Heart Failure

What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure? A. Urine output B. Lung sounds C. Blood pressure D. Respiratory rate

Answer: C. Blood Pressure. Rational: Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.

After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108/minute. What should the nurse suspect is happening? A. ADHF B. Chronic HF C. Left-sided HF D. Right-sided HF

Answer: D. Right-sided heart failure. Rational: An MI is a primary cause of heart failure. The jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure.

The nurse recognizes that primary manifestations of systolic failure include: A. Decreased EF and increased PAWP. B. Decreased PAWP and increased EF. C. Decreased pulmonary hypertension associated with normal EF. D. Decreased afterload and decreased left-ventricular end-diastolic pressure.

Answer: A. Decreased EF and increased PAWP.

A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient? A. Reduce preload. B. Decrease afterload. C. Increase contractility. D. Promote vasodilation.

Answer: A. Reduce preload. Rational: Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.

A PT with chronic HF and atrial fibrillation is treated with a digitalis glycoside and a loop diuretic. To prevent possible complications of this combination of drugs, what does the nurse need to do? (Select all that apply): A. Monitor serum potassium levels. B. Teach PT how to take a pulse rate. C. Keep an accurate measure of intake and output. D. Teach the PT about dietary restriction of potassium. E. Withhold digitalis and notify health care provider if heart rate is irregular.

Answers: A. monitor serum potassium levels, B. teach PT how to take a pulse.

PT's with a heart transplantation are at risk for which complications in the first year after transplantation? (Select all that apply): A. Cancer. B. Infection. C. Rejection. D. Vasculopathy. E. Sudden cardiac death.

Answers: B. Infection, C. Rejection, E. Sudden cardiac death.

You are caring for a PT with ADHF who is receiving IV dobutamine (Dobutrex). You notice that this drug is ordered because it (Select all that apply): A. Increases SVR. B. Produces diuresis. C. Improves contractility. D. Dilates renal blood vessels. E. Works on the B1-receptors in the heart.

Answers: C. Improves contractility, E. Works on the B1-receptors in the heart.

A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid? A. High-potassium foods B. Drugs to treat erectile dysfunction C. Nonsteroidal antiinflammatory drugs D. Over-the-counter H2 -receptor blockers

Answer: B. Drugs to treat erectile dysfunction. Rational: The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. High-potassium foods, NSAIDs, and H2-receptor blockers do not pose a risk in combination with nitrates.

The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What should the nurse do next? A. Withhold the daily dose until the following day. B. Withhold the dose and report the potassium level. C. Give the digoxin with a salty snack, such as crackers. D. Give the digoxin with extra fluids to dilute the sodium level.

Answer: B. Withhold the dose and report the potassium level. Rational: The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the potassium level. The physician may order the digoxin to be given once the potassium level has been treated and decreases to within normal range.

A compensatory mechanism involved in heart failure that leads to inappropriate fluid retention and additional workload of the heart is: A. Ventricular dilation. B. Ventricular hypertrophy. C. Neurohormonal response. D. Sympathetic Nervous System activation.

Answer: C. Neurohormonal response.

The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom(s)? A. Muscle aches B. Constipation C. Pounding headache D. Anorexia and nausea

Answer: D. Anorexia and nausea. Rational: Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms.

A stable patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before positioning the patient on the bedside, what should the nurse assess first? A. Urine output B. Heart rhythm C. Breath sounds D. Blood pressure

Answer: D. Blood pressure. Rational: The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the semi-Fowler's position and use other measures to improve gas exchange.

Beyond the first year after a heart transplant, the nurse knows that what is a major cause of death? A. Infection B. Acute rejection C. Immunosuppression D. Cardiac vasculopathy

Answer: D. Cardiac Vasculopathy. Rational: Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated CAD) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection.

What should the nurse recognize as an indication for the use of dopamine (Intropin) in the care of a patient with heart failure? A. Acute anxiety B. Hypotension and tachycardia C. Peripheral edema and weight gain D. Paroxysmal nocturnal dyspnea (PND)

Answer: B. Hypotension and tachycardis. Rational: Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.

The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to ADHF? A. Take medications as prescribed. B. Use oxygen when feeling short of breath. C. Only ask the physician's office questions. D. Encourage most activity in the morning when rested.

Answer: A. Take medications as prescribed. Rational: The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies such as alternating activity with rest will help the patient meet this goal. If the patient needs to use oxygen at home, it will probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient. This nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening HF.

A male patient with a long-standing history of heart failure has recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? A. Taper the patient off his current medications. B. Continue education for the patient and his family. C. Pursue experimental therapies or surgical options. D. Choose interventions to promote comfort and prevent suffering.

Answer: D. Choose interventions to promote comfort and prevent suffering. Rational: The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount. Medications should be continued unless they are not tolerated. Experimental therapies and surgeries are not commonly used in the care of hospice patients.

A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)? A. Administer ordered morphine sulfate. B. Position patient in a semi-Fowler's position. C. Position patient on left side with head of bed flat. D. Instruct patient on the use of relaxation techniques. E. Use a calm, reassuring approach while talking to patient.

Answers: A. Administer ordered morphine sulfate, B. Position patient in a semi-Fowler's position, D. Instruct patient on the use of relaxation techniques, E. Use a calm, reassuring approach while talking to patient. Rational: Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety.

The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient (select all that apply)? A. Left ventricular function is documented. B. Controlling dysrhythmias will eliminate HF. C. Prescription for digoxin (Lanoxin) at discharge. D. Prescription for angiotensin-converting enzyme (ACE) inhibitor at discharge. E. Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen.

Answers: A. Left ventricular function is documented, D. Prescription for angiotensin-converting enzyme (ACE) inhibitor at discharge, E. Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen. Rational: The Joint Commission has identified these three core measures for heart failure patients. Although controlling dysrhythmias will improve CO and workload, it will not eliminate HF. Prescribing digoxin for all HF patients is no longer done because there are newer effective drugs and digoxin toxicity occurs easily related to electrolyte levels and the therapeutic range must be maintained.