Chapter 38: Heart Failure

The client is admitted to the telemetry unit diagnosed with left-sided heart failure. Which clinical manifestations would the nurse expect to find when assessing this client? 1. Apical pulse rate of 110 and crackles on auscultation. 2. Jugular vein distention and 4+ pitting edema of feet. 3. The client sleeping with no pillow and eupnea. 4. Radial pulse rate of 90 and CRT less than 3 seconds.

1. Apical pulse rate of 110 and crackles on auscultation. The client diagnosed with left-sided heart failure would exhibit tachycardia (apical pulse rate of 110), shortness of breath, crackles on auscultation, fatigue, third heart sounds, and change in mental status.

4 Cardiovascular Condition Leading to HF & 4 Preventive Measures

1. Hypertension; Use drugs, diet, and exercise to control 2. Valvular defects: Surgical replacement if contributing to HF and symptoms; prophylactic antibiotics 3. CAD: Coronary revascularization procedures; fibrinolytic therapy for occlusions 4. Dysrhythmias: Antidysrhythmic agents, pacemakers, or defibrillators to control; also, adequate treatment of pulmonary hypertension, hyperthyroidism, or myocarditis

The charge nurse is making shift assignments for the medical floor. Which client should be assigned to the most experienced registered nurse? 1. The client diagnosed with chronic heart failure being discharged in the morning. 2. The client having frequent incontinent liquid bowel movements and vomiting. 3. The client with an apical pulse rate of 116, a respiratory rate of 26, and a blood pressure of 94/62. 4. The client reporting chest pain on inspiration and a nonproductive cough.

3. The client with an apical pulse rate of 116, a respiratory rate of 26, and a blood pressure of 94/62. This client is exhibiting clinical manifestations of shock, which makes this client the most unstable. An experienced nurse should care for this client.

In the patient with HF, 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. Nesiritide (Natrecor) d. Spironolactone (Aldactone) e. Metoprolol CR/XL (Toprol XL)

b, d. Furosemide is a diuretic that eliminates potassium and spironolactone is a potassium-sparing diuretic that retains potassium. The other treatments and medications are used for patients with HF, but they do not directly affect serum potassium levels.

Which are the greatest risks for patients in the first year after heart transplantation? (select all that apply) a. Cancer b. Infection c. Rejection d. Vasculopathy e. Sudden cardiac death

b. Infection c. Rejection e. Sudden cardiac death

A 2400-mg sodium diet is prescribed for a patient with chronic HF. 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.

c. Not adding salt to foods will not eliminate enough sodium for the 2400-mg sodium diet. 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 foods as well as unexpected sodium sources that are identified by reading the label of prepared foods and medicines

Which statement by the patient with chronic HF would 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."

d. 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 HF, this type of weight gain reflects fluid retention and is a sign of HF that should be reported to the HCP. The other options show patient understanding of the HF management teaching (see Table 34.10).

The nurse enters the room of the client diagnosed with heart failure. The client is lying in bed gasping for breath, is cool and clammy, and has buccal cyanosis. Which intervention would the nurse implement first? 1. Sponge the client's forehead. 2. Obtain a pulse oximetry reading. 3. Take the client's vital signs. 4. Assist the client to a sitting position.

4.Assist the client to a sitting position. The nurse must first put the client in a sitting position to decrease the workload of the heart by decreasing venous return and maximizing lung expansion. Then, the nurse could take vital signs and check the pulse oximeter and then sponge the client's forehead.

The nurse on the telemetry unit has just received the morning shift report. Which client should the nurse assess first? 1. The client diagnosed with myocardial infarction (MI) with an audible S3 heart sound. 2. The client diagnosed with right-sided heart failure with 4+ sacral pitting edema. 3. The client diagnosed with pneumonia with a pulse oximeter reading of 94%. 4. The client diagnosed with chronic renal failure with an elevated creatinine level.

1. The client diagnosed with myocardial infarction (MI) with an audible S3 heart sound. An S3 heart sound indicates left-sided heart failure, and the nurse must assess this client first because it is an emergency situation.

The nurse is assessing the client diagnosed with heart failure. Which laboratory data would indicate that the client is in heart failure? 1. An elevated B-type natriuretic peptide (BNP). 2. An elevated creatine kinase (CK-MB). 3. A positive D-dimer. 4. A positive ventilation-perfusion (VQ) scan.

1.An elevated B-type natriuretic peptide (BNP). BNP is a specific diagnostic test to diagnose heart failure. Levels higher than normal indicate heart failure and the need for additional assessment such as echocardiography (VanLeeuwen & Bladh, 2017).

The client diagnosed with chronic heart failure is reporting leg cramps at night. Which nursing interventions should be implemented? 1. Check the client for peripheral edema and make sure the client takes a diuretic early in the day. 2. Monitor the client's potassium level and assess the client's intake of bananas and orange juice. 3. Determine if the client has gained weight and instruct the client to keep the legs elevated. 4. Instruct the client to ambulate frequently and perform calf-muscle stretching exercises daily.

2. Monitor the client's potassium level and assess the client's intake of bananas and orange juice. The most probable cause of the leg cramping is potassium excretion as a result of diuretic medication. Bananas and orange juice are foods that are high in potassium.

The nurse is developing a discharge-teaching plan for the client diagnosed with heart failure. Which interventions should be included in the plan? Select all that apply. 1. Notify the health-care provider (HCP) of a weight gain of more than 1 pound in a week. 2. Teach the client how to count the radial pulse when taking digoxin. 3. Instruct the client to remove the saltshaker from the dinner table. 4. Encourage the client to monitor urine output for change to a dark color. 5. Discuss the importance of taking furosemide at bedtime.

2. Teach the client how to count the radial pulse when taking digoxin. 3. Instruct the client to remove the saltshaker from the dinner table. 2. The client should not take digoxin, a cardiac glycoside, if the radial pulse is less than 60. 3. The client should be on a low-sodium diet to prevent water retention.

The HCP has ordered an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with heart failure. Which discharge instructions should the nurse include? Select all that apply. 1. Instruct the client to take a cough suppressant if a cough develops. 2. Teach the client how to prevent orthostatic hypotension. 3. Encourage the client to eat bananas to increase potassium levels. 4. Explain the importance of taking the medication with food. 5. Tell the client to avoid the use of NSAIDs.

2. Teach the client how to prevent orthostatic hypotension. 5. Tell the client to avoid the use of NSAIDs. 2. Orthostatic hypotension may occur with ACE inhibitors as a result of vasodilation. Therefore, the nurse should instruct the client to rise slowly and sit on the side of the bed until equilibrium is restored. 5. ACE inhibitors taken with NSAIDs can cause an adverse effect in the kidneys and decrease the antihypertensive benefits of the ACE inhibitor.

The nurse is developing a nursing care plan for a client diagnosed with left-sided heart failure. A nursing diagnosis of "decreased cardiac output related to the inability of the heart to pump effectively" is written. Which short-term goal would be best for the client? 1. The client will be able to ambulate in the hall by date of discharge. 2. The client will have an audible S1 and S2 with no S3 heard by the end of shift. 3. The client will turn, cough, and deep breathe every 2 hours. 4. The client will have a Sao2 reading of 98% by day 2 of care.

2. The client will have an audible S1 and S2 with no S3 heard by the end of shift. Audible S1 and S2 sounds are normal for a heart with adequate output. An audible S3 sound might indicate left ventricular failure, which could be life-threatening.

The nurse is assessing the client diagnosed with heart failure. Which clinical manifestations would indicate that medical treatment has been effective? 1. The client's peripheral pitting edema has gone from 3+ to 4+. 2. The client is able to take the radial pulse accurately. 3. The client is able to perform activities of daily living (ADLs) without dyspnea. 4. The client has minimal jugular vein distention.

3. The client is able to perform activities of daily living (ADLs) without dyspnea. Being able to perform ADLs without shortness of breath (dyspnea) would indicate the client's condition is improving. The client's heart is a more effective pump and can oxygenate the body better without increasing fluid in the lungs.

The nurse and an unlicensed assistive personnel (UAP) are caring for four clients on a telemetry unit. Which nursing task would be best for the RN to delegate to the UAP? 1. Assist the client to go down to the smoking area for a cigarette. 2. Transport the client to the intensive care unit (ICU) via a stretcher. 3. Provide the client going home discharge-teaching instructions. 4. Help position the client having a portable x-ray done.

4. Help position the client having a portable x-ray done. The UAP can assist the x-ray technician in positioning the client for the portable x-ray. This does not require judgment.

The nurse has written an outcome goal "demonstrates tolerance for increased activity" for a client diagnosed with heart failure. Which intervention should the nurse implement to assist the client in achieving this outcome? 1. Measure intake and output. 2. Provide 2 g sodium diet. 3. Weigh the client daily. 4. Plan for frequent rest periods.

4. Plan for frequent rest periods. Scheduling activities and rest periods allows the client to participate in the care and addresses the desired outcome.

Describe how each of the following compensatory mechanisms of HF increases cardiac output and identify at least 1 effect of the mechanism that is detrimental to cardiac function. Cardiac dilation Cardiac hypertrophy Renin-angiotensin-aldosterone system Antidiuretic hormone (ADH) Sympathetic nervous system

Cardiac dilation: Increased force of contraction by stretching of cardiac muscle; Overstrains the muscle fibers; mitral valve incompetence Cardiac hypertrophy: Increased ventricular mass and increased contractile force of muscle; Increased myocardial oxygen need, then poor contractility Renin-angiotensin-aldosterone system: Increased fluid and sodium retention and vasoconstriction to maintain BP; ncreased preload and afterload Antidiuretic hormone: Increased water retention; Increased blood volume when already overloaded (ADH) Sympathetic nervous system: ncreased BP, heart rate (HR) and contractility; increased preload; Increased myocardial oxygen need; overwhelming preload; increased afterload

Which initial physical assessment finding would the nurse expect to be present in a patient with acute left-sided HF? 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

a. Early clinical manifestations of acute left-sided HF are those of interstitial edema, with bubbling crackles and tachycardia, as well as tachypnea. Later frothy, blood-tinged sputum; severe dyspnea; and orthopnea develop with alveolar edema. Severe tachycardia and cool, clammy skin are present as a result of stimulation of the SNS from hypoxemia. Systemic edema reflected by jugular vein distention, peripheral edema, and hepatosplenomegaly are characteristic of right-sided HF.

Which statements accurately describe heart failure (HF)? Select all that apply. a. A common cause of HF with preserved ejection fraction (HFpEF) is left ventricular dysfunction. b. A primary risk factor for HF is coronary artery disease (CAD). c. Systolic failure results in a normal left ventricular ejection fraction. d. HF with reduced ejection fraction (HFrEF) is characterized by abnormal resistance to ventricular filling.

a, b. Heart failure with preserved ejection fraction (HFpEF) (diastolic failure) is characterized by abnormal resistance to ventricular filling. Hypertension, coronary artery disease (CAD), advanced age, and diabetes are all risk factors for heart failure (HF). Ejection fraction (EF) is decreased in systolic HF. Decreased cardiac output (CO) and increased workload and oxygen requirements of the myocardium precipitate HF because of left ventricle dysfunction.

The nurse reviews the following vital signs recorded by assistive personnel (AP) on a patient with acute decompensated heart failure (ADHF): BP 98/60 mm Hg, heart rate (HR) 102 beats/min, respiratory rate (RR) 24, temperature 98.2°F (36.7°C), arterial oxygen saturation by pulse oximetry (SpO2) 84% on 2 L/min via nasal cannula. a. Which of these findings is of highest priority? b. What would the nurse do next?

a. Arterial oxygen saturation by pulse oximetry (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 airway, breathing and circulation [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.

The patient with chronic HF is being discharged with a diuretic, a renin-angiotensin-aldosterone system (RAAS) inhibitor, and a β-adrenergic blocker. Which medication would not be included for this patient? a. Dopamine b. Losartan (Cozaar) c. Carvedilol (Coreg) d. Hydrochlorothiazide

a. Dopamine 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 ACE inhibitors. Carvedilol (Coreg) is the β-adrenergic blocker that blocks the sympathetic nervous system's negative effects on the failing heart. Hydrochlorothiazide is the diuretic.

When planning long-term goals for the patient who had a heart transplant, what would the nurse consider is the most common cause of death in heart transplant patients during the first year? a. Infection b. HF c. Embolization d. Malignant conditions

a. In the first year after transplant, with the need for long-term immunosuppressant 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 health care provider prescribes spironolactone (Aldactone) for the patient with chronic HF. What diet modifications, related to the use of this drug, would the nurse include in 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 by using salt substitutes for seasoning.

a. Spironolactone is a potassium-sparing diuretic, and when it is the only diuretic used in the treatment of HF, 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 HF, but salt substitutes cannot be freely used because many contain high concentrations of potassium. Calcium intake is not increased

A patient with chronic heart failure and atrial fibrillation is treated with low-dose digitalis and a loop diuretic. Which actions would the nurse take to prevent complications of this drug combination? (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. Withhold digitalis if the pulse rhythm is irregular. e. Teach the patient about diet potassium restrictions.

a. Monitor serum potassium levels. b. Teach the patient how to take a pulse rate.

Which statements accurately describe heart failure with preserved ejection fraction (HFpEF)? (select all that apply) a. Uncontrolled hypertension is a primary cause. b. Left ventricular ejection fraction may be within normal limits. c. The pathophysiology involves ventricular relaxation and filling. d. Multiple evidence-based therapies have been shown to decrease mortality. e. Therapies focus on symptom control and treatment of underlying conditions.

a. Uncontrolled hypertension is a primary cause. b. Left ventricular ejection fraction may be within normal limits. c. The pathophysiology involves ventricular relaxation and filling. e. Therapies focus on symptom control and treatment of underlying conditions.

What are ventricular assist devices (VADs) designed to do for the patient? Select all that apply. a. To support a patient with renal failure or liver failure unrelated to a cardiac event b. Support circulation when patients cannot be weaned from cardiopulmonary bypass c. Partially or totally support circulation temporarily until a donor heart can be obtained d. Provide permanent, total circulatory support for a patient with limited life expectancy e. Reverse the effects of circulatory failure in patients with acute MI in cardiogenic shock

b, c. Ventricular assist devices (VADs) are temporary devices that can partially or totally support circulation until the heart recovers and can be weaned from cardiopulmonary bypass, until a donor heart can be obtained, or for New York Heart Association Class IV heart disease patients who have failed medical therapy. An implantable artificial heart can now sustain the body's circulatory system for patients who are ineligible for a transplant

A patient with chronic HF has atrial fibrillation and a left ventricular ejection fraction (LVEF) of 18%. To decrease the risk of complications from these conditions, what drug would the nurse anticipate administering? a. Diuretic b. Anticoagulant c. β-Adrenergic blocker d. Potassium supplement

b. 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 HF is treated with hydrochlorothiazide, digoxin, and lisinopril. To prevent the risk of digitalis toxicity, what is most important to monitor? a. HR b. Potassium levels c. BP d. Gastrointestinal function

b. 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-excreting diuretics, such as hydrochlorothiazide or furosemide, it is essential to monitor the patient's serum potassium levels to prevent digitalis toxicity. Monitoring the HR assesses for complications related to digoxin but does not prevent toxicity.

What is the pathophysiologic mechanism that results in pulmonary edema from left-sided HF? 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

b. In left-sided HF, 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.

The hemodynamic changes the nurse expects to find after successful initiation of intraaortic balloon pump therapy include (select all that apply) a. decreased SV. b. decreased SVR. c. decreased PAWP. d. increased diastolic BP. e. decreased myocardial O2 consumption.

b. decreased SVR. c. decreased PAWP. d. increased diastolic BP. e. decreased myocardial O2 consumption.

What would the nurse do to prevent arterial trauma during the use of the IABP? a. Reposition the patient every 2 hours. b. Check the site for bleeding every hour. c. Prevent hip flexion of the cannulated leg. d. Cover the insertion site with an occlusive dressing

c. Because the IABP is inserted into the femoral artery and advanced to the descending thoracic aorta, compromised distal extremity circulation is common and requires that the cannulated extremity be extended at all times. Repositioning the patient to prevent pneumonia is limited to side-lying or supine positions with the head of the bed elevated <45 degrees. Assessment for bleeding is important because the IABP may cause platelet destruction (not arterial trauma) and occlusive dressings are used to prevent site infection.

What describes the action of natriuretic peptides and nitric oxide in response to HF? a. Excretion of potassium b. Increased release of ADH c. Vasodilation and decreased BP d. Decreased glomerular filtration rate and edema

c. Both natriuretic peptides and nitric oxide contribute to vasodilation, decreased BP, 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 assessment findings indicate that treatment of HF has been successful? 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)

c. Successful treatment of HF 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 level of consciousness (LOC) may occur without resolution of pulmonary symptoms. Chest pain is not a common finding in HF unless coronary artery perfusion is impaired.

Which diagnostic test is most useful in differentiating dyspnea related to pulmonary effects of HF 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)

c. 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 HF. If BNP is elevated, shortness of breath is caused by HF; if BNP is normal, dyspnea is caused by pulmonary disease. BNP opposes the actions of the RAAS, resulting in vasodilation and reduction in blood volume. Exercise stress testing and cardiac catheterization are more important tests to diagnose CAD, and although the blood urea nitrogen (BUN) may be elevated in HF, it is a reflection of decreased renal perfusion. (See Table 31.6.)

The nurse is caring for a patient with acute decompensated heart failure who is receiving IV dobutamine. Which drug action is expected? (select all that apply) a. Raises the heart rate b. Dilates renal blood vessels c. Increases heart contractility d. Acts as a selective β-agonist e. Increases systemic vascular resistance

c. Increases heart contractility d. Acts as a selective β-agonist

A patient is admitted to the emergency department with ADHF. Which IV medication would the nurse expect to administer first? a. Digoxin (Lanoxin) b. Morphine sulfate c. Nesiritide (Natrecor) d. Furosemide (Lasix)

d. Diuretics are the first line for treating patients with volume overload. They decrease sodium reabsorption at various sites within the kidneys, enhancing sodium and water loss. Decreasing intravascular volume with diuretics reduces volume returning to the LV (preload). This allows for more efficient LV pumping, decreased pulmonary vascular pressures, and improved alveolar gas exchange. IV Nesiritide is a recombinant form of BNP used for short-term treatment of acute decompensated heart failure (ADHF) after a failed response to IV diuretics. Digoxin 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 effects.

The nurse monitors the patient receiving treatment for ADHF with the knowledge that marked hypotension is most likely to occur with the IV administration of which medication? a. Milrinone b. Furosemide c. Nitroglycerin d. Nitroprusside

d. 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. Milrinone has a positive inotropic effect in addition to peripheral vasodilation. Nitroglycerin is a vasodilator and can decrease BP but not as severely as nitroprusside. It primarily dilates veins and increases myocardial oxygen supply.

Which statement about the function of the IABP is accurate? a. Deflation of the balloon allows the HR to increase. b. A primary effect of the IABP is increased systolic blood pressure. c. The rapid deflation of the intraaortic balloon causes a decreased preload. d. During intraaortic counterpulsation, the balloon is inflated during diastole

d. During intraaortic counterpulsation, the balloon of the IABP is inflated during diastole and deflated during systole. This causes decreased HR, decreased peak systolic pressure, and decreased afterload.

The acronym FACES is used to help teach patients to identify early symptoms of HF. What does this acronym stand for? 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

d. FACES is used to teach patients to identify early HF symptoms. F = Fatigue; A = Activity limitations; C = Chest congestion/cough; E = Edema; S = Shortness of breath. The other options are not correct.

Which medication improves hypertension and angina in black patients with HFrEF? a. Captopril b. Nitroglycerin c. Spironolactone (Aldactone) d. Isosorbide dinitrate and hydralazine (BiDil)

d. Isosorbide dinitrate and hydralazine (Bidil) is recommended for use in black patients with HFrEF to treat hypertension and angina. Captopril is used for hypertension by all patients. Nitroglycerin is used with hydralazine for patients who cannot tolerate RAAS inhibitors (angiotensin-converting enzyme [ACE] inhibitors or angiotensin II receptor blocker [ARBs]) for HF management. Spironolactone (Aldactone) is used for hypertension.

The nurse assesses the patient with chronic biventricular HF for paroxysmal nocturnal dyspnea (PND). What question would the nurse ask? a. Do you wake feeling restless or confused? b. Do you frequently urinate during the night? c. Do you have any swelling in your legs? d. Do you wake in a panic with a feeling of suffocation?

d. Paroxysmal nocturnal dyspnea (PND) is awakening from sleep with a feeling of suffocation and a need to sit up to be able to breathe. Patients learn that sleeping with the upper body elevated on several pillows helps prevent PND. Behavior changes are seen in late stages of HF. Nocturia occurs with HF as fluid moves back into the vascular system during recumbency, increasing renal blood flow. Dependent edema does not indicate PND.

The evaluation team for cardiac transplantation is evaluating patients. Which patient is most likely to receive the greatest 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 CAD who has not been compliant with lifestyle changes and rehabilitation programs d. A 52-year-old woman with end-stage CAD who has limited financial resources but is emotionally stable and has strong social support

d. The 52-year-old woman does not have any contraindications for cardiac transplantation, even though she lacks the indication of adequate financial resources. The 24-year-old man does not have a current cardiac diagnosis. The postoperative transplant regimen is complex and rigorous, and patients who have not been compliant with other treatments or who may 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 transplan

A patient who is hemodynamically stable has an order to wean the IABP. How would the nurse accomplish this? a. Decrease the augmentation pressure to zero. b. Stop the machine since hemodynamic parameters are satisfactory. c. Stop the infusion flow through the catheter when weaning is initiated. d. Change the pumping ratio from 1 : 1 to 1 : 2 or 1 : 3 until the balloon is removed

d. Weaning from the IABP involves reducing the pumping to every second or third heartbeat until the IABP catheter is removed. The pumping and infusion flow are continued to reduce the risk for thrombus formation around the catheter until it is removed.

Which factor is a significant barrier to hospice referrals for patients with stage D heart failure? a. Family member refusal b. Scarcity of hospice care c. History of pacemaker placement d. Difficulty in estimating prognosis

d. Difficulty in estimating prognosis

Which compensatory mechanism involved in both chronic heart failure and acute decompensated heart failure leads to fluid retention and edema? a. Ventricular dilation b. Ventricular hypertrophy c. Increased systemic blood pressure d. Renin-angiotensin-aldosterone activation

d. Renin-angiotensin-aldosterone activation

A patient with which disorder would benefit most from the use of the intraaortic balloon pump (IABP)? a. An insufficient aortic valve b. A dissecting thoracic aortic aneurysm c. Generalized peripheral vascular disease d. Acute myocardial infarction (MI) with cardiogenic shock

d. The counterpulsation of the intraaortic balloon pump (IABP) increases diastolic arterial pressure, forcing blood back into the coronary arteries and main branches of the aortic arch, increasing coronary artery perfusion pressure and blood flow to the myocardium. The IABP also causes a drop in aortic pressure just before systole, decreasing afterload and myocardial oxygen consumption. These effects make the IABP valuable in treating unstable angina, acute myocardial infarction with cardiogenic shock, and a variety of surgical heart situations. Its use is contraindicated in incompetent aortic valves, dissecting aortic and thoracic aneurysms, and generalized peripheral vascular disease