Heart Failure Study Aid

A client is admitted to the hospital with a diagnosis of heart failure and acute pulmonary edema. The healthcare provider prescribes furosemide 40 mg intravenous (IV) stat to be repeated in 1 hour. What nursing action will best evaluate the effectiveness of the furosemide in managing the client's condition? Perform daily weights Auscultate breath sounds Monitor intake and output Assess for dependent edema

Auscultate breath sounds Maintaining adequate gas exchange and minimizing hypoxia with pulmonary edema are critical; therefore, assessing the effectiveness of furosemide therapy as it relates to the respiratory system is most important. Furosemide inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule, causing diuresis; as diuresis occurs fluid moves out of the vascular compartment, thereby reducing pulmonary edema and the bilateral crackles.

A nurse expects that a client with right-sided heart failure will exhibit which of these signs or symptoms? Oliguria Pallor Cool extremities Distended neck veins

Distended neck veins Veins are distended because of the systemic venous pressure and congestion that are associated with right-sided heart failure.

The parent of a 5-month-old infant with heart failure questions the necessity of weighing the baby every morning. What does the nurse say that this daily information is important in determining? Fluid retention Kidney function Nutritional status Medication dosage

Fluid retention Fluid retention is reflected by an excessive weight gain in a short period.

A client with heart failure has anxiety. Which effect of anxiety makes it particularly important for the nurse to reduce the anxiety of this client? Increases the cardiac workload Interferes with usual respirations Produces an elevation in temperature Decreases the amount of oxygen used

Increases the cardiac workload Irritability and restlessness associated with anxiety increase the metabolic rate, heart rate, and blood pressure; these complicate heart failure.

A client is taking furosemide and digoxin for heart failure. Why does the nurse advise the client to drink a glass of orange juice every day? Maintaining potassium levels Preventing increased sodium levels Limiting the drugs' synergistic effects Correcting the associated dehydration

Maintaining potassium levels Orange juice is an excellent source of potassium. Furosemide promotes excretion of potassium, which can result in hypokalemia. Digoxin toxicity can occur in the presence of hypokalemia.

A nurse is caring for a client who is admitted to the hospital for medical management of heart failure and severe peripheral edema. Which clinical indicator associated with unresolved severe peripheral edema should the nurse initially assess? Proteinemia Contractures Tissue ischemia Thrombus formation

Tissue ischemia Oxygen perfusion is impaired during prolonged edema, leading to tissue ischemia, and should be assessed first.

A client with hypertensive heart disease, who had an acute episode of heart failure, is to be discharged on a regimen of metoprolol and digoxin. What outcome does the nurse anticipate when metoprolol is administered with digoxin? Headaches Bradycardia Hypertension Junctional tachycardia

Bradycardia Metoprolol and digoxin both exert a negative chronotropic effect, resulting in a decreased heart rate. Metoprolol reduces, not produces, headaches. These drugs may cause hypotension, not hypertension. These drugs may depress nodal conduction; therefore, junctional tachycardia would be less likely to occur.

A nurse is caring for a client with a diagnosis of right ventricular heart failure. The nurse expects what assessment findings associated with right-sided heart failure? Select all that apply. Dependent edema Swollen hands and fingers Collapsed neck veins Right upper quadrant discomfort Oliguria

Dependent edema Swollen hands and fingers Right upper quadrant discomfort With right-sided heart failure, signs of systemic congestion occur as the right ventricle fails; key features include dependent edema and swollen hands and fingers. Upper right quadrant discomfort is expected with right ventricular failure because venous congestion in the systemic circulation results in hepatomegaly.

The nurse is caring for a client who is admitted to the hospital with early heart failure. Which client statement indicates a clinical manifestation that is related to heart failure? I see spots before my eyes. I am tired at the end of the day. I feel bloated when I eat a large meal. I have trouble breathing when I climb a flight of stairs.

I have trouble breathing when i climb a flight of stairs Dyspnea on exertion occurs with heart failure because of the heart's inability to meet the oxygen needs of the body.

A client hospitalized for heart failure is receiving digoxin and will continue taking the drug after discharge. What should be included in the plan of care for the next few days? Monitoring vital signs and encouraging a vigorous aerobic exercise program Providing written material on the adverse effects of the medication Contacting Social Services for a home health nursing consultation Teaching the client how to count the pulse

Teaching the client how to count the pulse Adverse effects of digoxin include many types of dysrhythmias. If the client's apical pulse rate is less than 60, the medication is "held" and the primary healthcare provider is notified. Because the client will be taking the medication at home, the client should be taught how to take an accurate pulse and to contact the healthcare provider if the rate falls outside predetermined parameters. The client will be assuming responsibility for drug administration at home; teaching is the priority.

While auscultating the heart, a healthcare provider notices S3 heart sounds in four clients. Which client is at more risk for heart failure? 1. Child client 2. Pregnant client 3. Older adult client 4. Young adult client

3. Older adult client The S3 is the third heart sound heard after the normal "lub-dub." It is indicative of congestive heart failure in adults over 30 years old. In young, pregnant, and under 30 year old clients, the third heart sound is often considered to be a normal parameter.

A nurse is caring for a client who has been admitted with right-sided heart failure. The nurse notes that the client has dependent edema around the area of the feet and ankles. To characterize the severity of the edema, the nurse presses the medial malleolus area, noting an 8 mm depression after release. How should the edema be documented? 1+ 2+ 3+ 4+

4+ Dependent edema around the area of feet and ankles often indicates right-sided heart failure or venous insufficiency. The nurse should assess for pitting edema by pressing firmly for several seconds, then releasing to assess for any depression left on the skin.

A nurse is caring for a client with heart failure. The healthcare provider prescribes a 2-gram sodium diet. What should the nurse include when explaining how a low-salt diet helps achieve a therapeutic outcome? Allows excess tissue fluid to be excreted Helps to control the volume of food intake and thus weight Aids the weakened heart muscle to contract and improves cardiac output Assists in reducing potassium accumulation that occurs when sodium intake is high

Allows excess tissue fluid to be excreted A decreased concentration of extracellular sodium causes a decrease in the release of antidiuretic hormone (ADH); this leads to increased excretion of urine.

How can the nurse best describe heart failure to a client? A cardiac condition caused by inadequate circulating blood volume An acute state in which the pulmonary circulation pressure decreases An inability of the heart to pump blood in proportion to metabolic needs A chronic state in which the systolic blood pressure drops below 90 mm Hg

An inability of the heart to pump blood in proportion to metabolic needs As the heart fails, cardiac output decreases; eventually the decrease will reach a level that prevents tissues from receiving adequate oxygen and nutrients.

A client with heart failure is on a drug regimen of digoxin and furosemide. The client dislikes oranges and bananas. Which fruit should the nurse encourage the client to eat? Apples Grapes Cantaloupe Cranberries

Cantaloupe Furosemide is potassium depleting; cantaloupe is high in potassium.

The nurse is caring for a client who is admitted with the diagnosis of mild heart failure. Which type of lung sounds should the nurse expect to hear? Stridor Crackles Wheezes Friction rubs

Crackles Left-sided heart failure causes fluid accumulation in the capillary network of the lungs; fluid eventually enters alveolar spaces and causes crackling sounds at the end of inspiration.

The nurse is assessing a client with the diagnosis of chronic heart failure. Which clinical finding should the nurse expect the client to experience? Dependent edema in the evening Chest pain that decreases with rest Palpitations in the chest when resting Frequent coughing with yellow sputum

Dependent edema in the evening Decreased cardiac output causes fluid retention, which results in dependent edema; this is often noticed in the evening after the client has been standing or sitting for prolonged periods.

A client is receiving furosemide to help treat heart failure. Which laboratory result will cause the nurse to notify the primary healthcare provider? Hematocrit 46% Hemoglobin 14.1 g/dL (141 mmol/L) Potassium 3.0 mEq/L (3.0 mmol/L) White blood cell 9200/mm3 (9.2 × 109/L)

Potassium 3.0 mEq/L (3.0 mmol/L) A potassium level of 3.0 mEq/L (3.0 mmol/L) is indicative of hypokalemia. Normal values for an adult are 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Potassium, calcium, and magnesium control the rate and force of heart contractions. Diuretics often are used to reduce fluid volume, so the heart does not work as hard. Furosemide is a potassium-losing diuretic. Hypokalemia can result in death from dysrhythmia; therefore this must be addressed.

What intervention is included in the nursing care plan for a 4-month-old infant with tetralogy of Fallot and heart failure? Providing small, frequent feedings Positioning the child flat on the back Encouraging nutritional fluids often Measuring the head circumference daily

Providing small, frequent feedings Small, frequent feedings with adequate rest periods in between may improve the infant's intake at each feeding; infants with tetralogy of Fallot become extremely fatigued while suckling.

A nurse identifies signs of electrolyte depletion in a client with heart failure who is receiving bumetanide and digoxin. What does the nurse determine is the cause of the depletion? Diuretic therapy Sodium restriction Continuous dyspnea Inadequate oral intake

Diuretic therapy Diuretic therapy that affects the loop of Henle generally involves the use of drugs (e.g., bumetanide) that directly or indirectly increase urinary sodium, chloride, and potassium excretion.

A client with a history of heart failure on daily weights has a 2-pound (0.9 kilogram) weight gain and pitting edema in lower extremities bilaterally. Which action should the nurse take next? Check the record to ascertain the code status. Encourage increased intake of favorite drink. Perform a head-to-toe assessment, including vital signs. Continue to monitor daily weights and edema and to document findings.

Perform a head-to-toe assessment, including vital signs Performing a head-to-toe assessment, including vital signs, would indicate symptoms, such as jugular distention with right-sided heart failure, or pulmonary issues (crackles) associated with left-sided heart failure.

What should the nurse do to help alleviate the distress of a client with heart failure and pulmonary edema? Encourage frequent coughing. Elevate the client's lower extremities. Prepare for modified postural drainage. Place the client in the orthopneic position.

Place the client in the orthopneic position The orthopneic, or tripod position, allows maximum lung expansion because gravity reduces the pressure of the abdominal viscera on the diaphragm and lungs

A client with a history of heart failure is experiencing dyspnea with a respiratory rate of 32. Crackles are noted bilaterally. The client is in Sims position, receiving oxygen at 2 L/min via nasal cannula. Which action should the nurse take first? Raise the client to high-Fowler position Obtain the apical pulse and blood pressure Call the primary healthcare provider immediately Monitor the pulse oximeter to ascertain the oxygen level

Raise the client to high-Fowler position Raising the client to high-Fowler position will decrease orthopnea by using gravity to keep fluid in lower extremities, putting less stress on the heart.

The nurse is conducting a nutrition class for a group of clients with heart failure (HF). Which information is most important for the nurse to share with the class? Restricting fluid intake Eating a low caloric diet to reduce weight Recognizing which products are high in cholesterol Choosing fresh or frozen vegetables instead of canned ones

Choosing fresh or frozen vegetables instead of canned ones The key principle to teach HF clients is the importance of decreasing sodium in their diet and which foods contain sodium. If sodium is decreased, water retention will decrease also. Fresh or frozen vegetables have less sodium than canned ones. If the client is on a low-sodium diet and receiving diuretics but continues to be fluid overloaded, then fluid restriction may be instituted.

A client with left ventricular heart failure is taking digoxin 0.25 mg daily. What changes does the nurse expect to find if this medication is therapeutically effective? Select all that apply. Diuresis Tachycardia Decreased edema Decreased pulse rate Reduced heart murmur Jugular vein distention

Diuresis Decreased edema Decreased pulse rate Digoxin increases kidney perfusion, which results in urine formation and diuresis. The urine output increases because of improved cardiac output and kidney perfusion, resulting in a reduction in edema. Because of digoxin's inotropic and chronotropic effects, the heart rate will decrease. Digoxin increases the force of contractions (inotropic effect) and decreases the heart rate (chronotropic effect).

A client with heart failure is to receive digoxin and asks the nurse why the medication is necessary. What physiologic response will the nurse include when answering the client's question? Reduces edema Increases cardiac conduction Increases rate of ventricular contractions Slows and strengthens cardiac contractions

Slows and strengthens cardiac contractions Digoxin increases the strength of myocardial contractions (positive inotropic effect) and, by altering the electrophysiological properties of the heart, slows the heart rate (negative chronotropic effect).

The nurse instructs the client admitted for an acute exacerbation of chronic obstructive pulmonary disease (COPD) about the importance of assessing for right-sided heart failure after discharge. What does the nurse instruct the client to assess for? Increased appetite Clubbing of the nail beds Hypertension Weight gain

weight gain The most common signs and symptoms of right-sided heart failure are hepatomegaly, weight gain, jugular vein distention, and peripheral edema.

A nurse is assessing a client with a diagnosis of early left ventricular heart failure. Specific to this type of heart failure, what statement by the client would the nurse expect? "My ankles are swollen." "I am tired at the end of the day." "When I eat a large meal, I feel bloated." "I have trouble breathing when I walk rapidly."

"I have trouble breathing when I walk rapidly" Dyspnea on exertion often occurs with left ventricular heart failure because the heart is unable to pump enough oxygenated blood to meet the energy requirements for muscle contractions related to the activity.

A client is diagnosed with heart failure and is admitted for medical management. Which statement made by the client may indicate worsening heart failure? "I am unable to run a mile (1.6 kilometers) now." "I wake up at night short of breath." "My wife says I snore very loudly." "My shoes seem larger lately."

"I wake up at night short of breath." Increased shortness of breath is often an indicator of fluid overload in the heart failure client

Which nursing interventions may promote safe drug administration in a child diagnosed with heart failure who is receiving digoxin? Select all that apply. 1. Checking for compliance with the client's drug regimen 2. Monitoring the client's serum potassium and magnesium levels regularly 3. Administering digoxin only through the intramuscular route 4. Calculating the correct dosage form, prescribed amounts, and the prescriber's order 5. Monitoring and recording the client's intake and output, heart rate, blood pressure, daily weight, and respiration rate regularly

1,2,4,5 Digoxin may alter the serum potassium and serum magnesium levels, which affects heart function. Calculating the correct dose according to the healthcare provider's orders helps to prevent drug toxicity. Checking for compliance with the client's drug regimen is important so that the child does not have drug to drug interactions. Monitoring and recording drug intake and output, heart rate, blood pressure, daily weight, and respiration rate is a part of general nursing care. Administering digoxin through the intramuscular route is not advised because this method is very painful.

When an older client with heart failure is transferred from the emergency department to the medical service, what should the nurse on the unit do first? Interview the client for a health history. Assess the client's heart and lung sounds. Monitor the client's pulse and temperature. Obtain the client's blood specimen for electrolytes.

Assess the client's heart and lung sounds With heart failure, the left ventricle is not functioning effectively, which is evidenced by an increased heart rate and crackles associated with pulmonary edema.

A client has left ventricular heart failure. For which clinical indicators should the nurse assess the client? Select all that apply. Ascites Crackles Peripheral edema Dyspnea on exertion Jugular vein distention

Crackles Dyspnea on exertion Pressure in the pulmonic circulation increases when the left ventricle fails; fluid moves from the intravascular compartment into the alveoli, causing crackles. Pressure in the pulmonic circulation increases when the left ventricle fails; fluid in the alveoli impairs gas exchange, which causes dyspnea on exertion.

The nurse is planning to teach a client with heart failure about the signs and symptoms of cardiac decompensation. What clinical manifestations should the nurse include? Select all that apply. Weight loss Extreme fatigue Coughing at night Excessive urination Difficulty breathing

Extreme fatigue Coughing at night Difficulty breathing Fatigue is caused by a lack of adequate oxygenation of body cells caused by a decreased cardiac output. As the cardiac output decreases, pulmonary congestion increases, resulting in pulmonary edema; coughing, especially when lying down, and blood-tinged sputum occur. Auscultation reveals crackles and rhonchi. Dyspnea is associated with pulmonary edema that occurs as cardiac output decreases and pulmonary congestion increases.

A client with a history of heart failure and atrial fibrillation reports a nine-pound (four kilogram) weight gain in the last two weeks. Which factor does the nurse consider as the most likely cause of this sudden weight gain? Fluid retention Urinary retention Renal insufficiency Abdominal distention

Fluid retention With the client's history and the large weight gain, fluid retention is the most likely cause of the increase in weight.

The nurse's physical assessment of a client with heart failure reveals tachypnea and bilateral crackles. Which is the priority nursing intervention? Initiate oxygen therapy Obtain chest x-ray film immediately Place client in a high-Fowler position Assess the client for a pleural friction rub

Place client in a high-fowler position Placing the client in a high-Fowler position promotes lung expansion and gas exchange; it also decreases venous return and cardiac workload.