Ch. 25 Management of Patients with Complications of Heart Disease PrepU
Frequently, what is the earliest symptom of left-sided heart failure? dyspnea on exertion anxiety confusion chest pain
dyspnea on exertion Explanation: Dyspnea on exertion is often the earliest symptom of left-sided heart failure.
Before discharge, which instruction should a nurse give to a client receiving digoxin? "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." Explanation: The nurse should instruct the client to notify the physician if his heart rate is greater than 90 beats/minute because cardiac arrhythmias may occur with digoxin toxicity. To prevent toxicity, the nurse should instruct the client never to take an extra dose of digoxin if he misses a dose. The nurse should show the client how to take his pulse and tell him to call the physician if his pulse rate drops below 60 beats/minute — not 80 beats/minute, which is a normal pulse rate and doesn't warrant action. The client shouldn't take digoxin with meals; doing so slows the absorption rate.
The nurse is teaching a client with heart failure about digoxin. What statements by the client indicate the teaching is effective? Select all that apply. "I will watch my urine output to be sure that the medication is not affecting my kidneys." "If I take my digoxin I should have limited episodes of shortness of breath." "The digoxin will increase my appetite, so I should weight myself daily." "The medication will increase my heart rate and my blood pressure." "Digoxin therapy requires monthly drug levels."
"I will watch my urine output to be sure that the medication is not affecting my kidneys." "If I take my digoxin I should have limited episodes of shortness of breath." Explanation: Digoxin is excreted by the kidneys and causes renal failure, so the client should monitor urine output. Digoxin therapy will increase ventricular output, so it can be effective in decreasing heart failure symptoms like shortness of breath. Digoxin toxicity may can anorexia, not increased appetite. Digoxin therapy will slow AV conduction, not increase heart rate or blood pressure. A client taking digoxin therapy will have levels drawn if symptoms of toxicity or renal function changes are present.
The nurse is assigned to care for a patient with heart failure. What classification of medication does the nurse anticipate administering that will improve symptoms as well as increase survival? ACE inhibitor Calcium channel blocker Diuretic Bile acid sequestrants
ACE inhibitor Explanation: Several medications are routinely prescribed for heart failure (HF), including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and diuretics (Table 29-3). Many of these medications, particularly ACE inhibitors and beta-blockers, improve symptoms and extend survival. Others, such as diuretics, improve symptoms but may not affect survival (Fonarow et al., 2010). Calcium channel blockers are no longer recommended for patients with HF because they are associated with worsening failure (ICSI, 2011). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 25: Management of Patients with Complications of Heart Disease, HEART FAILURE, p. 799. Chapter 25: Management of Patients with Complications of Heart Disease - Page 799
A nurse is caring for a client with left-sided heart failure. During the nurse's assessment, the client is wheezing, restless, tachycardic, and has severe apprehension. The clients reports that these symptoms came on suddenly. The nurse knows that these are symptoms of what condition? Acute pulmonary edema Progressive heart failure Pulmonary hypertension Cardiogenic shock
Acute pulmonary edema Explanation: Clients with acute pulmonary edema exhibit sudden dyspnea, wheezing, orthopnea, restlessness, cough (often productive of pink, frothy sputum), cyanosis, tachycardia, and severe apprehension. These symptoms do not indicate progressive heart failure, pulmonary hypertension, or cardiogenic shock.
he nurse is developing a plan of care for a client following pericardiocentesis. Which interventions should the nurse implement? Choose all that apply. Assess vital signs every 15 minutes for the first hour. Monitor heart and lung sounds. Record fluid output. Evaluate the cardiac rhythm. Place the client in a supine position.
Assess vital signs every 15 minutes for the first hour. Monitor heart and lung sounds. Record fluid output. Evaluate the cardiac rhythm. Explanation: The nurse should monitor the vital signs for any client who has undergone surgery. Because this procedure requires entering the pericardial sac, assessing heart and lung sounds assists in determining heart failure. The pericardial fluid is recorded as output and assessing the cardiac rhythm allows to assess for cardiac failure. The client should be kept in the semi-Fowler's position, not flat.
A client is brought to the emergency department via rescue squad with suspicion of cardiogenic pulmonary edema. What complication should the nurse monitor for? Select all that apply. Nausea and vomiting Pulmonary embolism Cardiac arrhythmias Respiratory arrest Cardiac arrest
Cardiac arrhythmias Respiratory arrest Cardiac arrest Explanation: Pulmonary edema is fluid accumulation in the lungs, which interferes with gas exchange in the alveoli. It represents an acute emergency and is a frequent complication of left-sided heart failure. Cardiac arrhythmias and cardiac or respiratory arrest are associated complications. Nausea and vomiting are not complications but are symptoms of many disorders. The client is not at increased risk for the development of pulmonary embolism with pulmonary edema.
The nurse is caring for a client experiencing a rapidly developing pericardial effusion. Which assessment findings indicate to the nurse that the client is developing cardiac tamponade? Select all that apply. Anuria Dyspnea Tachycardia Distant heart sounds Jugular vein distention
Dyspnea Tachycardia Distant heart sounds Jugular vein distention Explanation: Pericardial fluid may build up slowly without causing noticeable symptoms until a large amount (1 to 2 L) accumulates. However, a rapidly developing effusion can quickly stretch the pericardium to its maximum size and cause an acute problem. As pericardial fluid increases, pericardial pressure increases, reducing venous return to the heart and decreasing CO. This can result in cardiac tamponade, which causes low CO and obstructive shock. Symptoms of cardiac tamponade include dyspnea, tachycardia, distant heart rounds, and jugular vein distention. Anuria is not a symptom of cardiac tamponade.
The critical care nurse is caring for a client who is in cardiogenic shock. What assessments must the nurse perform on this client? Select all that apply. Platelet level Fluid status Cardiac rhythm Action of medications Sputum volume
Fluid status Cardiac rhythm Action of medications Explanation: The critical care nurse must carefully assess the client in cardiogenic shock, observe the cardiac rhythm, monitor hemodynamic parameters, monitor fluid status, and adjust medications and therapies based on the assessment data. Platelet levels and sputum production are not major assessment parameters in a client who is experiencing cardiogenic shock.
The nurse is assessing a patient who reports no symptoms of heart failure at rest but is symptomatic with ordinary physical activity. Under what classification does the nurse understand this patient would be categorized? I II III IV
II Explanation: Classification II of heart failure is indicated by the patient being comfortable at rest, but experiencing fatigue, palpitation, or dyspnea during ordinary physical activity.
A patient seen in the clinic has been diagnosed with stage A heart failure (according to the staging classification of the American College of Cardiology [ACC]). What education will the nurse provide to this patient? Information about ACE inhibitors and risk factor reduction Information about diuretic therapy and risk factor reduction Information about beta blockers, ACE inhibitors, and diuretics Information about implantable cardioverter/defibrillators
Information about ACE inhibitors and risk factor reduction Explanation: Teaching for patients with stage A heart failure should include information about risk factor control and use of ACE inhibitors. Beta blockers pertain to stages B-D, and diuretics implantable cardioverters/defibrillators to stages C-D.
A client with heart failure is taking an angiotensin-converting enzyme inhibitor (ACE-I) and reports a nagging cough. Which replacement medication will the nurse expect to be prescribed for this client? Metoprolol Spironolactone Diltiazem Losartan
Losartan Explanation: An adverse effect of ACE inhibitors includes a dry, persistent cough that may not respond to cough suppressants due to the inhibition of the enzyme kininase, which inactivates bradykinin. If the client cannot continue taking an ACE inhibitor because of development of a cough, an angiotensin receptor blocker (ARB) is prescribed, such as losartan. A beta-adrenergic blocker, such as metoprolol, or aldosterone antagonist, such as spironolactone, are not prescribed for the client experiencing the adverse effect of a cough from an ACI inhibitor. Calcium channel blockers, such as diltiazem, are not used to treat heart failure.
The nurse is caring for a client with heart failure. What are the management goals for the client with heart failure? Select all that apply. Promoting a healthy lifestyle Increasing cardiac output by strengthening muscle contractions Reducing the amount of circulating blood volume Lowering the risk for hospitalization Increasing preload and afterload
Promoting a healthy lifestyle Increasing cardiac output by strengthening muscle contractions Lowering the risk for hospitalization Explanation: The management of a client with heart failure includes promotion of a healthy lifestyle, increasing cardiac output by strengthening muscle contractions, and lowering the risk for hospitalization. There is no need to reduce circulating blood volume for clients with heart failure. The goal in treating heart failure is to decrease preload and afterload, both of which increase stress on the ventricular wall, causing an increase in the workload of the heart.
The nurse is caring for a client who has developed obvious signs of pulmonary edema. What is the priority nursing action? Lay the client flat. Notify the family of the client's critical state. Stay with the client. Update the health care provider.
Stay with the client. Explanation: Because the client has an unstable condition, the nurse must remain with the client. The health care team must be updated promptly, but the client should not be left alone in order for this to happen. Supine positioning is unlikely to relieve dyspnea. The family should be informed, but this is not the priority action.
What disease process(es) contributes to chronic heart failure? Select all that apply. Tachyarrhythmias Valvular disease Pancreatic disease Renal failure Pulmonary insufficiency
Tachyarrhythmias Renal failure Valvular disease Explanation: Hypertension, tachyarrhythmias, valvular disease, cardiomyopathy, and renal failure can contribute to chronic heart failure. Pancreatic disease and pulmonary insufficiency do not contribute to chronic heart failure.
The triage nurse in the Emergency Department (ED) is admitting a client with a history of Class III heart failure. What symptoms would the nurse expect the client to exhibit? Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea. The client does not experience any limitation of activity. Ordinary physical activity results in fatigue, heart palpitation, or dyspnea. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitation, or dyspnea. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.
The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitation, or dyspnea. Explanation: Class III (Moderate): There is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitation, or dyspnea. This makes options A, B, and D incorrect.
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 he has been hungry in the evening. 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 his rings have become tight and are difficult to remove. Explanation: Clients may observe that rings, shoes, or clothing have become tight. The client would most likely be urinating more frequently in the evening. Accumulation of blood in abdominal organs may cause anorexia, nausea, flatulence, and a decrease in hunger. Shortness of breath with ambulation would occur most often in left-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? Valsartan Furosemide Metoprolol Isosorbide dinitrate
Valsartan Explanation: If the patient cannot continue taking an angiotensin-converting enzyme (ACE) inhibitor because of development of cough, an elevated creatinine level, or hyperkalemia, an angiotensin receptor blocker (ARB) or a combination of hydralazine and isosorbide dinitrate is prescribed (see Table 29-3).
The client asked the nurse to describe Stage C heart failure. What is the best explanation by the nurse? a client who reports no symptoms of heart failure at rest but has risk factors of heart disease a client who reports no symptoms of heart failure at rest but has a cardiac history and is taking medications a client who reports no symptoms of heart failure at rest but is symptomatic with increased physical activity a client who reports symptoms of heart failure at rest and is a candidate for a heart transplant
a client who reports no symptoms of heart failure at rest but is symptomatic with increased physical activity Explanation: Once a patient has structural heart disease, the client has progressed from stage A to either stage B or stage C. The difference between B and C has to do with the presence of signs and symptoms of heart failure. When dyspnea and fatigue occur with exertion, heart failure Stage C is suspected. Stage D is a client with heart failure symptoms and maximal medical therapy.
A nurse is discussing cardiac hemodynamics with a client and explains the concept of afterload. What are other preexisting medical conditions to discuss that may increase afterload? Select all that apply aging hypertension mitral valve stenosis aortic valve stenosis diabetes mellitus
aging hypertension aortic valve stenosis Explanation: Major factors that determine afterload are the diameter and distensibility of the great vessels (aorta and pulmonary artery) and the opening and competence of the semilunar valves (pulmonic and aortic valves). If the client has significant vasoconstriction, hypertension, or a narrowed valvular opening, resistance or afterload increases. Aging causes muscle stiffness, thus increasing afterload. Diabetes mellitus and mitral valve stenosis do not directly affect afterload.
The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema? decreased left ventricular pumping decreased right ventricular elasticity increased left atrial contractility increased right atrial resistance
decreased left ventricular pumping Explanation: Pulmonary edema is an acute event that results from heart failure. Myocardial scarring, resulting from ischemia, limits the distensibility of the ventricle, making it vulnerable to demands for increased workload. When the demand on the heart increases, there is resistance to left ventricular filling and blood backs up into the pulmonary circulation. Pulmonary edema quickly develops.
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. electrocardiogram chest radiograph echocardiography pulmonary arteriography
electrocardiogram chest radiograph echocardiography Explanation: An echocardiogram is usually performed to confirm the diagnosis of heart failure, identify the underlying cause, and determine the EF, which helps identify the type and severity of heart failure. This information may also be obtained noninvasively by radionuclide ventriculography or invasively by ventriculography as part of a cardiac catheterization procedure. A chest x-ray and an electrocardiogram (ECG) are obtained to assist in the diagnosis. Pulmonary arteriography does not apply.
The nurse is interviewing a client during an initial visit at a cardiologist's office. What symptom will the nurse expect to find as an early symptom of chronic heart failure? fatigue pedal edema nocturia irregular pulse
fatigue Explanation: Fatigue is commonly the earliest symptom of chronic heart failure; it is caused by decreased cardiac output and tissue oxygenation. Pedal edema and nocturia are symptoms of heart failure, but they occur later in the course of the condition. An irregular pulse can be a complication of heart failure, but it is not necessarily an early indication of the condition.
The nurse is receiving a client from the emergency in cardiogenic shock. What mechanical device does the nurse anticipate will be inserted into the client? cardiac pacemaker hypothermia-hyperthermia machine defibrillator intra-aortic balloon pump
intra-aortic balloon pump Explanation: Counterpulsation with an intra-aortic balloon pump may be indicated for temporary circulatory assistance in clients with cardiogenic shock. The intra-aortic balloon pump increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen consumption in a client with cardiogenic shock. Cardiac pacemakers are used to maintain the heartbeat at a predetermined rate. Hypothermia-hyperthermia machines are used to cool or warm clients with abnormalities in temperature regulation. The defibrillator is commonly used for termination of life-threatening ventricular rhythms.
The nurse is assigned to care for a client with heart failure. What medication does the nurse anticipate administering that will improve client symptoms as well as increase survival? lisinopril diltiazem bumetanide cholestyramine
lisinopril Explanation: Several medications are routinely prescribed for heart failure (HF), including angiotensin-converting enzyme (ACE) inhibitors such as lisinopril, beta-blockers, and diuretics such as bumetanide. Many of these medications, particularly ACE inhibitors and beta-blockers, improve symptoms and extend survival. Others, such as diuretics, improve symptoms but may not affect survival. Calcium channel blockers such as diltiazem are no longer recommended for patients with HF because they are associated with worsening failure. Cholestyramine is used to lower cholesterol.
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? pitting edema oliguria S4 ventricular gallop sign decreased O2 saturation levels
pitting edema Explanation: The presence of pitting edema is a significant sign of right-sided heart failure because it indicates fluid retention of about 10 lbs. Sodium and water are retained because reduced cardiac output causes a compensatory neurohormonal response. Oliguria is a sign of kidney failure or dehydration. The S4 heart sound is from a thickened left ventricle, seen with aortic stenosis or hypertension. The decreased oxygen saturation levels are from hypoxemia.
The nurse finds a client unresponsive in the hospital room and calls a cardiac arrest. Which health care professionals will be responsible for an insertion of the endotracheal tube during the cardiac arrest? Select all that apply. respiratory therapist nurse nurse anesthetist physician paramedic
respiratory therapist nurse anesthetist physician Explanation: Respiratory therapists, physicians, and nurse anesthetists can place an endotracheal airway during cardiac arrest in a hospital. Nurses and paramedics may insert endotracheal tubes in the community setting (field), but not in the hospital.
