prepu ch 15 heart disease
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. A - Monitor the client for signs of lethargy or confusion. B - Examine the client's eyes for excess tears. C - Examine the client's joints for crepitus. D - Examine the client's neck for distended veins.
A - Monitor the client for signs of lethargy or confusion. D - Examine the client's neck for distended veins.
Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole? A - Preload B - Stroke volume C - Afterload D - Ejection fraction
A - Preload
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? A - Encourage the client to ambulate in room B - Monitor blood pressure frequently C - Teach the client about safe home use of the medication D - Titrate milrinone rate slowly before discontinuing
B - Monitor blood pressure frequently
The client with cardiac failure is taught to report which symptom to the health care provider or clinic immediately? A - Weight loss B - Persistent cough C - Increased appetite D - Ability to sleep through the night
B - Persistent cough
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? A - Left-sided heart failure B - Chronic heart failure C - Acute heart failure D - Right-sided heart failure
D - Right-sided heart failure
A client taking an ACE inhibitor has developed a dry, hacking cough. Because of this side effect, the client no longer wants to take that medication. What medication that has similar hemodynamic effects does the nurse anticipate the health care provider ordering? A - Furosemide B - Metoprolol C - Valsartan D - Isosorbide dinitrate
Valsartan
A patient has been newly diagnosed with heart failure (HF) and has come to the meet with the nurse at the clinic for health education. What lifestyle recommendation should the nurse provide to this patient when discussing dietary modifications? A - "It's in your best interests to avoid excessive fluids and sodium in your diet." B - "I'll teach you some good sources of potassium, which you should try to eat regularly." C - "Try to replace as many of the complex carbohydrates in your diet with simple sugars." D - "Many people with HF find that small, frequent meals allow them to manage their diet effectively."
A - "It's in your best interests to avoid excessive fluids and sodium in your diet."
The cardiac monitor alarm alerts the critical care nurse that the patient is showing no cardiac rhythm on the monitor. When the nurse assesses the patient, the patient is found to be experiencing cardiac arrest. In providing cardiac resuscitation documentation, how will the nurse describe this initial absence of cardiac rhythm? A - Asystole B - Ventricular fibrillation C - Ventricular tachycardia D - Pulseless electrical activity (PEA)
A - Asystole
The nurse is providing care for a patient newly diagnosed with systolic heart failure (HF). What medications should the nurse anticipate administering? A - Beta-blockers B - Angiotensin prohibitors C - Alpha agonists D - Calcium channel blockers
A - Beta-blockers
A nurse has asked the unit educator what happens when the amount of fluid in the pericardial sac increases. What should the educator tell the nurse? A - It raises the pressure inside the pericardial sac, compressing the heart. B - It raises the pressure inside the pericardial sac, compressing the lungs. C - It raises the pressure inside the pericardial sac, causing fluid to leak through. D - It raises the pressure inside the pericardial sac, causing it to rupture.
A - It raises the pressure inside the pericardial sac, compressing the heart.
A nurse is teaching a client about heart failure. What will the nurse explain is causing the heart to fail? A - The heart cannot pump sufficient blood to meet the body's metabolic needs. B - The heart is pumping too slow to disseminate nutrients to the body. C - The heart is fibrillating. D - The heart is pumping too fast to adequately meet the body's metabolic needs.
A - The heart cannot pump sufficient blood to meet the body's metabolic needs.
A client who has developed congestive heart failure must learn to make dietary adaptations. The client should avoid: A - canned peas. B - angel food cake. C - dried peas. D - ready-to-eat cereals.
A - canned peas.
A nurse is administering digoxin. What client parameter would cause the nurse to hold the digoxin and notify the health care prescriber? A - heart rate of 55 beats per minute B - atrial fibrillation rhythm C - urine output of 300 mL in eight hours D - blood pressure of 125/80
A - heart rate of 55 beats per minute
The nurse is caring for a client with advanced heart failure. What treatment will be considered after all other therapies have failed? A - heart transplant B - implantable cardiac defibrillator (ICD) C - cardiac resynchronization therapy D - ventricular access device
A - heart transplant
A client has been admitted to the cardiac step-down unit with acute pulmonary edema. Which symptoms would the nurse expect to find during assessment? A - moist, gurgling respirations B - drowsiness, numbness C - hypertension D - increased cardiac output
A - moist, gurgling respirations
When the client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating A - orthopnea. B - dyspnea upon exertion. C - hyperpnea. D - paroxysmal nocturnal dyspnea
A - orthopnea
A client is receiving captopril for heart failure. During the nurse's assessment, what sign indicates that the medication therapy is ineffective? A - peripheral edema B - skin rash C - bradycardia D - postural hypotension
A - peripheral edema
A client has been diagnosed with systolic heart failure. What percentage will the nurse expect the patient's ejection fraction to be? A - 65% B - 30% C - 5% D - 55%
B - 30%
The nurse is administering sublingual nitroglycerin to a client with chest pain. What action will the nurse take after administering two sublingual tablets if the client continues with chest pain and has a blood pressure of 120/82 mm Hg? A - Notify the health care provider of the chest pain. B - Administer the third sublingual nitroglycerin tablet. C - Wait ten minutes after the second tablet to assess pain. D - Hold any further treatment until the client's blood pressure increases.
B - Administer the third sublingual nitroglycerin tablet.
A 70-year-old man has been living with a diagnosis of heart failure (HF) for several years and has been vigilant about monitoring the trajectory of disease and adhering to his prescribed treatment regimen. The man has scheduled an appointment with his primary care provider because he has noted a weight gain of 6 pounds over the past week. The nurse should anticipate that this patient may benefit from which of the following treatment measures? A - A further reduction in his dietary sodium intake B - An increase in the dose of his prescribed diuretic C - A decrease in his daily activity level D - Thoracentesis
B - An increase in the dose of his prescribed diuretic
A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client? A - Intubation of the airway B - BP and pulse measurements every 15 to 30 minutes C - Insertion of a central venous catheter D - Hourly administration of a fluid bolus
B - BP and pulse measurements every 15 to 30 minutes
Which feature is the hallmark of systolic heart failure? A - Limited activities of daily living (ADLs) B - Low ejection fraction (EF) C - Basilar crackles D - Pulmonary congestion
B - Low ejection fraction (EF)
A client develops cardiogenic pulmonary edema and is extremely apprehensive. What medication can the nurse administer with a health care provider's order that will relieve anxiety and slow respiratory rate? A - Furosemide B - Morphine sulfate C - Dopamine D - Nitroglycerin
B - Morphine sulfate
A client has been diagnosed with right-sided heart failure based on symptomology. The cardiologist will confirm this suspicion through diagnostics. Which diagnostics are used to reveal right ventricular enlargement? Select all that apply. A - pulmonary arteriography B - echocardiography C - chest radiograph D - electrocardiogram
B - echocardiography C - chest radiograph D - electrocardiogram
A client with chronic heart failure is receiving digoxin 0.25 mg by mouth daily and furosemide 20 mg by mouth twice daily. The nurse should assess the client for what sign of digoxin toxicity? A - dry mouth and urine retention. B - visual disturbances. C - taste and smell alterations. D - nocturia and sleep disturbances.
B - visual disturbances.
A client in the emergency room is in cardiac arrest and exhibiting pulseless electrical activity (PEA) on the cardiac monitor. What will be the nurse's next action? A - Analyze the arterial blood gas. B - Change oxygen delivery to a mask. C - Administer epinephrine. D - Stop all emergency measures.
C - Administer epinephrine.
Which is a key diagnostic indicator of heart failure? A - Blood urea nitrogen (BUN) B - Creatinine C - Brain natriuretic peptide (BNP) D - Complete blood count (CBC)
C - Brain natriuretic peptide (BNP)
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? A - Blood glucose testing reveals a glucose level of 158 mg/dL. B - The patient has put out 600 mL of dilute urine over the past 8 hours. C - Crackles are audible on chest auscultation. D - The patient's blood pressure (BP) is 144/99.
C - Crackles are audible on chest auscultation.
A 69-year-old man has been experiencing progressive dyspnea and activity intolerance in recent months and is currently undergoing a diagnostic workup for heart failure (HF). During echocardiography, systolic HF could be differentiated from diastolic HF by appraising the patient's: A - Stroke volume B - Sinus rhythm C - Ejection fraction (EF) D - Left ventricular wall thickness
C - Ejection fraction (EF)
Which medication is categorized as a loop diuretic? A - Chlorothiazide B - Spironolactone C - Furosemide D - Chlorthalidone
C - Furosemide
A nurse is assessing a client with congestive heart failure for jugular vein distension (JVD). Which observation is important to report to the physician? A - No JVD is present. B - JVD is noted 2 cm above the sternal angle. C - JVD is noted 4 cm above the sternal angle. D - JVD is noted at the level of the sternal angle.
C - JVD is noted 4 cm above the sternal angle.
A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which assessment finding for this client? A - Jugular venous distention B - Nausea C - Pulmonary congestion D - Pedal edema
C - Pulmonary congestion
The nurse has attended morning report on a busy medical unit. The nurse recognizes which patient to be at greatest risk for the development of cardiogenic shock? A - The patient admitted following hypertensive urgency. B - The patient admitted following a stroke. C - The patient admitted following a myocardial infarction (MI). D - The patient admitted with acute renal failure.
C - The patient admitted following a myocardial infarction (MI).
A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status? A - Measuring and recording fluid intake and output B - Assessing the client's vital signs every 4 hours C - Weighing the client daily at the same time each day D - Checking the client's lungs for crackles during every shift
C - Weighing the client daily at the same time each day
A client with left-sided heart failure reports 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 what condition? A - pneumonia. B - right-sided heart failure. C - acute pulmonary edema. D - cardiogenic shock.
C - acute pulmonary edema.
A client asks the nurse if systolic heart failure will affect any other body function. What body system response correlates with systolic heart failure (HF)? A - dehydration B - vasodilation of skin C - decrease in renal perfusion D - increased blood volume ejected from ventricle
C - decrease in renal perfusion
The nurse completes an assessment of a client admitted with a diagnosis of right-sided heart failure. What will be a significant clinical finding related to right-sided heart failure? A - decreased O2 saturation levels B - S4 ventricular gallop sign C - pitting edema D - oliguria
C - pitting edema
The nurse is admitting a client with heart failure. What client statement indicates that fluid overload was occurring at home? A - "My best time of the day is the morning." B - "I eat six small meals a day when I am hungry." C - "I've stopped eating foods with salt, though I miss the taste." D - "I'm having trouble going up the steps during the day."
D - "I'm having trouble going up the steps during the day."
The nurse understands that a client with which cardiac arrhythmia is most at risk for developing heart failure? A - Sinus tachycardia B - First-degree heart block C - Supraventricular tachycardia D - Atrial fibrillation
D - Atrial fibrillation
Which diagnostic study is usually performed to confirm the diagnosis of heart failure? A - Serum electrolytes B - Blood urea nitrogen (BUN) C - Electrocardiogram (ECG) D - Echocardiogram
D - Echocardiogram
The nurse visits the home of a client with heart failure. Which assessment finding indicates to the nurse that the client's tolerance to activity is deteriorating? A - Weight loss of 0.5 kg (1.1 lbs.) B - Bilateral lower extremity edema +1 C - Needs to use a scooter for shopping D - Fatigue after walking to answer the door
D - Fatigue after walking to answer the door
Signs of cardiogenic shock include all of the following except: A - Respiratory alkalosis. B - Tachypnea C - Tachycardia D - Hypertension
D - Hypertension
A client is already being treated for hypertension. The doctor is concerned about the potential for heart failure, and has the client return for regular check-ups. What does hypertension have to do with heart failure? A - Hypertension in older males regularly leads to heart failure. B - Heart failure occurs when blood pressures drops. C - Hypertension causes the heart's chambers to shrink. D - Hypertension causes the heart's chambers to enlarge and weaken.
D - Hypertension causes the heart's chambers to enlarge and weaken.
Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest? A - I B - II C - III D - IV
D - IV
The nurse is preparing to administer furosemide to a client with severe heart failure. What lab study should be of most concern for this client while taking furosemide? A - Sodium level of 135 B - Hemoglobin of 12 C - BNP of 100 D - Potassium level of 3.1
D - Potassium level of 3.1
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? A - The development of chronic obstructive pulmonary disease (COPD) B - The development of cor pulmonale C - The development of right-sided heart failure D - The development of left-sided heart failure
D - The development of left-sided heart failure
The nurse is conducting a morning assessment of an 80-year-old female patient who has a longstanding diagnosis of heart failure (HF). The nurse notes an elevation in jugular venous pressure (JVP) greater than 4 cm above the woman's sternal angle, a finding that did not exist the day before. What conclusion should the nurse draw from this assessment finding? A - The woman is also likely to experience shortness of breath. B - The woman has left-sided heart failure. C - The woman is demonstrating the early signs of cardiogenic shock. D - The woman may be experiencing an exacerbation of right-sided HF.
D - The woman may be experiencing an exacerbation of right-sided HF.
The nurse is caring for a client with heart failure. What sign will lead the nurse to suspect right-sided heart failure? A - weight loss B - resting bradycardia C - warm extremities D - ascites
D - ascites
A client with heart failure is prescribed an angiotensin converting enzyme (ACE) inhibitor. When teaching the client about this medication, the nurse would explain that this class of medications are effective because they: A - cause an increase in myocardial contraction. B - result in an increase in the oxygen demand. C - lead to a reduction in sodium and water retention. D - cause vasodilation to reduce the heart's workload.
D - cause vasodilation to reduce the heart's workload "ACE inhibitors, such as captopril and enalapril, block the conversion of angiotensin I to angiotensin II, a vasoconstrictor that can raise blood pressure. These drugs alleviate HF symptoms by causing vasodilation and decreasing myocardial workload. They are preload and afterload reducers that provide renal protection." (460)
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 coarse crackles in the lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing A - bilateral pneumonia. B - tuberculosis. C - acute exacerbation of chronic obstructive pulmonary disease. D - decompensated heart failure with pulmonary edema.
D - decompensated heart failure with pulmonary edema.
The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema? A - increased left atrial contractility B - decreased right ventricular elasticity C - increased right atrial resistance D - decreased left ventricular pumping
D - decreased left ventricular pumping
