3.Hepatomegaly 4.Dry, hacking cough 5.Orthopnea

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10. The nurse is caring for a client with heart failure. Which intervention should the nurse implement? 1.Encourage ambulation. 2.Weigh the client daily at the same time. 3.Instruct the client to increase sodium in their diet. 4.Teach the client to sleep without a pillow.

2

12. The nurse is administering furosemide (Lasix) to a client with heart failure. Which laboratory value would concern the nurse? 1.Sodium 135 mEq/dL 2.Potassium 2.8 mEq/dL 3.Calcium 9.0 mg/dL 4.Magnesium 2.0 mEq/L

2

43. The nurse is preparing to draw blood for a creatine kinase (CK) test. Which of the following should the nurse avoid before drawing the blood? 1.Hooking the client up to leads for an electrocardiogram (ECG) 2.Starting the client's intravenous (IV) line 3.Giving the client ice chips 4.Taking a medication history

2 Rationales Option 1:An ECG can be done before the CK. Option 2:Any intravenous procedures or intramuscular (IM) injections should be avoided before drawing blood for the first CK level. Option 3:The client can have ice chips before drawing blood for the CK. Option 4:This can be done before drawing blood for the CK.

36. The nurse is caring for a client with heart failure who awakens during the night with feelings of suffocation and anxiety. The nurse knows the client is experiencing which of the following? 1.Cheyne-Stokes respirations 2.Paroxysmal nocturnal dyspnea 3.Ascites 4.Splenomegaly

2 Rationales Option 1:Cheyne-Stokes breathing is a pattern of shallow respirations building to deep breaths followed by a period of apnea. Option 2:A client will typically awaken at night with feelings of suffocation and anxiety with paroxysmal nocturnal dyspnea. Option 3:Ascites is not associated with sudden awakening at night with suffocation and anxiety. Option 4:Suffocation and anxiety are not associated with splenomegaly.

11. Clients with heart failure typically present with a decrease of which of the following? 1.Blood urea nitrogen (BUN) 2.Red blood cells (RBCs) 3.Brain natriuretic peptide (BNP) 4.Sodium (Na)

2 Rationales Option 1:In early heart failure, BUN is within normal range, but in mild to moderate heart failure, BUN levels are high. Option 2:RBCs are low due to hemodilution from fluid overload and decreased angiotensin-converting enzyme (ACE) action. Option 3:A BNP is high in clients with heart failure. Option 4:Sodium level is typically high in clients with heart failure, which is why fluid restriction is prescribed.

37. The nurse is caring for a client with heart failure who has a pattern of shallow respirations building to deep breaths, followed by apnea. Which of the following does this describe? 1.Kussmaul respirations 2.Cheyne-Stokes breathing 3.Bradypnea 4.Agonal breathing

2 Rationales Option 1:Kussmaul breathing is deep and labored breathing associated with metabolic acidosis. Option 2:This describes Cheyne-Stokes breathing. Option 3:Bradypnea is abnormally slow breathing. Option 4:Agonal breathing is an abnormal pattern of breathing characterized by gasping and labored breathing.

44. The nurse is caring for a client with heart failure who has a pattern of shallow respirations building to deep breaths, followed by apnea. Which of the following does this describe? 1.Kussmaul respirations 2.Cheyne-Stokes breathing 3.Bradypnea 4.Agonal breathing

2 Rationales Option 1:Kussmaul breathing is deep and labored breathing associated with metabolic acidosis. Option 2:This describes Cheyne-Stokes breathing. Option 3:Bradypnea is abnormally slow breathing. Option 4:Agonal breathing is an abnormal pattern of breathing characterized by gasping and labored breathing.

25. The nurse is teaching a client with heart failure about nutrition. Which statement made by the client indicates an understanding of the teaching? 1."I should increase the amount of sodium in my diet." 2."I need to reduce the amount of fluids I drink like the health-care provider said." 3."I ate a bag of chips and a deli sandwich for lunch today." 4."I need to eat three large meals each day."

2 Rationales Option 1:Sodium should be decreased, not increased. Option 2:This statement is accurate; fluid should be restricted. Option 3:Chips and a deli-prepared sandwich are high in sodium. Option 4:Smaller meals are recommended to decrease the heart's workload.

31. The nurse is providing teaching for a client who is being sent home with a Holter monitor. Which information is important for the nurse to include in the teaching? 1.Do not eat or drink during the monitoring period. 2.Press the button on the monitor if symptoms occur. 3.The computer will record electrical heart signals for 20 minutes. 4.This test will show the blood flow through heart valves.

2 Rationales Option 1:The client is not NPO (nothing by mouth) during the monitoring period. Option 2:This statement should be included in the teaching. Option 3:This describes a signal-averaged electrocardiogram (ECG). Option 4:This describes an ECG color Doppler.

42. The nurse is providing teaching to a client taking bumetanide (Bumex). Which statement made by the client indicates an understanding of the teaching? 1."I should weigh myself every week while taking Bumex." 2."I should take this medication early so I don't pee all night." 3."This medication will cause dry mouth." 4."Muscle cramps are a normal side effect of this medication."

2 Rationales Option 1:The client should weight themselves daily. Option 2:This statement is accurate; the medication should not be taken late in the day because it can cause nocturia. Option 3:Dry mouth can be indicative of electrolyte imbalance. Option 4:Muscle cramps are indicative of hypokalemia, and the health-care provider should be notified.

28. The nurse is taking a health history of a client with suspected heart failure. Which question assesses respiratory function? 1."Have you had a decrease in daytime urine output?" 2."How many flights of stairs can you climb without dyspnea?" 3."Have you had any weight gain recently?" 4."Do you experience nausea or vomiting?"

2 Rationales Option 1:This question assesses urinary function. Option 2:This question assesses respiratory function. Option 3:This question assesses fluid retention . Option 4:This question assesses gastrointestinal (GI) function.

7. The nurse is obtaining data to assess a client for fluid retention. Which questions should the nurse include in the assessment? Select all that apply. 1."How many pillows do you use for sleeping?" 2."Are your shoes tight?" 3."Have you had any weight gain recently?" 4."How often do you urinate at night?" 5."Have you noticed a change in behavior?"

23 Option 1:This question assesses respiratory function. Option 2:This question assesses fluid retention. Option 3:This question assesses fluid retention. Option 4:This question assesses urinary function. Option 5:This question assesses neurological status.

2. A client asks the nurse about the goal for heart failure treatment. Which response by the nurse is best? 1."The goal is to increase the strength of the heart's contraction while increasing workload." 2."The goal is to reduce the amount of oxygen delivered to the tissues and decrease the heart's workload." 3."The goal is to improve your heart's ability to pump and decrease oxygen demands of the heart." 4."The goal is to increase water and sodium in the body while decreasing the strength of the heart's contraction."

3

1. The nurse is caring for a group of clients. Which client will warrant a call to the health-care provider? 1. A client with a dry cough 2.A client with dyspnea 3.A client with pink, frothy sputum 4.A client with crackles

3 Pink, frothy sputum is indicative of pulmonary edema, which is life threatening.

39. A client with heart failure is taking furosemide (Lasix). The nurse is teaching about appropriate food choices when taking furosemide. Which food selection by the client indicates understanding of this teaching? 1.Canned tuna 2.Smoked meat 3.Baked potato 4.Instant rice

3 Rationales Option 1:Canned tuna is high in sodium. Option 2:Smoked meat is high in sodium. Option 3:A baked potato is high in potassium. Option 4:Instant rice is high in sodium.

24. Which new class of medications used to treat heart failure (HF) has reduced hospitalizations and deaths from chronic HF? 1.Inotropic agents 2.Beta-adrenergic blockers 3.Angiotensin receptor neprilysin inhibitors (ARNIs) 4.Diuretics

3 Rationales Option 1:Inotropic agents are older drugs that strengthen ventricular contraction. Option 2:Beta-adrenergic blockers improve cardiac output, reduce symptoms, reduce disease progression, and reduce sudden death. Option 3:This new medication class of ARNIs has been found to reduce hospitalizations and deaths from HF and reduced ejection fraction. Option 4:Diuretics reduce fluid volume and increase urine output, reducing pulmonary venous pressure.

14. The nurse is reviewing laboratory results of a client who is taking spironolactone (Aldactone) and notes a potassium level of 6.5. Which action should the nurse take? 1.Administer the medication as ordered. 2.Administer a potassium supplement. 3.Notify the health-care provider (HCP). 4.Administer half of the ordered dose of medication.

3 Rationales Option 1:The medication should not be given; this potassium is high. Option 2:The potassium is high; the client does not require a potassium supplement. Option 3:The HCP should be notified of the elevated potassium level. Option 4:The nurse cannot change the order of the dose of medication; in addition, the potassium level is high.

15. Which of the following is shown here? 1.Mitral valve 2.Aortic semilunar valve 3.Pulmonary semilunar valve 4.Tricuspid valve

4

13. The nurse is caring for a client with heart failure (HF). Which medication does the nurse know is often a first-choice drug for HF? 1.Valsartan/sucubitril (Entresto) 2.Torsemide (Demadex) 3.Digoxin (Lanoxin) 4.Enalapril (Vasotec)

4 Angiotensin-converting enzyme (ACE) inhibitors are the first drug of choice to treat heart failure.

32. The nurse is caring for a client who develops pulmonary edema. Which classic symptom can the nurse expect to find? 1.Decreased heart rate 2.Decreased blood pressure 3.Bradypnea 4.Pink, frothy sputum

4 Rationales Option 1:Compensatory mechanisms increase the heart rate. Option 2:Compensatory mechanisms increase the blood pressure. Option 3:Tachypnea occurs with pulmonary edema. Option 4:Pink, frothy sputum is the classic symptom of pulmonary edema.

34. The nurse is caring for a group of clients with heart failure (HF). Which client should the nurse see first? 1.A client reporting fatigue 2.A client with a potassium of 6.0 mEq/dL 3.A client with an elevated brain natriuretic peptide (BNP) 4.A client with new-onset confusion

4 Rationales Option 1:Fatigue is a normal finding of HF. Option 2:This potassium level is high, but this client can be seen after the client with new-onset confusion. Option 3:An elevated BNP is normal in clients with HF. Option 4:New-onset confusion is indicative of decreased oxygenation; this client should be seen first because this is a new finding.

30. The nurse is caring for a group of clients. Which client should the nurse identify as high risk for heart failure? 1.A client with kidney disease 2.A client with liver disease 3.A client with leukemia 4.A client with hypertension

4 Rationales Option 1:Kidney disease does not place the client at risk for heart failure. Option 2:Liver disease does not place a client at risk for heart failure. Option 3:Leukemia does not place a client at risk for heart failure. Option 4:Hypertension places a client at risk for heart failure.

17. The nurse is reviewing laboratory values for a client with heart failure. Which of the following should the nurse expect to find? 1.Elevated red blood cells (RBCs) 2.Decreased blood urea nitrogen (BUN) 3.Decreased serum cystatin C 4.Elevated brain natriuretic peptide (BNP)

4 Rationales Option 1:RBCs are decreased. Option 2:BUN is elevated. Option 3:Serum cystatin C is increased. Option 4:BNP is elevated.

19. Which of the following describes Stage C heart failure (HF)? 1.Those at high risk of HF 2.Those with refractory HF requiring extraordinary support or hospice care 3.Those who have no HF symptoms but do have structural heart disease 4.Those with heart failure with reduced ejection fraction and symptoms

4 Rationales Option 1:This describes Stage A. Option 2:This describes Stage D. Option 3:This describes Stage B. Option 4:This describes Stage C.

38. The nurse is providing teaching for a client taking metoprolol succinate (Toprol XL). Which statement made by the client indicates a need for further teaching? 1."I should get up slowly while taking this medication." 2."If my heart rate (HR) is lower than 60, I need to call my health-care provider (HCP)." 3."I should let the HCP know if I feel dizzy." 4."If my systolic blood pressure (BP) is less than 100 mm Hg, I can take the pill."

4 Rationales Option 1:This statement is correct; the client should rise slowly while taking Toprol XL. Option 2:This statement is accurate; the client should let the HCP know if the heart rate is less than 60. Option 3:The client should let the nurse or HCP know if they are dizzy (could indicate low HR or BP). Option 4:If the BP is less than 100 mm Hg systolic, the client should notify the HCP.

33. The nurse is assessing a client with heart failure. What should the nurse expect to hear upon auscultating lung sounds? 1.Wheezing 2.Pleural friction rub 3.Rhonchi 4.Crackles

4 Rationales Option 1:Wheezing is heard in clients with asthma. Option 2:Pleural friction rub is heart in clients with pneumonia, pleural effusion, or pulmonary embolism (PE). Option 3:Rhonchi are not a clinical finding of heart failure. Option 4:Crackles are a clinical finding of heart failure.

23. The nurse is caring for a client who reports pink and frothy sputum. Which action should the nurse take first? 1.Place the client in left side-lying position. 2.Apply oxygen via a facemask. 3.Prepare the client for a chest x-ray. 4.Notify the health-care provider (HCP) immediately.

4 Rationales Option 1:The client should be placed in semi-Fowler or Fowler position. Option 2:An order is required for oxygen. Option 3:A chest x-ray will be ordered, but the HCP should be notified first. Option 4:Pulmonary edema is life threatening and should be reported immediately.

4. The nurse is reviewing laboratory results before administering medication and notes a potassium level of 2.5. Which medication would the nurse question? 1.Bumetanide (Bumex) 2.Spironolactone (Aldactone) 3.Isosorbide dinitrate (Isorbid) 4.Carvedilol (Coreg)

Ans 1 This medication is potassium wasting; the nurse should notify the health-care provider before giving this medication. explain : 2 Aldactone is a potassium-sparing diuretic and will not deplete potassium.