CHAPTER 38 - HF

After receiving change-of-shift report on four patients admitted to a heart failure unit, which patient should the nurse assess first? a. A patient who reported dizziness after receiving the first dose of captopril. b. A patient who has new-onset confusion and restlessness and cool, clammy skin. c. A patient who is receiving oxygen and has crackles bilaterally in the lung bases. d. A patient who is receiving IV nesiritide (Natrecor), with a blood pressure of 100/62.

b. A patient who has new-onset confusion and restlessness and cool, clammy skin.

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 does the nurse anticipate giving? a. Diuretic b. Anticoagulant c. β-Adrenergic blocker d. Potassium supplement

b. Anticoagulant

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. e. Hypervolemia precipitates HF by decreasing cardiac output and increasing oxygen consumption.

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).

The nurse reviews the following vital signs recorded by an unlicensed assistive personnel (UAP) on a patient with acute decompensated heart failure (ADHF): BP 98/60 mm Hg, heart rate (HR) 102 bpm, 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 should the nurse do next?

a. Arterial oxygen saturation by pulse oximetry (SpO2) of 84% on 2L/min via nasal cannula indicates impaired oxygen saturation. 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.

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. Bubbling crackles and tachycardia

The health care provider prescribes spironolactone (Aldactone) for the patient with chronic HF. 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 by using salt substitutes for seasoning.

a. Decrease both sodium and potassium intake.

The patient with chronic HF 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

a. Dopamine

A patient in the intensive care unit who has acute decompensated heart failure (ADHF) reports severe dyspnea and is anxious, tachypneic, and tachycardic. Several drugs have been prescribed for the patient. Which action should the nurse take first? a. Give PRN IV morphine sulfate 4 mg. b. Give PRN IV diazepam (Valium) 2.5 mg. c. Increase nitroglycerin infusion by 5 mcg/min. d. Increase dopamine infusion by 2 mcg/kg/min.

a. Give PRN IV morphine sulfate 4 mg.

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. HF c. Embolization d. Malignant conditions

a. Infection

Which action should the nurse include in the plan of care for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? a. Monitor blood pressure frequently. b. Encourage patient to ambulate in room. c. Teach patient to drink at least 3 liters of fluid daily. d. Titrate nesiritide dose down slowly before stopping.

a. Monitor blood pressure frequently.

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse? a. O2 saturation of 88% b. Weight gain of 1 kg (2.2 lb) c. Heart rate of 106 beats/min d. Urine output of 50 mL over 2 hours

a. O2 saturation of 88%

A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-lb weight gain in the past 3 days. What is the nurse's priority action? a. Teach the patient about restricting dietary sodium. b. Assess the patient for manifestations of acute heart failure. c. Ask the patient about the use of the prescribed medications. d. Have the patient recall the dietary intake for the past 3 days.

b. Assess the patient for manifestations of acute heart failure.

Which topic will the nurse plan to include in discharge teaching for a patient who has heart failure with reduced ejection fraction (HFrEF)? a. Need to begin an aerobic exercise program several times weekly b. Benefits and effects of angiotensin-converting enzyme (ACE) inhibitors c. Use of salt substitutes to replace table salt when cooking and at the table d. Importance of making an annual appointment with the health care provider

b. Benefits and effects of angiotensin-converting enzyme (ACE) inhibitors

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. Furosemide (Lasix) d. Spironolactone (Aldactone)

What is the pathophysiologic mechanism that results in the pulmonary edema of 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. Increased pulmonary hydrostatic pressure

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? a. Patient who is taking carvedilol (Coreg) and has a heart rate of 58. b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L. c. Patient who is taking captopril and has a frequent nonproductive cough. d. Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache.

b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L.

A patient with chronic HF is treated with hydrochlorothiazide, digoxin, and lisinopril. To prevent the risk of digitalis toxicity with these drugs, what is most important that the nurse monitor for this patient? a. HR b. Potassium levels c. BP d. Gastrointestinal function

b. Potassium levels

The acronym FACES is used to help teach patients to identify early symptoms of HF. 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

d. Fatigue, limitation of activities, chest congestion/cough, edema, shortness of breath

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. "I can eat most foods as long as I do not add salt when cooking or at the table."

A patient with chronic heart failure has a new order for captopril 12.5 mg PO. After giving the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective? a. "I plan to take the medication with food." b. "I should eat more potassium-rich foods." c. "I will call for help when I need to get up to use the bathroom." d. "I can expect to feel more short of breath for the next few days."

c. "I will call for help when I need to get up to use the bathroom."

A 53-yr-old patient with stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is an option. Which response is accurate? a. "Your heart failure has not reached the end stage yet." b. "You could not manage the multiple complications of that surgery." c. "The suitability of a heart transplant for you depends on many factors." d. "Because you have diabetes, you would not be a heart transplant candidate."

c. "The suitability of a heart transplant for you depends on many factors."

A patient who has chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. Which action should the nurse take first? a. Auscultate the abdomen. b. Check the capillary refill. c. Auscultate the breath sounds. d. Ask about the patient's allergies.

c. Auscultate the breath sounds.

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? a. Serum troponin b. Arterial blood gases c. B-type natriuretic peptide d. 12-lead electrocardiogram

c. B-type natriuretic peptide

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) levels

While assessing an older adult patient, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. What does this finding indicate? a. Decreased fluid volume b. Jugular vein atherosclerosis c. Increased right atrial pressure d. Incompetent jugular vein valves

c. Increased right atrial pressure

A patient who is receiving dobutamine for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)? a. Teach the patient the reasons for remaining on bed rest. b. Change the peripheral IV site according to agency policy. c. Monitor the patient's blood pressure and heart rate every hour. d. Titrate the dobutamine to keep the systolic blood pressure >90 mm Hg.

c. Monitor the patient's blood pressure and heart rate every hour.

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide. Which instruction should the nurse include? a. Limit dietary sources of potassium. b. Take the hydrochlorothiazide at bedtime. c. Notify the health care provider if nausea develops. d. Take the digoxin if the pulse is below 60 beats/min.

c. Notify the health care provider if nausea develops.

A patient who has chronic heart failure tells the nurse, "I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" How should the nurse document this finding? a. Orthopnea b. Pulsus alternans c. Paroxysmal nocturnal dyspnea d. Acute bilateral pleural effusion

c. Paroxysmal nocturnal dyspnea

The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective? a. Weight loss of 2 lb in 24 hours b. Hourly urine output greater than 60 mL c. Reduced dyspnea with the head of bed at 30 degrees d. Patient denies experiencing chest pain or chest pressure

c. Reduced dyspnea with the head of bed at 30 degrees

While admitting an 82-yr-old patient with acute decompensated heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." What should the nurse include in the discharge plan? a. Consult with a psychologist. b. Transfer to a long-term care facility. c. Referral to a home health care agency. d. Arrangements for around-the-clock care.

c. Referral to a home health care agency.

A patient who has heart failure has recently started taking digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril. Which finding by the home health nurse is a priority to communicate to the health care provider? a. Presence of 1+ to 2+ edema in the feet and ankles b. Palpable liver edge 2 cm below the ribs on the right side c. Serum potassium level 3.0 mEq/L after 1 week of therapy d. Weight increase from 120 pounds to 122 pounds over 3 days

c. Serum potassium level 3.0 mEq/L after 1 week of therapy

IV sodium nitroprusside is ordered for a patient with acute pulmonary edema. Which reassessment finding during the first hours of administration indicates that the nurse should decrease the rate of nitroprusside infusion? a. Ventricular ectopy b. Dry, hacking cough c. Systolic BP below 90 mm Hg d. Heart rate below 50 beats/min

c. Systolic BP below 90 mm Hg

What describes the action of the natriuretic peptides and nitric oxide in their counterregulatory processes 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. Vasodilation and decreased BP

When teaching a patient with heart failure on a 2000-mg sodium diet, which foods should the nurse recommend limiting? a. Chicken and eggs b. Canned and frozen fruits c. Yogurt and milk products d. Fresh or frozen vegetables

c. Yogurt and milk products

The nurse determines that treatment of HF 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).

c. clear lung sounds and decreased HR.

Which statement by the patient with chronic HF 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."

d. "I should weigh myself every morning and go on a diet if I gain more than 2 or 3 pounds in 2 days."

Which statement by a patient with newly diagnosed heart failure indicates to the nurse that teaching was effective? a. "I will take furosemide (Lasix) every day just before bedtime." b. "I will use the nitroglycerin patch whenever I have chest pain." c. "I will use an additional pillow if I am short of breath at night." d. "I will call the clinic if my weight goes up 3 pounds in a week."

d. "I will call the clinic if my weight goes up 3 pounds in a week."

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 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. A 52-year-old woman with end-stage CAD who has limited financial resources but is emotionally stable and has strong social support

Following an acute myocardial infarction, a previously healthy 63-yr-old develops heart failure. What medication topic should the nurse anticipate including in discharge teaching? a. β-Adrenergic blockers b. Calcium channel blockers c. Digitalis and potassium therapy regimen d. Angiotensin-converting enzyme (ACE) inhibitors

d. Angiotensin-converting enzyme (ACE) inhibitors

An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider? a. 2+ bilateral pedal edema b. Heart rate of 52 beats/min c. Report of increased fatigue d. Blood pressure (BP) of 88/42 mm Hg

d. Blood pressure (BP) of 88/42 mm Hg

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. Furosemide (Lasix)

Which medication shows improvement for 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)

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. Nitroprusside

A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving? a. captopril (Capoten) 25 mg b. furosemide (Lasix) 60 mg c. digoxin (Lanoxin) 0.125 mg d. carvedilol (Coreg) 3.125 mg

d. carvedilol (Coreg) 3.125 mg

The nurse assesses the patient with chronic biventricular HF for paroxysmal nocturnal dyspnea (PND) by questioning the patient regarding a. the presence of restlessness and confusion. b. frequent awakening to void during the night. c. the presence of swelling in dependent body areas. d. waking in a panic with a feeling of suffocation.

d. waking in a panic with a feeling of suffocation.