Chapter 29: Management of Patients With Complications from Heart Disease

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

Answer: D.) IV Rationale: Symptoms of cardiac insufficiency at rest are classified as IV, according to the New York Heart Association Classification of Heart Failure. In class I, ordinary activity does not cause undue fatigue, dyspnea, palpitations, or chest pain. In class II, ADLs are slightly limited. In class III, ADLs are markedly limited.

A new client has been admitted with right-sided heart failure. When assessing this client, the nurse knows to look for which finding? A.) Pulmonary congestion B.) Cough C.) Dyspnea D.) Jugular venous distention

Answer: D.) Jugular venous distention

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? A.) Low-fat diet B.) Low-potassium diet C.) Low-cholesterol diet D.) Low-sodium diet

Answer: D.) Low-sodium diet Rationale: Medical management of both left-sided and right-sided heart failure is directed at reducing the heart's workload and improving cardiac output primarily through dietary modifications, drug therapy, and lifestyle changes. A low-sodium diet is prescribed, and fluids may be restricted. Because the client will be on a diuretic such as Lasix, he may become potassium depleted and would need potassium in the diet. A low-cholesterol and low-fat diet may be ordered but are not specific to the heart failure.

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.) BNP of 100 B.) Sodium level of 135 C.) Hemoglobin of 12 D.) Potassium level of 3.1

Answer: D.) Potassium level of 3.1

The nurse is administering digoxin to a client with heart failure. What laboratory value may predispose the client to digoxin toxicity? A.) magnesium level of 2.5 mg/dL B.) calcium level of 7.5 mg/dL C.) sodium level of 152 mEq/L D.) potassium level of 2.8 mEq/L

Answer: D.) potassium level of 2.8 mEq/L

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. - Examine the client's neck for distended veins. - Monitor the client for signs of lethargy or confusion. - Examine the client's joints for crepitus. - Examine the client's eyes for excess tears.

Answer: - Examine the client's neck for distended veins. - Monitor the client for signs of lethargy or confusion.

A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.) - Jugular vein distention - Ascites - Pulmonary crackles - Dyspnea - Cough

Answer: - Pulmonary crackles - Dyspnea - Cough

A health care provider in the outpatient department examines a client with chronic heart failure to investigate recent-onset peripheral edema and increased shortness of breath. The nurse documents the severity of pitting edema as +1. What is the best description of this type of edema? A.) Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours B.) Detectable depression of less than 5 mm when the thumb is released from the swollen area; normal foot and leg contours C.) A 5- to 10-mm depression when the thumb is released from the swollen area; foot and leg swelling D.) A depression of more than 1 cm when the thumb is released from the swollen area; severe foot and leg swelling

Answer: A.) Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours

A client with chronic heart failure is able to continue with his regular physical activity and does not have any limitations as to what he can do. According to the New York Heart Association (NYHA), what classification of chronic heart failure does this client have? A.) Class I (Mild) B.) Class II (Mild) C.) Class III (Moderate) D.) Class IV (Severe)

Answer: A.) Class I (Mild) Rationale: Class I is when ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea. The client does not experience any limitation of activity. Class II (Mild) is when the client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea. Class III (Moderate) is when there is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitations, or dyspnea. Class IV (Severe), the client is unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.

The nurse is caring for a client with heart failure. What procedure should the nurse prepare the client for in order to determine the ejection fraction to measure the efficiency of the heart as a pump? A.) Echocardiogram B.) A pulmonary arteriography C.) A chest radiograph D.) Electrocardiogram

Answer: A.) Echocardiogram Rationale: The heart's ejection fraction is measured using an echocardiogram or multiple gated acquisition scan. A pulmonary arteriography is used to confirm cor pulmonale. A chest radiograph can reveal the enlargement of the heart. An electrocardiogram is used to determine the activity of the heart's conduction system.

A nurse finds a client with absent breathing and prepares to begin one-person cardiopulmonary resuscitation. What will the nurse do first? A.) Establish unresponsiveness. B.) Call for help. C.) Open the airway. D.) Assess the client for a carotid pulse.

Answer: A.) Establish unresponsiveness. Rationale: The correct sequence begins with establishing unresponsiveness. The nurse should then call for help, assess the client for breathing while opening the airway, deliver two breaths, and check for a carotid pulse.

The nurse identifies which symptom as a characteristic of right-sided heart failure? A.) Jugular vein distention (JVD) B.) Dyspnea C.) Pulmonary crackles D.) Cough

Answer: A.) Jugular vein distention (JVD)

The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following? A.) Left ventricular function B.) Right ventricular function C.) Left atrial function D.) Right atrial function

Answer: A.) Left ventricular function

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.) Monitor blood pressure frequently B.) Encourage the client to ambulate in room C.) Titrate milrinone rate slowly before discontinuing D.) Teach the client about safe home use of the medication

Answer: A.) Monitor blood pressure frequently Rationale: Milrinone is a phosphodiesterase inhibitor that delays the release of calcium from intracellular reservoirs and prevents the uptake of extracellular calcium by the cells. This promotes vasodilation, resulting in decreased preload and afterload and reduced cardiac workload. Milrinone is administered intravenously to clients with severe HF, including those who are waiting for a heart transplant. Because the drug causes vasodilation, the client's blood pressure is monitored before administration because if the client is hypovolemic the blood pressure could drop quickly. The major side effects are hypotension and increased ventricular dysrhythmias. Blood pressure and the electrocardiogram (ECG) are monitored closely during and after infusions of milrinone.

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.) Pulmonary congestion B.) Pedal edema C.) Nausea D.) Jugular venous distention

Answer: A.) Pulmonary congestion Rationale: When the left ventricle cannot effectively pump blood out of the ventricle into the aorta, the blood backs up into the pulmonary system and causes congestion, dyspnea, and shortness of breath. All the other choices are symptoms of right-sided heart failure. They are all symptoms of systolic failure.

The nurse recognizes which symptom as a classic sign of cardiogenic shock? A.) Restlessness and confusion B.) Hyperactive bowel sounds C.) High blood pressure D.) Increased urinary output

Answer: A.) Restlessness and confusion

A client who has developed congestive heart failure must learn to make dietary adaptations. The client should avoid: A.) canned peas. B.) dried peas. C.) angel food cake. D.) ready-to-eat cereals.

Answer: A.) canned peas. Rationale: There is a wide variety of foods that the client can still eat; the key is to have low-salt content. Canned vegetables are usually very high in salt or sodium, unless they have labels such as low-salt or sodium free or salt free. It is important to read food labels and look for foods that contain less than 300 mg sodium/serving.

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.) decrease in renal perfusion B.) increased blood volume ejected from ventricle C.) vasodilation of skin D.) dehydration

Answer: A.) decrease in renal perfusion

The nurse is providing care to a client with cardiogenic shock requiring a intra-aortic balloon pump (IABP). What is the therapeutic effect of the IABP therapy? A.) decreased left ventricular workload B.) decreased right ventricular workload C.) decreased peripheral perfusion to the extremities D.) decreased renal perfusion

Answer: A.) decreased left ventricular workload Rationale: The signs and symptoms of cardiogenic shock reflect the circular nature of the pathophysiology of HF. The therapeutic effect is decreased left ventricular workload. The IABP does not change right ventricular workload. The IABP increases perfusion to the coronary and peripheral arteries. The renal perfusion is not affected by IABP.

Frequently, what is the earliest symptom of left-sided heart failure? A.) dyspnea on exertion B.) anxiety C.) confusion D.) chest pain

Answer: A.) dyspnea on exertion

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.) visual disturbances. B.) taste and smell alterations. C.) dry mouth and urine retention. D.) nocturia and sleep disturbances.

Answer: A.) visual disturbances.

A client has been diagnosed with systolic heart failure. What percentage will the nurse expect the patient's ejection fraction to be? A.) 5% B.) 30% C.) 55% D.) 65%

Answer: B.) 30% Rationale: The ejection fraction is normal in diastolic heart failure, but severely reduced in systolic heart failure. The normal EF is 55%-65%. An EF of 5% is not life sustaining and an EF of 30% is about half the normal percentage.

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.) Change oxygen delivery to a mask. B.) Administer epinephrine. C.) Analyze the arterial blood gas. D.) Stop all emergency measures.

Answer: B.) Administer epinephrine. Rationale: PEA can be caused by hypovolemia, hypoxia, hypothermia, hyperkalemia, massive pulmonary embolism, myocardial infarction, and medication overdose (beta blockers, calcium channel blockers). PEA is treated with epinephrine according to advanced life support protocol. Applying oxygen or analyzing an arterial blood gas will not change the client's heart rhythm. PEA is treated until there is no change in the client's rhythm after treatments.

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

Answer: B.) BP and pulse measurements every 15 to 30 minutes

A client has been prescribed furosemide 80 mg 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? A.) Notify the health care provider. B.) Check the client's potassium level. C.) Calculate the client's intake and output. D.) Administer potassium.

Answer: B.) Check the client's potassium level.

The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure? A.) Decreased urinary output B.) Dyspnea on exertion C.) Hypotension D.) Tachycardia

Answer: B.) Dyspnea on exertion

Which diagnostic study is usually performed to confirm the diagnosis of heart failure? A.) Electrocardiogram (ECG) B.) Echocardiogram C.) Serum electrolytes D.) Blood urea nitrogen (BUN)

Answer: B.) Echocardiogram

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? A.) The pericardial space is eliminated with scar tissue and thickened pericardium. B.) Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. C.) The parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction. D.) Fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction.

Answer: B.) Excess pericardial fluid compresses the heart and prevents adequate diastolic filling.

The nurse is caring for a client with suspected right-sided heart failure. What would the nurse know that clients with suspected right-sided heart failure may experience? A.) Increased urine output B.) Gradual unexplained weight gain C.) Increased perspiration D.) Sleeping in a chair or recliner

Answer: B.) Gradual unexplained weight gain

The client with cardiac failure is taught to report which symptom to the health care provider or clinic immediately? A.) Increased appetite B.) Persistent cough C.) Weight loss D.) Ability to sleep through the night

Answer: B.) Persistent cough Rationale: Persistent cough may indicate an onset of left-sided heart failure. Loss of appetite, weight gain, interrupted sleep, unusual shortness of breath, and increased swelling should also be reported immediately.

A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient? A.) Vasculitis B.) Potassium levels C.) Flexion contractures D.) Enlargement of joints

Answer: B.) Potassium levels Rationale: A key concern associated with digoxin therapy is digitalis toxicity. Clinical manifestations of toxicity include anorexia, nausea, visual disturbances, confusion, and bradycardia. The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur.

Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole? A.) Afterload B.) Preload C.) Ejection fraction D.) Stroke volume

Answer: B.) Preload Rationale: Preload is the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. Afterload is the amount of resistance to ejection of blood from a ventricle. The ejection fraction is the percentage of blood volume in the ventricles at the end of diastole that is ejected during systole. Stroke volume is the amount of blood pumped out of the ventricle with each contraction.

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 left-sided heart failure C.) The development of right-sided heart failure D.) The development of cor pulmonale

Answer: B.) The development of left-sided heart failure

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.) right-sided heart failure. B.) acute pulmonary edema. C.) pneumonia. D.) cardiogenic shock.

Answer: B.) acute pulmonary edema.

The nurse is caring for a client with heart failure. What sign will lead the nurse to suspect right-sided heart failure? A.) warm extremities B.) ascites C.) resting bradycardia D.) weight loss

Answer: B.) ascites

The nurse is admitting a client with heart failure. What client statement indicates that fluid overload was occurring at home? A.) "I eat six small meals a day when I am hungry." B.) "I've stopped eating foods with salt, though I miss the taste." C.) "I'm having trouble going up the steps during the day." D.) "My best time of the day is the morning."

Answer: C.) "I'm having trouble going up the steps during the day."

The nurse recognizes that which laboratory test 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)

Answer: C.) Brain natriuretic peptide (BNP)

The pathophysiology of pericardial effusion is associated with all of the following except: A.) Increased right and left ventricular end-diastolic pressures. B.) Atrial compression. C.) Increased venous return. D.) Inability of the ventricles to fill adequately.

Answer: C.) Increased venous return. Rationale: Venous return is decreased (not increased) with Pericardial effusion because there is an increase in the pericardial fluid, which raises the pressure within the pericardial sac and compresses the heart. Increased right and left ventricular end-diastolic pressures, inability of the ventricles to fill adequately, and atrial compression are all effects of pericardial effusion.

A nurse administers furosemide to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully? A.) Increase in blood pressure B.) Increase in blood volume C.) Low serum potassium level D.) High serum sodium level

Answer: C.) Low serum potassium level

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? A.) The client says that he has been urinating less frequently at night. B.) The client says he has been hungry in the evening. C.) The client says his rings have become tight and are difficult to remove. D.) The client says he is short of breath when ambulating.

Answer: C.) The client says his rings have become tight and are difficult to remove.

Which nursing intervention should the nurse perform when a client with valvular disorder of the heart has a heart rate less than 60 beats/min before administering beta-blockers? A.) Observe for symptoms of pulmonary edema. B.) Continue the drug and document in the client's chart. C.) Withhold the drug and inform the primary health care provider. D.) Check for signs of toxicity.

Answer: C.) Withhold the drug and inform the primary health care provider.

The nurse is assessing a client with crackling breath sounds or pulmonary congestion. What is the cause of the congestion? A.) ascites B.) hepatomegaly C.) inadequate cardiac output D.) nocturia

Answer: C.) inadequate cardiac output

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.) drowsiness, numbness B.) increased cardiac output C.) moist, gurgling respirations D.) hypertension

Answer: C.) moist, gurgling respirations

A nurse suspects that a client has digoxin toxicity. The nurse should assess for: A.) hearing loss. B.) vision changes. C.) decreased urine output. D.) gait instability.

Answer; B.) vision changes. Rationale: Vision changes, such as halos around objects, are signs of digoxin toxicity. Hearing loss can be detected through hearing assessment; however, it isn't a common sign of digoxin toxicity. Intake and output aren't affected unless there is nephrotoxicity, which is uncommon. Gait changes are also uncommon.