Chapter 25: Management of Patients with complications of Heart disease
A client has been diagnosed with systolic heart failure. What percentage will the nurse expect the patient's ejection fraction be?
30%
The nurse is teaching a group of clients with heart failure about how to decrease leg edema. What dietary advice will the nurse give to clients with severe heart failure?
Avoid the intake of processed and commercially prepared foods
A patient is seen in the emergency department 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?
B-type natriuretic peptide (BNP)
Which is a key diagnostic indicator of heart failure?
BNP
A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client?
BP and pulse measurements every 15 to 30 minutes
A patient is undergoing a pericardiocentesis. Following withdrawal of pericardial fluid, which assessment by the nurse indicates that cardiac tamponade has been relieved?
Decrease in central venous pressure
A client with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, and muffled heart sounds. The nurse recognizes these as symptoms of what occurrence?
Excess pericardial fluid compresses the heart and prevents adequate diastolic filling
A client with CHF is admitted after reporting shortness of breath. How should the nurse position the client in order to decrease preload?
Head of the bed elevated 45 degrees and lower arms supported by pillows
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?
Hypertension causes the heart's chambers to enlarge and weaken
A patient seen in the clinic has been diagnosed with stage A failure. What education will the nurse provide to this patient?
Information about ACE inhibitors and risk factor reduction
The nurse is preparing a client for a multiple gated acquisition (MUGA) scan. What would be an important instruction for the nurse to give a client who is to undergo a MUGA scan?
Lie very still at intermittent times during the test.
Which feature is the hallmark of systolic heart failure?
Low ejection fraction (EF)
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)?
Myocardial ischemia
Assessment of a client on a medical surgical unit finds a regular heart rate of 120 bpm, audible third and fourth heart sounds, blood pressure of 84/64, bibasilar crackles on lung auscultation, and a urine output of 5ml over the past hours. What is the reason the nurse anticipates transferring the client to the ICU?
The client is going into cariogenic shock.
The nurse is administering furosemide to a client with heart failure. What best describes the therapeutic action of the medication?
The medication blocks sodium reabsorption in the ascending loop and dilate renal vessels
While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). How should the nurse document this sound?
a third heart sound (S3)
A nurse is caring for a client with left-sided heart failure. During the nurse's assessment, the client is wheezing, restless, tachycardia, 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
A nurse is discussing cardiac hemodynamics with a client and explains the concept of after load. What are other preexisting medical conditions to discuss that may increase after load?
aging, hypertension, aortic valve stenosis
A client has been diagnosed with congestive heart failure. The client's cardiac function has been compromised since the client suffered a MI 3 years ago. heart failure is classified by:
amount of activity restriction the failure imposes
A client has been experiencing increasing shortness of breath and fatigue. the health care provider has ordered a diagnostic test in order to determine what type of heart failure the client is having. What test does the nurse anticipate?
an echocardiogram
The nurse is caring for a client with heart failure. What sign will lead the nurse to suspect right-sided and left sided heart failure?
ascites
The nurse understands that a client with which cardiac arrhythmia is most at risk for developing heart failure?
atrial fibrillation
The nurse is teaching a group of clients with heart failure about how to decrease leg edema. What dietary advice will the nurse give to clients with severe heart failure?
avoid the intake of processed and commercially prepared foods
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?
call for a chest xray
A client has been prescribed 80mg furosemide twice daily. the asymptomatic client begins to have rare premature ventricular contractions followed by runs of bigeminy with stable signs. What action will the nurse perform next?
check the clients potassium level
A nurse caring for a client recently admitted to the IU 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
decompensated heart failure with pulmonary edema
A client asks the nurse if systolic heart failure will affect any other body function. What body system correlates with systolic heart failure?
decrease in renal perfusion
The nurse is providing care to a client with cariogenic shock requiring a intra-aortic balloon pump. What is the therapeutic effect of the IABP therapy?
decreased left ventricular workload
Which is a cerebrovascular manifestation of heart failure?
dizziness
The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure?
dyspnea on exertion
What diagnostic test will measure the ejection fraction of the heart?
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?
fatigue after walking to answer the door
The nurse is teaching client about medications prescribed for severe volume overload from heart failure. What diuretic is the first-line treatment for clients diagnosed with heart failure?
furosemide
The nurse is caring for a client with suspected right-sided heart failure. What would the nurse know that clients with suspected right sided HF may experience?
gradual unexplained weight gain
A nurse is administering digoxin. What client parameter would cause the nurse to hold the digoxin and notify the health care provider?
heart rate of 55 bpm
The nurse is assessing a client with crackling breath sounds or pulmonary congestion. What is the cause of the congestion?
inadequate cardiac output
A new client has been admitted with right-sided heart failure. When assessing this client, the nurse knows to look for which finding?
jugular venous distention
The clinical manifestations of cariogenic shock reflect the pathophysiology of heart failure. By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following?
left ventricular function
The nurse is providing discharge instructions to a client with heart failure preparing to leave the following day. What type of diet should the nurse request the dietitian to discuss with the client?
low-sodium
Which action will the nurse include in the plan of care for a client admitted with acute decompensated heart failure (ADHF) who is receiving milrinone?
monitor blood pressure frequently
A client is prescribed digitalis. Which condition should the nurse closely monitor when caring for the client?
nausea and vomiting
The nurse is working in a long term care facility with a group of older adults with cardiac disorders. Why would it be important for the nurse to closely monitor an older adult receiving digitalis preparations for cardiac disorders?
older adults are at increased risk for toxicity
When a client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating
orthopnea
A client is receiving captopril for heart failure. During the nurse's assessment, what sign indicates that the medication therapy is ineffective?
peripheral edema
The nurse is administering digoxin to a client with heart failure. What laboratory value may predispose the client to digoxin toxicity?
potassium level of 2.8 mEq/L
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?
potassium level of 3.1
Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole?
preload
A client has been diagnosed with congestive heart failure. Which is a cause of crackles heard in the bases of the lungs?
pulmonary congestion
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." What additional assessment information would be important for the CSU nurse to obtain?
pulmonary crackles
A patient is admitted to the ICU with left sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment?
pulmonary crackles, dyspnea, cough
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 visible anxious. The nurse immediately assesses the client for other signs and symptoms of
pulmonary embolism
The nurse finds a client unresponsive in the room and calls a cardiac arrest. Which health care professionals will be responsible for an insertion of the ET tube during the arrest?
respiratory therapist, nurse anesthetist, physician
Which is a manifestations of right-sided heart failure?
systemic venous congestion
A client with a history of heart failure is returning from the operating room after inguinal hernia repair and the nurse assesses a low pulse oximetry reading. What is the most important nursing intervention?
titrate oxygen therapy
A client with chronic heart failure is receiving digoxin 0.25mg by mouth daily and furosemide 20mg by mouth twice daily. The nurse should assess the client for what sign of digoxin toxicity?
visual disturbances
