Ch. 34 Heart Failure
A 52-year-old woman with end-stage coronary artery disease who has limited financial resources but is emotionally stable and has strong social support (The 52-year-old woman does not have any contraindications for cardiac transplantation, even though she lacks the indication of adequate financial resources. The postoperative transplant regimen is complex and rigorous and patients who have not been compliant with other treatments or who might not have the means to understand the care would not be good candidates. A history of drug or alcohol abuse is usually a contraindication to heart transplant.)
22. The evaluation team for cardiac transplantation is evaluating patients. Which patient is most likely to receive the most benefit from a new heart? a. A 24-year-old man with Down syndrome who has received excellent care from parents in their 60s b. A 46-year-old single woman with a limited support system who has alcohol-induced cardiomyopathy c. A 60-year-old man with inoperable coronary artery disease who has not been compliant with lifestyle changes and rehabilitation programs d. A 52-year-old woman with end-stage coronary artery disease who has limited financial resources but is emotionally stable and has strong social support
"I can eat most foods as long as I do not add salt when cooking or at the table." (All foods that are high in sodium should be eliminated in a 2400-mg sodium diet, in addition to the elimination of salt during cooking. Examples include obviously salted snack foods as well as pickles, processed prepared foods, and many sauces and condiments)
A 2400-mg sodium diet is prescribed for a patient with chronic heart failure. The nurse recognizes that additional teaching is necessary when the patient makes which statement? a. "I should limit my milk intake to 2 cups a day." b. "I can eat fresh fruits and vegetables without worrying about sodium content." c. "I can eat most foods as long as I do not add salt when cooking or at the table." d. "I need to read the labels on prepared foods and medicines for their sodium content."
neurohormonal response (The following mechanisms in heart failure lead to inappropriate fluid retention and additional workload of the heart: activation of the renin-angiotensin-aldosterone system (RAAS) cascade and release of antidiuretic hormone from the posterior pituitary gland in response to low cerebral perfusion pressure that results from low cardiac output.)
A compensatory mechanism involved in HF 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
a, b, d, e (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.)
A patient admitted with heart failure is anxious and reports shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (SATA)? 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.
Cardiac vasculopathy (Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated coronary artery disease) 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 & increases the patient's risk of an infection.)
A patient is scheduled for a heart transplant. 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
Assist the patient to a sitting position with arms on the overbed table. (The nurse should place the patient with ADHF in a high Fowler's position with the feet horizontal in the bed or dangling at the bedside. This position helps decrease venous return because of the pooling of blood in the extremities. This position also increases the thoracic capacity, allowing for improved ventilation. Pursed-lip breathing helps with obstructive air trapping but not with acute pulmonary edema. Restricting fluids takes considerable time to have an effect.)
A patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first? a. Perform a bladder scan to assess for urinary retention. b. Restrict the patient's oral fluid intake to 500 mL per day. c. Assist the patient to a sitting position with arms on the overbed table. d. Instruct the patient to use pursed-lip breathing until the dyspnea subsides.
Choose interventions to promote comfort and prevent suffering. (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 with a long-standing history of heart failure 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.
Reduction of preload. (Diuretics such as furosemide are used in the treatment of heart failure to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.)
A patient with a recent diagnosis of heart failure has been prescribed furosemide. What outcome does the nurse anticipate will occur that demonstrates medication effectiveness? a. Promote vasodilation. b. Reduction of preload. c. Decrease in afterload. d. Increase in contractility.
a,b (Hypokalemia, which can be caused by the use of potassium-depleting diuretics (e.g., thiazides, loop diuretics), is one of the most common causes of digitalis toxicity. Low serum levels of potassium enhance the action of digitalis, causing a therapeutic dose to achieve toxic levels. Hypokalemia can also precipitate dysrhythmias. Monitoring the serum potassium levels of patients receiving digitalis preparations and potassium-depleting diuretics is essential. Patients taking digitalis preparations should be taught how to measure their pulse rate because bradycardia and atrioventricular blocks are late signs of digitalis toxicity. In addition, patients should know what pulse rate would require a call to the HCP. Patients should not independently decide to skip a dose of digitalis.)
A patient 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 the patient how to take a pulse rate c. Keep an accurate measure of intake and output d. Teach the patient about dietary restriction of potassium e. Withhold digitalis and notify health care provider if pulse is irregular
Potassium supplements (Thrombus formation occurs in the heart when the chambers do not contract normally and empty completely. Both atrial fibrillation and very low left ventricular output (LVEF <20%) lead to thrombus formation, which is treated with anticoagulants to prevent the release of emboli into the circulation as well as antidysrhythmics or cardioversion to control atrial fibrillation.)
A patient with chronic heart failure has atrial fibrillation and a left ventricular ejection fraction (LVEF) of 18%. To decrease the risk of complications from these conditions, what drug does the nurse anticipate giving? a. Diuretics b. Anticoagulants c. β-Adrenergic blockers d. Potassium supplements
Right-sided HF (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.)
After having a myocardial infarction (MI), the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108 beats/min. What should the nurse suspect is happening? a. ADHF b. Chronic HF c. Left-sided HF d. Right-sided HF
Blood pressure (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.)
An asymptomatic patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before dangling the patient on the bedside, what should the nurse assess first? a. Urine output b. Heart rhythm c. Breath sounds d. Blood pressure
"The medication prevents blood clots from forming in your heart." (Chronic HF causes enlargement of the chambers of the heart and an altered electrical pathway, especially in the atria. When numerous sites in the atria fire spontaneously and rapidly, atrial fibrillation occurs. Atrial fibrillation promotes thrombus formation within the atria with an increased risk of stroke and requires treatment with cardioversion, antidysrhythmics, and/or anticoagulants. Warfarin is an anticoagulant that interferes with hepatic synthesis of vitamin K-dependent clotting factors.)
An older adult patient with chronic heart failure (HF) and atrial fibrillation asks the nurse why warfarin has been prescribed to continue at home. What is the best response by the nurse? a. "The medication prevents blood clots from forming in your heart." b. "The medication dissolves clots that develop in your coronary arteries." c. "The medication reduces clotting by decreasing serum potassium levels." d. "The medication increases your heart rate so that clots do not form in your heart."
"I will limit the amount of milk and cheese in my diet." (Milk products should be limited to 2 cups per day for a 2500-mg sodium-restricted diet. Salt should not be added during food preparation or at the table. Diuretics should be taken as prescribed (usually daily) and not based on sodium intake. Foods labeled as reduced sodium contain at least 25% less sodium than regular.)
At a clinic visit, the nurse provides dietary teaching for a patient recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement? a. "I will limit the amount of milk and cheese in my diet." b. "I can add salt when cooking foods but not at the table." c. "I will take an extra diuretic pill when I eat a lot of salt." d. "I can have unlimited amounts of foods labeled as reduced sodium."
b,c,e (A variety of complications can occur after heart transplantation. In the first year after transplantation, the major causes of death are acute rejection and infection. Heart transplant recipients also are at risk for sudden cardiac death. Later, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated CAD) are major causes of death.)
Patients 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
Nesiritide (Natrecor) (Nesiritide (Natrecor) is a recombinant form of a natriuretic peptide that decreases preload and afterload by reducing pulmonary artery wedge pressure (PAWP) and systolic BP which decreases the workload of the heart for short-term emergency treatment of acute decompensated heart failure (ADHF). Digoxin (Lanoxin) requires a loading dose and time to work, so it is not recommended for emergency treatment of ADHF. Morphine sulfate relieves dyspnea but has more adverse events and mortality. Bumetanide (Bumex) will decrease fluid volume but also will decrease potassium levels and activate the sympathetic nervous system and renin-angiotensin-aldosterone system, which can exacerbate HF symptoms.)
Priority Decision: A patient is admitted to the emergency department with acute decompensated heart failure (ADHF). Which IV medication would the nurse expect to administer first? a. Digoxin (Lanoxin) b. Morphine sulfate c. Nesiritide (Natrecor) d. Bumetanide (Bumex)
Potassium levels (Hypokalemia is one of the most common causes of digitalis toxicity because low serum potassium levels enhance ectopic pacemaker activity. When a patient is receiving potassium-losing diuretics, such as hydrochlorothiazide or furosemide, it is essential to monitor the patient's serum potassium levels to prevent digitalis toxicity. Monitoring the heart rate (HR) assesses for complications related to digoxin but does not prevent toxicity.)
Priority Decision: A patient with chronic heart failure is treated with hydrochlorothiazide, digoxin, and lisinopril (Prinivil). To prevent the risk of digitalis toxicity with these drugs, what is most important that the nurse monitor for this patient? a. Heart rate (HR) b. Potassium levels c. Blood pressure (BP) d. Gastrointestinal function
a. SpO2 of 84% on 2 L/min via nasal cannula indicates impaired oxygen saturation. The patient is having trouble with gas exchange. Airway and breathing are the priority (follow ABCs). b. The nurse should place the patient in high Fowler's position, assess the patient immediately, recheck SpO2, auscultate breath sounds, assess level of consciousness (LOC), check the oxygen connection and rate setting (2 L/min), and talk with the patient about her or his breathing.
Priority Decision: The nurse reviews the following vital signs recorded by an unlicensed assistive personnel (UAP) on a patient with acute decompensated heart failure: BP 98/60, HR 102 bpm, RR 24, Temp 98.2°F (36.7° C), SpO2 84% on 2 L/min via nasal cannula. a. Which of these findings is of highest priority? b. What should the nurse do next?
Fatigue, limitation of activities, chest congestion/cough, edema, shortness of breath (FACES is used to teach patients signs and symptoms of worsening heart failure. F = Fatigue; A = Activity limitations; C = Congestion/cough; E = Edema; S = Shortness of breath.)
The acronym FACES is used to help educate patients to identify symptoms of heart failure. What does this acronym mean? a. Frequent activity leads to cough in the elderly and swelling b. Factors of risk: activity, cough, emotional upsets, salt intake c. Follow activity plan, continue exercise, and know signs of problems d. Fatigue, limitation of activities, chest congestion/cough, edema, shortness of breath
Decrease both sodium and potassium intake (Spironolactone is a potassium-sparing diuretic and when it is the only diuretic used in the treatment of heart failure, moderate to low levels of potassium intake should be maintained to prevent development of hyperkalemia. Sodium intake is usually reduced to at least 2400 mg/day in patients with heart failure but salt substitutes cannot be freely used because most contain high concentrations of potassium. Calcium intake is not increased.)
The health care provider prescribes spironolactone (Aldactone) for the patient with chronic heart failure. What diet modifications related to the use of this drug should the nurse include in the patient teaching? a. Decrease both sodium and potassium intake b. Increase calcium intake and decrease sodium intake c. Decrease sodium intake and increase potassium intake d. Decrease sodium intake and the use of salt substitutes for seasoning
Severe dyspnea and blood-streaked, frothy sputum (Clinical manifestations of pulmonary edema include anxiety, pallor, cyanosis, clammy and cold skin, severe dyspnea, use of accessory muscles of respiration, a respiratory rate greater than 30 breaths/min, orthopnea, wheezing, and coughing with the production of frothy, blood-tinged sputum. Auscultation of the lungs may reveal crackles, wheezes, and rhonchi throughout the lungs. The heart rate is rapid, and blood pressure may be elevated or decreased.)
The home care nurse visits a patient with chronic heart failure. Which clinical manifestations, assessed by the nurse, would indicate acute decompensated heart failure (pulmonary edema)? a. Fatigue, orthopnea, and dependent edema b. Severe dyspnea and blood-streaked, frothy sputum c. Temperature is 100.4oF and pulse is 102 beats/min d. Respirations 26 breaths/min despite oxygen by nasal cannula
the use of two or more pillows to help breathing during sleep (Paroxysmal nocturnal dyspnea (PND) is awakening from sleep with a feeling of suffocation and a need to sit up to be able to breathe and patients learn that sleeping with the upper body elevated on several pillows helps to prevent PND. Orthopnea is an inability to breathe effectively when lying down and nocturia occurs with heart failure as fluid moves back into the vascular system during recumbency, increasing renal blood flow.)
The nurse assesses the patient with chronic biventricular heart failure for paroxysmal nocturnal dyspnea (PND) by questioning the patient regarding a. the presence of difficulty breathing at night. b. frequent awakening to void during the night. c. the presence of a dry, hacking cough when resting. d. the use of two or more pillows to help breathing during sleep.
clear lung sounds and decreased HR (Successful treatment of heart failure is indicated by an absence of symptoms of pulmonary edema and hypoxemia, such as clear lung sounds and a normal HR. Weight loss and diuresis, warm skin, less fatigue, and improved LOC may occur without resolution of pulmonary symptoms. Chest pain is not a common finding in heart failure unless coronary artery perfusion is impaired.)
The nurse determines that treatment of heart failure has been successful when the patient experiences a. weight loss and diuresis. b. warm skin and less fatigue. c. clear lung sounds and decreased HR. d. absence of chest pain and improved level of consciousness (LOC).
Anorexia and nausea (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.)
The nurse is administering a dose of digoxin to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom? a. Muscle aches b. Constipation c. Pounding headache d. Anorexia and nausea
Avoid drugs to treat erectile dysfunction (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 a nitroglycerin patch to a patient. When providing instructions regarding the use of the patch, what should the nurse include in the teaching? a. Avoid high-potassium foods b. Avoid drugs to treat erectile dysfunction c. Avoid over-the-counter H2-receptor blockers d. Avoid NSAIDS
Withhold the dose and report the potassium level. (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 wait for the potassium level to normalize. The physician may order the digoxin to be given once the potassium level has been treated and decreases to within normal range.)
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 is the priority action by the nurse? 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.
Nitroprusside (Nipride) (Although all of these drugs may cause hypotension, nitroprusside is a potent dilator of both arteries and veins and may cause such marked hypotension that an inotropic agent (e.g., dobutamine) administration may be necessary to maintain the BP during its administration. Furosemide may cause hypotension because of diuretic-induced depletion of intravascular fluid volume. Nitroglycerin is a vasodilator and can decrease BP but not as severely as nitroprusside. It primarily dilates veins and increases myocardial oxygen supply. Milrinone has a positive inotropic effect in addition to direct arterial dilation.)
The nurse monitors the patient receiving treatment for acute decompensated heart failure with the knowledge that marked hypotension is most likely to occur with the IV administration of which medication? a. Furosemide (Lasix) b. Nitroglycerin (Tridil) c. Milrinone (Primacor) d. Nitroprusside (Nipride)
Infection (Because of the need for long-term immuno-suppressant therapy to prevent rejection, the patient with a transplant is at high risk for infection, a leading cause of death in transplant patients. Acute rejection episodes may also cause death in patients with transplants but many can be treated successfully with augmented immunosuppressive therapy. Malignancies occur in patients with organ transplants after taking immunosuppressants for a number of years.)
The nurse plans long-term goals for the patient who has had a heart transplant with the knowledge that what is the most common cause of death in heart transplant patients during the first year? a. Infection b. Heart failure c. Embolization d. Malignant conditions
Serum potassium level (Serum potassium should be monitored because hypokalemia increases the risk for digoxin toxicity. Changes in prothrombin time, urine specific gravity, and hemoglobin or hematocrit would not require holding the digoxin dose.)
The nurse prepares to administer digoxin 0.125 mg to a patient admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication? a. Prothrombin time b. Urine specific gravity c. Serum potassium level d. Hemoglobin and hematocrit
Decreased EF and increased PAWP (Systolic heart failure results in systolic failure in the left ventricle (LV). The LV loses its ability to generate enough pressure to eject blood forward through the aorta. This results in increased pulmonary artery wedge pressure (PAWP). The hallmark of systolic failure is a decrease in the left ventricular ejection fraction (EF).)
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
a,d,e (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.)
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 (SATA)? 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 inhibitor at discharge e. Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen
Take medications as prescribed. (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.)
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 acute decompensated heart failure (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.
Dopamine (Dopamine (Intropin) is a β-adrenergic agonist that is a positive inotrope given IV, not orally, and used for acute HF. Losartan (Cozaar) is an angiotensin II receptor blocker used for patients who do not tolerate angiotensin-converting enzyme inhibitors. Carvedilol (Coreg) is the β-adrenergic blocker that blocks the sympathetic nervous system's negative effects on the failing heart. Hydrochlorothiazide (HCTZ) is the diuretic.)
The patient with chronic heart failure is being discharged with a diuretic, a renin-angiotensin-aldosterone system (RAAS) inhibitor, and a β-adrenergic blocker. When received from the pharmacy, which medication should not be included for this patient? a. Dopamine b. Losartan (Cozaar) c. Carvedilol (Coreg) d. Hydrochlorothiazide (HCTZ)
Vasodilation and decreased blood pressure (Both the natriuretic peptides and nitric oxide contribute to vasodilation, decreased blood pressure, and decreased afterload. The natriuretic peptides also increase excretion of sodium by increasing glomerular filtration rate and diuresis (renal effects) as well as interfere with ADH release and inhibit aldosterone and renin secretion (hormonal effects).)
What describes the action of the natriuretic peptides and nitric oxide in their counter-regulatory processes in response to heart failure (HF)? a. Excretion of potassium b. Increased release of ADH c. Vasodilation and decreased blood pressure d. Decreased glomerular filtration rate and edema
Increased pulmonary hydrostatic pressure (In left-sided heart failure, blood backs up into the pulmonary veins and capillaries. This increased hydrostatic pressure in the vessels causes fluid to move out of the vessels and into the pulmonary interstitial space. When increased lymphatic flow cannot remove enough fluid from the interstitial space, fluid moves into the alveoli, resulting in pulmonary edema and impaired alveolar oxygen and carbon dioxide exchange. Initially the right side of the heart is not involved.)
What is the pathophysiologic mechanism that results in the pulmonary edema of left-sided heart failure? a. Increased right ventricular preload b. Increased pulmonary hydrostatic pressure c. Impaired alveolar oxygen and carbon dioxide exchange d. Increased lymphatic flow of pulmonary extravascular fluid
Blood pressure (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.)
What is the priority assessment by the nurse caring for a patient receiving IV nesiritide to treat heart failure? a. Urine output b. Lung sounds c. Blood pressure d. Respiratory rate
Hypotension and tachycardia (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.)
What should the nurse recognize as an indication for the use of dopamine 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)
b, d (Furosemide is a diuretic that eliminates potassium and spironalactone is a potassium-sparing diuretic that retains potassium. The other treatments and meds are used for patients with HF but they do not directly affect serum potassium levels.)
When caring for the patient with heart failure, which medications or treatments require careful monitoring of the patient's serum potassium level to prevent further cardiac dysfunction (select all that apply)? a. Enalapril (Vasotec) b. Furosemide (Lasix) c. Inamrinone (Inocor) d. Spironolactone (Aldactone) e. Metoprolol CR/XL (Toprol XL)
B-type natriuretic peptide (BNP) levels (B-type natriuretic peptide (BNP) is released from the ventricles in response to increased blood volume in the heart and is a good marker for heart failure. If BNP is elevated, shortness of breath is due to heart failure; if BNP is normal, dyspnea is due to pulmonary disease. BNP opposes the actions of the renin-angiotensin-aldosterone system, resulting in vasodilation and reduction in blood volume. Exercise stress testing and cardiac catheterization are more important tests to diagnose coronary artery disease and although the blood urea nitrogen (BUN) may be elevated in heart failure, it is a reflection of decreased renal perfusion.)
Which diagnostic test is most useful in differentiating dyspnea related to pulmonary effects of heart failure from dyspnea related to pulmonary disease? a. Exercise stress testing b. Cardiac catheterization c. B-type natriuretic peptide (BNP) levels d. Determination of blood urea nitrogen (BUN)
Bubbling crackles and tachycardia (Clinical manifestations of acute left-sided heart failure are those of interstitial edema, with bubbling crackles and tachycardia, as well as tachypnea. Later frothy, bloodtinged sputum; severe dyspnea; and orthopnea develop with alveolar edema. Severe tachycardia and cool, clammy skin are present as a result of stimulation of the sympathetic nervous system from hypoxemia. Systemic edema reflected by jugular vein distention, peripheral edema, and hepatosplenomegaly are characteristic of right-sided heart failure.)
Which initial physical assessment finding would the nurse expect to be present in a patient with acute left-sided heart failure? a. Bubbling crackles and tachycardia b. Hepatosplenomegaly and tachypnea c. Peripheral edema and cool, diaphoretic skin d. Frothy blood-tinged sputum and distended jugular veins
Isosorbide dinitrate and hydralazine (BiDil) (Isosorbide dinitrate and hydralazine (BiDil) is currently used only with African American patients for hypertension and angina. Captopril (Capoten) is used only for hypertension by all patients. Nitroglycerin (Nitro-Bid) is used with hydralazine (Apresoline) for patients who cannot tolerate renin-angiotensin-aldosterone system inhibitors for heart failure management. Spironolactone (Aldactone) is used for hypertension.)
Which medication is currently approved only for use with African American patients for hypertension and angina? a. Captopril (Capoten) b. Nitroglycerin (Nitro-Bid) c. Spironolactone (Aldactone) d. Isosorbide dinitrate and hydralazine (BiDil)
"I should weigh myself every morning and go on a diet if I gain more than 2 or 3 pounds in 2 days." (Further teaching is needed if the patient believes a weight gain of 2 to 3 pounds in 2 days is an indication for dieting. In a patient with heart failure, this type of weight gain reflects fluid retention and is a sign of heart failure that should be reported to the health care provider. The other options show patient understanding of the heart failure management teaching.)
Which statement by the patient with chronic heart failure should cause the nurse to determine that additional discharge teaching is needed? a. "I will call my health clinic if I wake up breathless at night." b. "I will look for sodium content on labels of foods and over-the-counter medicines." c. "I plan to organize my household tasks so I don't have to constantly go up and down the stairs." d. "I should weigh myself every morning and go on a diet if I gain more than 2 or 3 pounds in 2 days."
a, b (Diastolic failure is characterized by abnormal resistance to ventricular filling. Coronary artery disease (CAD), advanced age, and hypertension are all risk factors for heart failure (HF). Ejection fraction is decreased in systolic HF. Dysrthythmia precipitates HF with decreased cardiac output (CO) and increased workload and oxygen requirements of the myocardium.)
Which statements accurately describe heart failure (select all that apply)? a. A common cause of diastolic failure is left ventricular hypertrophy. b. A primary risk factor for heart failure is coronary artery disease (CAD). c. Systolic heart failure results in a normal left ventricular ejection fraction. d. Systolic failure is characterized by abnormal resistance to ventricular filling. e. Hypervolemia precipitates heart failure by decreasing cardiac output and increasing oxygen consumption.
c,e (Dobutamine (Dobutrex) has a positive chronotropic effect & increases heart rate and improves contractility. It is a selective β-adrenergic agonist and works primarily on the β1-adrenergic receptors in the heart. It is frequently used in the short-term management of acute decompensated heart failure (ADHF).)
You are caring for a patient with ADHF who is receiving IV dobutamine (Dobutrex). You know that this drug is ordered because it (SATA) a. increases SVR b. produces diuresis c. improves contractility d. dilates renal blood vessels e. works on the B1-receptors in the heart
