NURS 401 Ch. 29 (Brunner & Suddarth): Management of Patients With Complications From Heart Disease

A community health nurse is participating in a healthy-living workshop that has been sponsored by a local seniors' center. The discussion has turned to the problem of heart failure, and the nurse is emphasizing preventative measures. When teaching older adults to decrease their future risks of developing heart failure, the nurse should emphasize what action? Physical exercise and the importance of getting 30 to 60 minutes of activity each day A low-fat, high-protein diet Close blood pressure monitoring and vigilant adherence to hypertension therapy Effective stress management

Close blood pressure monitoring and vigilant adherence to hypertension therapy Explanation: Hypertension is a major risk factor for heart failure. Inactivity, obesity, and hyperlipidemia are also risk factors, but they are statistically less significant than hypertension. Effective stress management is beneficial, but stress is not a major risk factor for heart failure.

A patient is undergoing a pericardiocentesis. Following withdrawal of pericardial fluid, which assessment by the nurse indicates that cardiac tamponade has been relieved? Decrease in blood pressure Absence of cough Decrease in central venous pressure (CVP) Increase in CVP

Decrease in central venous pressure (CVP) Explanation: A resulting decrease in CVP and an associated increase in blood pressure after withdrawal of pericardial fluid indicate that the cardiac tamponade has been relieved. An absence of cough would not indicate the absence of cardiac tamponade.

The nurse is caring for a client with suspected right-sided heart failure. What would the nurse know that clients with suspected right-sided heart failure may experience? Increased urine output Increased perspiration Sleeping in a chair or recliner Gradual unexplained weight gain

Gradual unexplained weight gain Explanation: Clients with right-sided heart failure may have a history of gradual, unexplained weight gain from fluid retention. Left-sided heart failure produces paroxysmal nocturnal dyspnea, which may prompt the client to use several pillows in bed or to sleep in a chair or recliner. Right-sided heart failure does not cause increased perspiration or increased urine output.

Which feature is the hallmark of systolic heart failure? Low ejection fraction (EF) Basilar crackles Limited activities of daily living (ADLs) Pulmonary congestion

Low ejection fraction (EF) Explanation: A low EF is a hallmark of systolic heart failure (HF); the severity of HF is frequently classified according to the client's symptoms.

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 Low serum potassium level Increase in blood pressure Increase in blood volume

Low serum potassium level Explanation: Furosemide is a potassium-wasting diuretic. The nurse must monitor the serum potassium level and assess for signs of low potassium. As water and sodium are lost in the urine, blood pressure decreases, blood volume decreases, and urine output increases.

What do nitrates do?

Reduce the amount of blood return to the heart, which lowers preload

The nurse documents pitting edema in the bilateral lower extremities of the client. What does this documentation mean? There is excess fluid volume in the interstitial space in areas affected by gravity. There is excess fluid volume in the venous system of the lower extremities. There is excess fluid volume in the arterial system of the lower extremities. There is excess fluid volume in the hepatic system.

There is excess fluid volume in the interstitial space in areas affected by gravity. Explanation: Dependent pitting edema (excess fluid volume in the interstitial space in body areas affected by gravity) in the feet and ankles can be observed. This type of edema may seem to disappear overnight but really is temporarily redistributed by gravity to other tissues, such as the sacral area. The other options are not descriptive of pitting edema.

The physician writes orders for a patient to receive an angiotensin II receptor blocker for treatment of heart failure. What medication does the nurse administer? Carvedilol (Coreg) Valsartan (Diovan) Metolazone (Zaroxolyn) Digoxin (Lanoxin)

Valsartan (Diovan) Explanation: Valsartan (Diovan) is the only angiotensin receptor blocker listed. Digitalis/digoxin (Lanoxin) is a cardiac glycoside. Metolazone (Zaroxolyn) is a thiazide diuretic. Carvedilol (Coreg) is a beta-adrenergic blocking agent (beta-blocker).

A nurse is administering digoxin. What client parameter would cause the nurse to hold the digoxin and notify the health care prescriber? heart rate of 55 beats per minute atrial fibillation rhythm urine output of 300 mL in eight hours blood pressure of 125/80

heart rate of 55 beats per minute Explanation: Digoxin therapy slows conduction through the AV node. A heart rate of 55 is slow and the digoxin therapy may slow the heart rate further. Blood pressure of 125/80 is normal. Urine output of 300 mL is adequate, so the kidneys are functioning. Atrial fibrillation is not a parameter to hold medication.

A client has had an echocardiogram to measure ejection fracton. The nurse explains that ejection fraction is the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects? 40% 45% 55% 50%

55% Explanation: Normally, a healthy heart ejects 55% or more of the blood that fills the left ventricle during diastole.

A patient has been admitted to the hospital with exacerbation of heart failure (HF) that has resulted in pulmonary and peripheral edema. The nurse has been carefully monitoring the trajectory of the patient's signs and symptoms of HF. How can the nurse best monitor the patient's fluid balance? By performing daily weights at the same time each day By measuring and recording the patient's oral fluid intake By assessing the patient's skin turgor at several different sites By monitoring the patient's blood urea nitrogen (BUN) and creatinine levels

By performing daily weights at the same time each day Explanation: Changes in fluid balance can be identified by monitoring the patient's weight on a daily basis. This assessment is more accurate than assessing skin turgor. Intake must be considered in combination with output. BUN and creatinine levels provide important data, but these do not convey the patient's fluid balance when considered in isolation.

A client has been prescribed furosemide 80 mg twice daily. The asymptomatic client begins to have rare premature ventricular contractions followed by runs of bigeminy with stable signs. What action will the nurse perform next? Administer potassium. Calculate the client's intake and output. Notify the health care provider. Check the client's potassium level.

Check the client's potassium level. Explanation: The client is asymptomatic but has had a change in heart rhythm. More information is needed before calling the health care provider. Because the client is taking furosemide, a potassium-wasting diuretic, the next action would be to check the client's potassium level. The nurse would then call the health care provider with a more complete database. The health care provider will need to be notified after the nurse checks the latest potassium level. The intake and output will not change the heart rhythm. Administering potassium requires a health care provider's order.

The nurse has completed a head-to-toe assessment of a patient who was admitted for the treatment of heart failure (HF). Which of the following assessment findings should signal to the nurse a possible exacerbation of the patient's condition? Blood glucose testing reveals a glucose level of 158 mg/dL. The patient's blood pressure (BP) is 144/99. Crackles are audible on chest auscultation. The patient has put out 600 mL of dilute urine over the past 8 hours.

Crackles are audible on chest auscultation. Explanation: Patients with HF often exhibit crackles, which are produced by the sudden opening of edematous small airways and alveoli that have adhered together by exudate. These may be heard at the end of inspiration and are not cleared with coughing. A widened pulse pressure, increased BP, and production of dilute urine are not characteristic of HF. Changes in blood glucose levels are not normally symptomatic of HF.

The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure? Decreased urinary output Hypotension Tachycardia Dyspnea on exertion

Dyspnea on exertion Explanation: Left-sided heart failure produces hypoxemia as a result of reduced cardiac output of arterial blood and respiratory symptoms. Many clients notice unusual fatigue with activity. Some find exertional dyspnea to be the first symptom. An increase in urinary output may be seen later as fluid accumulates. Hypotension would be a later sign of decompensating heart failure as well as tachycardia.

A client has a significant history of congestive heart failure. What should the nurse specifically assess during the client's semiannual cardiology examination? Select all that apply. Monitor the client for signs of lethargy or confusion. Examine the client's joints for crepitus. Examine the client's neck for distended veins. Examine the client's eyes for excess tears.

Examine the client's neck for distended veins. Monitor the client for signs of lethargy or confusion. Explanation: During a head-to-toe assessment of a client with congestive heart failure, the nurse checks for dyspnea, auscultates apical heart rate and counts radial heart rate, measures BP, and documents any signs of peripheral edema, lethargy, or confusion. Excess tears are not part of the checklist.

The nurse is preparing to administer hydralazine and isosorbide dinitrate. When obtaining vital signs, the nurse notes that the blood pressure is 90/60. What is the priority action by the nurse? Hold the medication and call the health care provider. Administer the medication and check the blood pressure in 30 minutes. Administer the hydralazine and hold the dinitrate. Administer a saline bolus of 250 mL and then administer the medication.

Hold the medication and call the health care provider. Explanation: A combination of hydralazine and isosorbide dinitrate may be another alternative for patients who cannot take ACE inhibitors (ICSI, 2011). Nitrates (e.g., isosorbide dinitrate) cause venous dilation, which reduces the amount of blood return to the heart and lowers preload. Hydralazine lowers systemic vascular resistance and left ventricular afterload. If these medications lead to severe hypotension, the nurse should hold the medication and call the health care provider.

Which action will the nurse include in the plan of care for a client admitted with acute decompensated heart failure (ADHF) who is receiving milrinone? Monitor blood pressure frequently Titrate milrinone rate slowly before discontinuing Teach the client about safe home use of the medication Encourage the client to ambulate in room

Monitor blood pressure frequently Explanation: Milrinone is a phosphodiesterase inhibitor that delays the release of calcium from intracellular reservoirs and prevents the uptake of extracellular calcium by the cells. This promotes vasodilation, resulting in decreased preload and afterload and reduced cardiac workload. Milrinone is administered intravenously to clients with severe HF, including those who are waiting for a heart transplant. Because the drug causes vasodilation, the client's blood pressure is monitored before administration because if the client is hypovolemic the blood pressure could drop quickly. The major side effects are hypotension and increased ventricular dysrhythmias. Blood pressure and the electrocardiogram (ECG) are monitored closely during and after infusions of milrinone

The nurse is working in a long-term care facility with a group of older adults with cardiac disorders. Why would it be important for the nurse to closely monitor an older adult receiving digitalis preparations for cardiac disorders? Older adults are at increased risk for asthma. Older adults are at increased risk for toxicity. Older adults are at increased risk for hyperthyroidism. Older adults are at increased risk for cardiac arrests.

Older adults are at increased risk for toxicity. Explanation: Older adults receiving digitalis preparations are at increased risk for toxicity because of the decreased ability of the kidneys to excrete the drug due to age-related changes. The margin between a therapeutic and toxic effect of digitalis preparations is narrow. Using digitalis preparations does not increase the risk of cardiac arrests, hyperthyroidism, or asthma.

A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client? The development of left-sided heart failure The development of corpulmonale The development of right-sided heart failure The development of chronic obstructive pulmonary disease (COPD)

The development of left-sided heart failure Explanation: When the left ventricle fails, the heart muscle cannot contract forcefully enough to expel blood into the systemic circulation. Blood subsequently becomes congested in the left ventricle, left atrium, and finally the pulmonary vasculature. Symptoms of left-sided failure include fatigue; paroxysmal nocturnal dyspnea; orthopnea; hypoxia; crackles; cyanosis; S3 heart sound; cough with pink, frothy sputum; and elevated pulmonary capillary wedge pressure. COPD develops over many years and does not develop after a myocardial infarction. The development of right-sided heart failure would generally occur after a right ventricle myocardial infarction or after the development of left-sided heart failure. Corpulmonale is a condition in which the heart is affected secondarily by lung damage.

While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). How should the nurse document this sound? a first heart sound (S1). a fourth heart sound (S4). a third heart sound (S3). a murmur.

a third heart sound (S3). Explanation: An S3 is heard following an S2, which commonly occurs in clients experiencing heart failure and results from increased filling pressures. An S1 is a normal heart sound made by the closing of the mitral and tricuspid valves. An S4 is heard before an S1 and is caused by resistance to ventricular filling. A murmur is heard when there is turbulent blood flow across the valves.

A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client? Vasculitis nausea and vomiting Enlargement of joints Flexion contractures

nausea and vomiting Explanation: Digitalis medications are potent and may cause various toxic effects. The nurse should monitor the client for signs of digitalis toxicity, not just during the initial period of therapy, but throughout care management. The most common signs and symptoms include nausea and vomiting which can lead to dehydration and electrolyte imbalance.

The nurse is administering digoxin to a client with heart failure. What laboratory value may predispose the client to digoxin toxicity? magnesium level of 2.5 mg/dL calcium level of 7.5 mg/dL potassium level of 2.8 mEq/L sodium level of 152 mEq/L

potassium level of 2.8 mEq/L Explanation: Conditions that may predispose a client to digoxin toxicity include hypokalemia (evidenced by a potassium level less than 3.5 mEq/L), hypomagnesemia (evidenced by a magnesium level less than 1.5 mEq/L), hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia (evidenced by a magnesium level greater than 2.5 mEq/L), hypercalcemia (evidenced by an ionized calcium level greater than 5.3 mg/dl), and hypernatremia (evidenced by a sodium level greater than 145 mEq/L) aren't associated with a risk of digoxin toxicity.