Chapter 27 concepts
The patient takes insulin for diabetes mellitus. The physician orders metoprolol (Lopressor) for hypertension. After medication teaching, the nurse determines that learning has occurred when the patient makes which statement?
"I might need less insulin when I take metoprolol (Lopressor)."
The nurse volunteers at a senior citizen center. The nurse assesses which senior citizen as having the greatest risk of developing heart failure?
A 69-year-old African American male with hypertension
The patient has hypertension and asks the nurse how this can lead to heart failure. What is the best response by the nurse?
"Hypertension causes resistance in your blood vessels, or afterload; your heart works harder, and weakens."
The nurse teaches the patient about lisinopril (Prinivil) and evaluates that additional teaching is required when the patient makes which statement?
"I don't need to worry about having blood tests done."
The patient has heart failure and receives digoxin (Lanoxin). Prior to discharge, what will the best teaching plan by the nurse include?
"Report mental changes such as depression."
The patient is prescribed digoxin (lanoxin) for treatment of HF. Which of the following statements by the patient indicates the need for further teaching?
"This drug should cure my heart failure."
The nurse is educating a patient diagnosed with heart failure (HF). The nurse knows that instruction regarding compensatory mechanisms has been effective when the patient states, Select all that apply.
1. "My heart enlarged in order to compensate for the effects of heart failure." 2. "My nervous system kicks in to compensate for the effects of heart failure." 3. "My body will decrease blood flow to other organs in order to compensate for heart failure."
A nurse has been assigned to provide care for a patient who has class IV heart failure. Which nursing interventions are indicated? Select all that apply
1. Assist nursing support personnel with the patient's bed bath. 2.Monitor that the patient's position is changed every 2 hours. 5. Assist the patient with meals as indicated
The nurse is caring for a patient with heart failure. Which assessment findings indicate the patient is currently experiencing class 2 heart failure? Select all that apply
1. Fatigue with physical activity 2. Palpitations with physical activity Dyspnea with physical activity
The nurse is caring for a patient being treated pharmacologically for heart failure. Which laboratory values is the nurse careful to monitor during treatment? Select all that apply.
1. Potassium levels 2. BUN 3. Creatinine Serum drug levels
The nurse is caring for a patient who is being treated pharmacologically for the symptoms of heart failure. What would be included in the nurse's role of pharmacologic management of this patient? Select all that apply.
1. Teaching the patient how to space medications to decrease adverse effects 2. Teaching the patient the long-term benefits of beta blockers 3. Continually monitoring the patient during IV infusions
The nurse is caring for a patient who has been diagnosed with heart failure. The nurse knows that which conditions may have contributed to the development of heart failure in this patient? Select all that apply.
1. Uncontrolled hypertension 2. Coronary artery disease (CAD) 3. Diabetes (DM) Mitral stenosis
A patient says, "Ever since I changed jobs I just don't feel as good. I think my heart medicine is not working." What nursing assessment questions are priority? Select all that apply.
2. "How did your new job change your work schedule?" 3. "How did your new job change your insurance coverage?" 5. "In what way do you not feel as well?"
The patient comes to the emergency department complaining of coughing and difficulty breathing. The patient's diagnosis is heart failure. He asks the nurse how difficulty breathing could be a heart problem. What is the best response by the nurse? Select all that apply.
3. "What you have is called congestive heart failure." 5. "The left side of your heart has weakened and blood has entered your lungs."
The nurse teaches the patient about digoxin (Lanoxin) toxicity and determines that learning has occurred when the patient makes which statements? Select all that apply.
4. "I can drink orange juice every morning." 5. "I must check my pulse and not take the medication if it is less than 60."
Which individual listed below would be at the greatest risk for developing heart disease?
68-year-old with stage 2 hypertension and recent myocardial infarction
A patient with heart failure has an order for Lisinopril (Prinivil, Zestril). Which of the following conditions in the patient's history would lead the nurse to confirm the order with the provider?
A history of angioedema after taking enalapril (Vasotec)
The nurse is concerned that a patient is developing right heart failure. What did the nurse assess in this patient? Select all that apply
Ankle edema 2. Enlarged liver 3. Displaced apical heart rate
The patient receives digoxin (Lanoxin). Which assessment findings would indicate adverse effects to this medication?
Anorexia and nausea
The patient receives enalapril (Vasotec) as treatment for heart failure. What is the best nursing assessment following the initial administration of this drug?
Assess the patient's blood pressure
The patient has a history of cardiac disease and receives digoxin (Lanoxin). The nurse determines that education about dietary needs with this medication has been effective when the patient makes which selection for lunch?
Baked fish, sweet potatoes, and banana pudding
The teaching plan for a patient receiving hydralazine (Apresoline) should include which of the following points?
Rising slowly to standing from a lying or sitting position
Which statement is accurate regarding the physiological changes associated with heart failure?
Cardiac remodeling occurs after prolonged ventricular hypertrophy.
The nurse reviews laboratory studies of a patient receiving digoxin (lanoxin). Intervention by the nurse is required if the results include which of the following laboratory values?
Serum potassium level of 3 mEq/l
The patient who is prescribed furosemide (Lasix) and digoxin (Lanoxin) reports using an over-the-counter antacid for recurrent heartburn. The nurse would assess for which result?
Decreased effectiveness of digoxin (Lanoxin)
Which medication would be of most help to increase myocardial contractility in a patient with heart failure?
Digoxin (Lanoxin)
The patient who has not responded well to other therapies has been prescribed milrinone (Primacor) for treatment of his heart failure. What essential assessment must the nurse make before starting this drug?
Electrolytes, especially potassium
Which vital sign is of greatest concern to the nurse prior to administering digoxin (Lanoxin)?
Heart rate
Lisinopril (Prinivil) is part of the treatment regimen for a patient with heart failure. The nurse monitors the patient for the development of which of the following adverse effects of this drug? (Select all that apply.)
Hyperkalemia Cough Dizziness
Which situation would lead to an increase in cardiac output?
Increase in preload
Lisinopril (Prinivil) is often used to treat heart failure because it lowers blood volume. Which statement best explains how lisinopril lowers blood volume?
It lowers aldosterone secretion, a hormone that increases sodium reabsorption
The patient will receive an IV infusion of milrinone (Primacor) as treatment for acute heart failure. What is the priority plan by the nurse?
Plan to monitor the ECG continuously
The patient receives captopril (Capoten) as treatment for heart failure. Which adverse effect will the nurse plan to report to the physician?
The patient develops a cough
The physician orders metoprolol (Toprol-XL) for several patients. The nurse will most closely monitor the effects of this drug on which patient?
The patient with chronic bronchitis
Which statement is accurate regarding the use of beta-adrenergic blockers for use in patients with heart failure?
They are generally used in combination with other heart-failure drugs
Which is the most serious adverse effect associated with milrinone (Primacor)
Ventricular dysrhythmia
