Prep U Chapter 29
Which of the following types of diuretic is the first-line treatment for those diagnosed with heart failure (HF)? Loop Potassium-sparing Thiazide-like Thiazides
Loop
Which diagnostic study is usually performed to confirm the diagnosis of heart failure? Electrocardiogram (ECG) Echocardiogram Serum electrolytes Blood urea nitrogen (BUN)
Echocardiogram
The student nurse is caring for a client with heart failure. Diuretics have been ordered. What method might be used with a debilitated client to help the nurse evaluate the client''s response to diuretics? Using a biventricular pacemaker Using a urinary catheter Using a pulmonary artery catheter Using mechanical ventilation
Using a urinary catheter
A client has been rushed to the ED with pulmonary edema and is going to need oxygen immediately. Which oxygen delivery system should be used first? mechanical ventilation intubation nasal cannula mask
mask
The nurse understands that a client with which cardiac arrhythmia is most at risk for developing heart failure? Supraventricular tachycardia First-degree heart block Sinus tachycardia Atrial fibrillation
Atrial fibrillation
A client with right-sided heart failure is admitted to the medical-surgical unit. What information obtained from the client may indicate the presence of edema? The client says that he has been urinating less frequently at night. The client says his rings have become tight and are difficult to remove. The client says he is short of breath when ambulating. The client says he has been hungry in the evening.
The client says his rings have become tight and are difficult to remove.
The nurse is discussing cardiac hemodynamics with a nursing student. The nurse explains preload to the student and then asks the student what nursing interventions might cause decreased preload. The student correctly answers which of the following? Application of antiembolytic stockings Ambulation Maintaining the client's legs elevated Administration of a vasodilating drug (as ordered by a physician)
Administration of a vasodilating drug (as ordered by a physician)
Which of the following is a key diagnostic indicator of heart failure (HF)? Complete blood count (CBC) Blood urea nitrogen (BUN) Creatinine Brain natriuretic peptide (BNP)
Brain natriuretic peptide (BNP)
A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.) Cough Jugular vein distention Pulmonary crackles Ascites Dyspnea
Cough Pulmonary crackles Dyspnea
A patient in cardiogenic shock after a myocardial infarction is placed on an intra-aortic balloon pump (IABP). What does the nurse understand is the mechanism of action of the balloon pump? The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart. The balloon will inflate at the beginning of systole and deflate before diastole to provide a long-term solution to a failing myocardium. The balloon delivers an electrical impulse to correct dysrhythmias the patient experiences. The balloon keeps the vessels open so that blood will adequately deliver to the myocardium.
The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart
A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." The CSU nurse should be especially observant for: dry mucous membranes. high urine output. pulmonary crackles. hypertension.
pulmonary crackles.
A patient with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, bradycardia, and muffled heart sounds. The senior nursing student recognizes these symptoms occur when The pericardial space is eliminated with scar tissue and thickened pericardium. The parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction. Fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction. Excess pericardial fluid compresses the heart and prevents adequate diastolic filling.
Excess pericardial fluid compresses the heart and prevents adequate diastolic filling.
A nurse has come upon an unresponsive, pulseless victim. She has placed a 911 call and begins CPR. The nurse understands that if the patient has not been defibrillated within which time frame, the chance of survival is close to zero? 10 minutes 15 minutes 20 minutes 25 minutes
10 minutes
A client in the hospital informs the nurse he "feels like his heart is racing and can't catch his breath." What does the nurse understand occurs as a result of a tachydysrhythmia? It reduces ventricular ejection volume. It increases preload. It causes a loss of elasticity in the myocardium. It increases afterload.
It reduces ventricular ejection volume.
Before discharge, which instruction should a nurse give to a client receiving digoxin (Lanoxin)? "Take an extra dose of digoxin if you miss one dose." "Call the physician if your heart rate is above 90 beats/minute." "Call the physician if your pulse drops below 80 beats/minute." "Take digoxin with meals."
"Call the physician if your heart rate is above 90 beats/minute."
Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest? I II III IV
IV
A patient has missed 2 doses of digitalis (Digoxin). What laboratory results would indicate to the nurse that the patient is within therapeutic range? 4.0 mg/mL 3.2 mg/mL 2.0 mg/mL 0.25 mg/mL
2.0 mg/mL
A total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it different from an LVAD? It is specifically designed for long-term use. It is designed for extremely active patients. An LVAD only supports a failing left ventricle. It never needs batteries.
An LVAD only supports a failing left ventricle.
The nurse is performing a respiratory assessment for a patient in left-sided heart failure. What does the nurse understand is the best determinant of the patient's ventilation and oxygenation status? Arterial blood gases Listening to breath sounds Pulse oximetry End-tidal CO2
Arterial blood gases
A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion? Assess for elevated blood urea nitrogen levels. Assess for elevated blood potassium levels. Assess for reduced urine output. Assess for reduced blood sodium levels.
Assess for elevated blood urea nitrogen levels.
The Cardiac Nurse Clinician is teaching a group of clients with heart failure about self-management of their disease. What dietary advice should the Nurse Clinician give to clients with severe heart failure until edema resolves? Avoid the intake of canned fruit and fruit juices. Avoid the intake of processed and commercially prepared foods. Encourage increased intake of vegetables with natural sodium. Encourage increased intake of red meat.
Avoid the intake of processed and commercially prepared foods.
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? Complete blood count (CBC) Serum electrolytes Blood urea nitrogen (BUN) B-type natriuretic peptide (BNP)
B-type natriuretic peptide (BNP)
A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client? Intubation of the airway Insertion of a central venous catheter BP and pulse measurements every 15 to 30 minutes Hourly administration of a fluid bolus
BP and pulse measurements every 15 to 30 minutes
he nurse assessing a client with an exacerbation of heart failure identifies which symptom as a cerebrovascular manifestation of heart failure (HF)? Ascites Nocturia Tachycardia Dizziness
Dizziness
A client has been prescribed furosemide (Lasix) 80 mg twice daily. The cardiac monitor technician informs the nurse that the client has started having rare premature ventricular contractions followed by runs of bigeminy lasting 2 minutes. During the assessment, the nurse determines that the client is asymptomatic and has stable vital signs. Which of the following actions should the nurse perform next? Check the client's potassium level. Administer potassium. Summon the nurse-manager. Call the physician.
Check the client's potassium level.
The nurse is caring for a client in the hospital with chronic heart failure that has marked limitations in his physical activity. The client is comfortable when resting in the bed or chair, but when ambulating in the room or hall, he becomes short of breath and fatigued easily. What type of heart failure is this considered according to the New York Heart Association (NYHA)? Class III (Moderate) Class II (Mild) Class I (Mild) Class IV (Severe)
Class III (Moderate)
The nurse identifies which symptom as a manifestation of right-sided heart failure (HF)? Reduction in cardiac output Accumulation of blood in the lungs Reduction in forward flow Congestion in the peripheral tissues
Congestion in the peripheral tissues
A nurse is teaching clients newly diagnosed with coronary heart disease (CHD) about the disease process and risk factors for heart failure. Which problem can cause left-sided heart failure (HF)? Cystic fibrosis Pulmonary embolus Myocardial ischemia Ineffective right ventricular contraction
Myocardial ischemia
Which of the following body system responses correlates with systolic heart failure (HF)? Increased blood volume ejected from ventricle Dehydration Decrease in renal perfusion Vasodilation of skin
Decrease in renal perfusion
What is the primary underlying disorder of pulmonary edema? Increased right atrial resistance Decreased left ventricular pumping Increased left atrial contractility Decreased right ventricular elasticity
Decreased left ventricular pumping
A patient is exhibiting digitalis toxicity. Which of the following medications would the nurse expect to be ordered for this patient? Ibuprofen (Motrin) Digoxin immune FAB (Digibind) Warfarin (Coumadin) Amlodipine (Norvasc)
Digoxin immune FAB (Digibind)
The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure? Tachycardia Dyspnea on exertion Hypotension Decreased urinary output
Dyspnea on exertion
The diagnosis of heart failure is usually confirmed by which of the following? Echocardiogram Ventriculogram Chest x-ray Electrocardiogram (12-lead)
Echocardiogram
The nursing instructor is discussing heart failure with their clinical group. The instructor talks about heart failure in terms of a decreasing ejection fraction of the heart. What diagnostic test is used to measure the ejection fraction of the heart? Nuclear angiography Pulmonary arterial pressure MRI Echocardiogram
Echocardiogram
A client with congestive heart failure is admitted to the hospital after reporting shortness of breath. How should the nurse position the client in order to decrease preload? Head of the bed elevated 30 degrees and legs elevated on pillows Supine with arms elevated on pillows above the level of the heart Head of the bed elevated 45 degrees and lower arms supported by pillows Prone with legs elevated on pillows
Head of the bed elevated 45 degrees and lower arms supported by pillows
A nurse is discussing cardiac hemodynamics with a nursing student and explains the concept of afterload. The student asks what medical conditions might cause increased afterload. The nurse correctly answers which of the following? Diabetes mellitus and aortic valve stenosis Hypertension and mitral valve stenosis Hypertension and aortic valve stenosis Diabetes mellitus and mitral vave stenosis
Hypertension and aortic valve stenosis
The nurse is assessing a patient who reports no symptoms of heart failure at rest but is symptomatic with increased physical activity. Under what classification does the nurse understand this patient would be categorized? I II IV III
II
Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure? Increase in the cardiac index Decreased mean pulmonary artery pressure Increased pulmonary artery diastolic pressure Decreased central venous pressure
Increased pulmonary artery diastolic pressure
A nurse reviews the patient's chart. The doctor noted in the progress notes that he suspected the patient was experiencing decreased left ventricular function. The nurse knows to look for documentation of all of the following to validate that diagnosis except: Pulsus alternans. Tachycardia. A weak, thready pulse. Increased stroke volume.
Increased stroke volume.
Which feature is the hallmark of systolic heart failure? Pulmonary congestion Limited activities of daily living (ADLs) Low ejection fraction (EF) Basilar crackles
Low ejection fraction (EF)
Which is the hallmark of heart failure? Low ejection fraction (EF) Basilar crackles Limited ADLs Pulmonary congestion
Low ejection fraction (EF)
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? Titrate milrinone rate slowly before discontinuing Encourage the client to ambulate in room Teach the client about safe home use of the medication Monitor blood pressure frequently
Monitor blood pressure frequently
A client develops cardiogenic pulmonary edema and is extremely apprehensive. What medication can the nurse administer with physician orders that will relieve anxiety and slow respiratory rate? Furosemide Nitroglycerin Morphine sulfate Dopamine
Morphine sulfate
Which of the following medications is a human brain natriuretic peptide (BNP) preparation? Natrecor Enalapril Metoprolol Captopril
Natrecor
Nursing management of a client in heart failure with pulmonary edema includes which of the following? Assessment for decreased urine output Observation of the effectiveness of emergency drug therapy Pulse oximetry hourly Fluid bolus hourly
Observation of the effectiveness of emergency drug therapy
Which of the following clinical manifestations are consistent with right-sided heart failure (HF)? Positive hepatojugular reflux Pulmonary congestion Pulmonary interstitial edema Left ventricular insufficiency
Positive hepatojugular reflux
A physician orders digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity? Calcium level of 7.5 mg/dl Magnesium level of 2.5 mg/dl Potassium level of 2.8 mEq/L Sodium level of 152 mEq/L
Potassium level of 2.8 mEq/L
The nurse is administering nitroglycerin, which he knows decreases preload as well as afterload. Preload refers to which of the following? The amount of blood presented to the ventricles just before systole Fluid overload and tissue perfusion status The amount of resistance to the ejection of blood from the ventricles The force of the contraction related to the sympathetic nervous system
The amount of blood presented to the ventricles just before systole
A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which of the following assessment findings for this client? Pulmonary congestion Pedal edema Nausea Jugular venous distention
Pulmonary congestion
What disease processes contribute to chronic heart failure? Select all that apply. Renal failure Pancreatic disease Valvular disease Pulmonary insufficiency Tachydysrhythmias
Renal failure Valvular disease Tachydysrhythmias
A client with heart failure reports a sudden change in the ability to perceive colors. The client reports nausea, and assessment reveals an irregular pulse of 39 beats per minute. What is the nurse's best action? Withhold the client's next scheduled dose of furosemide and report to the care provider Facilitate an ophthalmology referral promptly Monitor the client's vital signs every 30 minutes Report the possibility of digitalis toxicity to the care provider promptly
Report the possibility of digitalis toxicity to the care provider promptly
The nurse recognizes which symptom as a classic sign of cardiogenic shock? Hyperactive bowel sounds Restlessness and confusion High blood pressure Increased urinary output
Restlessness and confusion
A nurse is administering lanoxin, which she knows increases contractility as well as cardiac output. Contractility refers to which of the following? The amount of blood presented to the ventricles just before systole The force of the contraction related to the status of the myocardium Fluid overload and tissue perfusion status The amount of resistance to the ejection of blood from the ventricles
The force of the contraction related to the status of the myocardium
A patient has been experiencing increasing shortness of breath and fatigue. The physician has ordered a diagnostic test in order to determine what type of heart failure the patient is having. What diagnostic test does the nurse anticipate being ordered? A ventriculogram An echocardiogram An electrocardiogram A chest x-ray
An echocardiogram
Which measurement should a nurse use to monitor the respiratory status of a client with pulmonary edema? Skin color assessment Lung sounds Pulse oximetry Arterial blood gas (ABG) analysis
Arterial blood gas (ABG) analysis
A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure? Bibasilar crackles Dependent edema Right upper quadrant pain Jugular vein distention
Bibasilar crackles
A patient in severe pulmonary edema is being intubated by the respiratory therapist. What priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea? Attach a pulse oximeter probe and obtain values. Listen for breath sounds over the epigastrium. Observe for mist in the endotracheal tube. Call for a chest x-ray.
Call for a chest x-ray.
Which is a cerebrovascular manifestation of heart failure? Nocturia Tachycardia Dizziness Ascites
Dizziness
Cardiogenic shock is pump failure that primarily occurs because of which of the following? Coronary artery stenosis Inadequate tissue perfusion Myocardial ischemia Right atrial flutter
Inadequate tissue perfusion
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 right-sided heart failure The development of corpulmonale The development of left-sided heart failure The development of chronic obstructive pulmonary disease (COPD)
The development of left-sided heart failure
Which statement best describes the therapeutic action of loop diuretics? They promote sodium secretion into the distal tubule. They block reabsorption of potassium on the collecting tubule. They promote potassium secretion into the distal tubule and constrict renal vessels. They block sodium reabsorption in the ascending loop and dilate renal vessels.
They block sodium reabsorption in the ascending loop and dilate renal vessels.
A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status? Weighing the client daily at the same time each day Assessing the client's vital signs every 4 hours Checking the client's lungs for crackles during every shift Measuring and recording fluid intake and output
Weighing the client daily at the same time each day
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). The nurse should document this as: a fourth heart sound (S4). a third heart sound (S3). a first heart sound (S1). a murmur.
a third heart sound (S3).
A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of: acute pulmonary edema. right-sided heart failure. pneumonia. cardiogenic shock.
acute pulmonary edema.
A client diagnosed with heart failure presents with a temperature of 99.1° F, pulse 100 beats/minute, respirations 42 breaths/minute, BP 110/50 mm Hg; crackles in both lung bases; nausea; and pulse oximeter reading of 89%. Which finding indicates a need for immediate attention? blood pressure temperature lung congestion nausea
lung congestion
A client diagnosed with heart failure presents with a temperature of 99.1° F, pulse 100 beats/minute, respirations 42 breaths/minute, BP 110/50 mm Hg; crackles in both lung bases; nausea; and pulse oximeter reading of 89%. Which finding indicates a need for immediate attention? blood pressure temperature lung congestion nausea
lung congestion
A client is receiving captopril (Capoten) for heart failure. The nurse should notify the physician that the medication therapy is ineffective if an assessment reveals: peripheral edema. postural hypotension. skin rash. dry cough.
peripheral edema.
A nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, the nurse should: administer oxygen. place the client in high Fowler's position. perform chest physiotherapy. have the client take deep breaths and cough.
place the client in high Fowler's position.
A client with a history of myocardial infarction is admitted with shortness of breath, anxiety, and slight confusion. Assessment findings include a regular heart rate of 120 beats/minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 ml over the past hour. The nurse anticipates preparing the client for transfer to the intensive care unit and pulmonary artery catheter insertion because: the client shows signs of aneurysm rupture. the client is experiencing heart failure. the client is in the early stage of right-sided heart failure. the client is going into cardiogenic shock.
the client is going into cardiogenic shock.
A client with chronic heart failure is receiving digoxin (Lanoxin), 0.25 mg by mouth daily, and furosemide (Lasix), 20 mg by mouth twice daily. The nurse instructs the client to notify the physician if nausea, vomiting, diarrhea, or abdominal cramps occur because these signs and symptoms may signal digoxin toxicity. Digoxin toxicity may also cause: visual disturbances. taste and smell alterations. dry mouth and urine retention. nocturia and sleep disturbances.
visual disturbances.
A client who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly reports chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the client for other signs and symptoms of myocardial infarction. pneumonia. pulmonary edema. pulmonary embolism.
pulmonary embolism.
A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient? Potassium levels Vasculitis Enlargement of joints Flexion contractures
Potassium levels
Which is a manifestation of right-sided heart failure? Accumulation of blood in the lungs Reduction in forward flow Reduction in cardiac output Systemic venous congestion
Systemic venous congestion
A client arrives at the ED with an exacerbation of left-sided heart failure and reports shortness of breath. Which is the priority nursing intervention? Administer diuretics Administer angiotensin II receptor blockers Assess oxygen saturation Administer angiotensin-converting enzyme inhibitors
Assess oxygen saturation
A patient has been diagnosed with systolic heart failure. The nurse would expect the patient's ejection fraction to be at which level? Severely reduced High Normal Slightly reduced
Severely reduced
A nurse caring for a client recently admitted to the ICU observes the client coughing up large amounts of pink, frothy sputum. Lung auscultation reveals course crackles to lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing tuberculosis. bilateral pneumonia. decompensated heart failure with pulmonary edema. acute exacerbation of chronic obstructive pulmonary disease.
decompensated heart failure with pulmonary edema.
A client with heart failure must be monitored closely after starting diuretic therapy. The best indicator for the nurse to monitor is: vital signs. urine specific gravity. fluid intake and output. weight.
weight.
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. Examine the client's neck for distended veins. Examine the client's eyes for excess tears. Monitor the client for signs of lethargy or confusion. Examine the client's joints for crepitus.
Examine the client's neck for distended veins. Monitor the client for signs of lethargy or confusion.
