Heart Failure
A nurse is caring for a client with end-stage heart failure. Which statement by the client best demonstrates a good understanding of an advance directive? "An advance directive allows my decisions for health care to be known if I cannot speak for myself." "An advance directive identifies the people I want to receive items from my estate once I pass away." "An advance directive will allow my daughter to use my funds to pay for my health care costs if I cannot do so." "An advance directive gives my family members permission to make decisions about my care needs."
a
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? lisinopril cholestyramine bumetanide diltiazem
a
The nurse is caring for a client with systolic heart failure whose previous adverse reactions rule out the safe use of angiotensin-converting enzyme (ACE) inhibitors. The nurse should anticipate that the prescriber may choose which combination of drugs? Combination of hydralazine and isosorbide dinitrate Loop diuretic and antiplatelet aggregator Loop diuretic and calcium channel blocker Combination of digoxin and normal saline
a
A client is diagnosed with heart failure. Which types of medications are usually prescribed to manage this disorder? Select all that apply. Digitalis Beta-adrenergic blockers (beta-blockers) Diuretics Nonsteroidal anti-inflammatory drugs (NSAIDs) Angiotensin-converting enzyme (ACE) inhibitors
a, b, c, e
Manifestations of heart failure are due to the decreased pumping ability of the heart. The nurse should monitor for which signs and symptoms of heart failure? Select all that apply. Fatigue Exercise intolerance Cyanosis Hyperglycemia Malnutrition
a, b, c, e
Acute pulmonary edema often occurs with heart failure. Which signs of acute pulmonary edema should the nurse monitor their clients for? Select all that apply. Respiratory crackles Rapid pulse Hot, dry skin Confusion Frothy, blood-tinged sputum
a, b, d, e
The nurse is caring for an adult client with heart failure who is prescribed digoxin. When assessing the client for adverse effects, the nurse should assess for which of the following signs and symptoms? Select all that apply. Confusion Shortness of breath Numbness and tingling in the extremities Chest pain Bradycardia Diuresis
a, e
A 54-year-old diabetic client has come to the urology clinic complaining of erectile dysfunction. His history includes obesity, coronary artery disease which required bypass graft 3 years ago, hypertension, and gout. The nurse practitioner is reviewing his record in order to prescribe medication. The practitioner is considering prescribing sildenafil. Which home medication is contraindicated if taken concurrently with sildenafil? Amiodarone, an antiarrhythmic Isosorbide mononitrate, a vasodilator Diltiazem, a calcium channel blocker Furosemide, a diuretic
b
A nurse is preparing to administer an antihypertensive drug that lowers the blood pressure primarily via suppression of the renin-angiotensin-aldosterone system. Which drug might this be? Diltiazem Lisinopril Verapamil Furosemide
b
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? Serum electrolytes B-type natriuretic peptide (BNP) Complete blood count (CBC) Blood urea nitrogen (BUN)
b
A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessment findings? Level of consciousness and pain level Heart rate and blood pressure Temperature and respiratory rate Oxygen saturation and respiratory rate
b
Which would a nurse identify as a nitrate? Amlodipine Isosorbide Nicardipine Metoprolol
b
After teaching a client who is using isosorbide dinitrate for treatment of angina, the client demonstrates understanding of the information when he identifies what needs to be avoided? (Select all that apply.) Ergotamine Tadalafil Vardenafil Sildenafil Heparin
b, c, d
A client has developed gout and is experiencing a "flare-up" with excruciating pain in the feet and toes. The client provides a list of recent new medications to treat worsening heart failure. The nurse's concern is that one may cause retention of uric acid. Which drug should the nurse ask the health care provider about? Isosorbide mononitrate, a nitrate Spironolactone, an aldosterone receptor antagonist Furosemide, a loop diuretic Lisinopril, an ACE-inhibitor
c
A client is hospitalized for heart failure and is scheduled to receive oral digoxin at 8 AM. The nurse will withhold the medication and notify the prescriber if the client's: respiratory rate is 24. weight is over 300 pounds. pulse is 52 beats per minute. blood pressure is 140/86.
c
A nurse administers furosemide to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully? high serum sodium level increase in blood pressure low serum potassium level increase in blood volume
c
A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." What is the best response by the nurse? "Hypertension is difficult to diagnose." "Hypertension often causes no pain." "Hypertension often causes no symptoms." "Hypertension often kills early in the disease process."
c
An older adult client has a complex medical history that includes heart failure, type 1 diabetes, and diabetic nephropathy. The nurse has questioned a health care provider's prescription for oral spironolactone because the client's health problems would contribute to a high risk of which adverse reaction? Metabolic acidosis Hemolytic anemia Hyperkalemia Hypocalcemia
c
Which antiarrhythmic medication works by blunting the effect of sympathetic nervous system stimulation on the heart? Calcium channel blockers, such as verapamil Antianginal drugs, such as nitroglycerin Beta-blockers, such as metoprolol Sodium channel blockers, such as lidocaine
c
Which is a potassium-sparing diuretic used in the treatment of heart failure (HF)? Ethacrynic acid Bumetanide Spironolactone Chlorothiazide
c
A client is using transdermal nitroglycerin. The nurse would instruct the client to apply a new patch at which frequency? Each time he has chest pain Every week Before activities that may cause chest pain Every day
d
A group of students are reviewing the various antianginal agents. The students demonstrate a need for additional review when they identify what as a beta blocker? Nadolol Propranolol Metoprolol Isosorbide
d
The nurse is caring for a client with left-sided heart failure being treated with both a thiazide diuretic and an aldosterone antagonist. What effect on potassium will the nurse anticipate with this treatment? The client is most at risk for hypokalemia from this treatment. There is a high risk of interaction leading to hyperkalemia. Potassium is not significantly affected by either medication. The medications have the opposite effect on potassium levels.
d
The nurse is to administer digoxin to a client with heart failure. The nurse auscultates an apical pulse rate of 52. What action should the nurse take? Administer half of the dose Administer medication Assess the blood pressure Notify the health care provider
d
The nurse recognizes that which laboratory test is a key diagnostic indicator of heart failure? Creatinine Blood urea nitrogen (BUN) Complete blood count (CBC) Brain natriuretic peptide (BNP)
d
Which would a nurse expect to assess if a client is experiencing right-sided heart failure? Dyspnea Wheezing Hemoptysis Peripheral edema
d
While assessing a neonate with a ventricular septal defect (VSD), the nurse notes crackles and retractions. The nurse obtains the following vital signs: temp 100.2°F (38°C), pulse 134 bpm, respirations 64 breaths/minute, oxygen saturation 97% on room air. What will the nurse do first? Administer acetaminophen rectally. Apply oxygen 10 liters/min (LPM) via oxyhood. Advise the mother to bottle feed. Give furosemide intravenously.
d
What are the signs and symptoms of heart failure? Select all that apply. Ruddy complexion Bradycardia Chronic productive cough Fluid retention Fatigue
d, e
A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene? Administer I.V. fluids as ordered. Insert an indwelling urinary catheter as ordered. Administer an isosorbide as ordered. Instruct the client to sit for several minutes before standing.
d
A 58-year-old man is admitted to the emergency department. A diagnosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which drug? Furosemide Captopril Dopamine Digoxin immune fab
d
A client is prescribed metoprolol extended-release PO for heart failure. What assessment finding would suggest an exacerbation of the client's underlying diagnosis? adventitious breath sounds upward trend in blood pressure bradycardia chest pain on exertion
a
A client who has been prescribed nitroglycerin, metoprolol, and furosemide is dizzy and has a blood pressure of 84/50 mm Hg. Which action should the nurse take when the medications are scheduled to be provided? Withhold the medications, and notify the health care provider. Ensure the client takes medications while lying in bed. Administer the furosemide and metoprolol, and withhold the nitroglycerin. Administer the nitroglycerin and metoprolol, and withhold the furosemide.
a
A client with a cardiac arrythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask: "Were you tired and depressed before starting the new medication?" "Have you tried exercising at all in the last week or two?" "Tell me about the foods you are eating." "Do you check your blood pressure and pulse before you take your medication?"
a
A client has been admitted to the cardiac unit for heart failure and has been ordered carvedilol (Coreg). The client's blood pressure is 80/50. What should the nurse do? Continue to take the client's blood pressure using different BP machines until a better blood pressure is obtained. Call the provider after giving the medication, informing the provider of client's blood pressure when the medication was administered. Give the medication so that the blood pressure will increase. Call the provider and advise them of the client's blood pressure prior to administering the medication.
d
A client is admitted to the ICU with a diagnosis of heart failure. The client is exhibiting symptoms of weakness, ascites, weight gain, and jugular vein distention. The nurse would know that the client is exhibiting signs of what kind of heart failure? Left-sided heart failure Chronic heart failure Acute heart failure Right-sided heart failure
d
A toddler with a ventricular septal defect is receiving digoxin to treat heart failure. Which assessment finding should be the nurse's priority concern? tachycardia hyperactivity hypertension bradycardia
d
An elderly client is being admitted to the hospital for surgery. The nurse is reconciling the client's medications. The client is prescribed digoxin 0.125 mg daily, furosemide 40 mg two times a day, Lanoxin 0.125 mg daily, metoprolol XL 25 mg once a day, and pravastatin (Pravachol) 40 mg at hours of sleep daily. The nurse recognizes a problem when the nurse notes: pravastatin should be taken in the morning and not the evening. the dose of metoprolol XL is too small for an extended-release medication. furosemide is not recommended to be given two times a day. digoxin and Lanoxin are the same medications.
d
