Clinical Concepts 3 - CHF and Cardiomyopathy

A female client presents to the emergency department with nausea, vomiting, and a heart rate of 45 beats per minute. Her husband states that she takes digoxin, Lasix, and nitroglycerin for chest pain. Laboratory results confirm digoxin toxicity. The nurse would expect the health care provider to order what medication to treat the bradycardia? A) Atropine B) Nifedipine C) Nitroglycerin D) Nesiritide

A) Atropine

Which is a characteristic of right-sided heart failure? A) Jugular vein distention B) Dyspnea C) Pulmonary crackles D) Cough

A) Jugular vein distention

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? A) Older adults are at increased risk for toxicity. B) Older adults are at increased risk for cardiac arrests. C) Older adults are at increased risk for hyperthyroidism. D) Older adults are at increased risk for asthma.

A) Older adults are at increased risk for toxicity.

Which is a potassium-sparing diuretic used in the treatment of heart failure (HF)? A) Spironolactone B) Bumetanide C) Chlorothiazide D) Ethacrynic acid

A) Spironolactone

A group of nursing students are reviewing cardiotonic drugs. The students demonstrate understanding of the information when they identify which adverse reaction associated with cardiotonic medications? A) Visual disturbances B) Diarrhea C) Constipation D) Restlessness

A) Visual disturbances

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.

A) canned peas.

The health care team is developing a plan of care for a client diagnosed with congestive heart failure (CHF). The primary treatment goal would be: A) improving quality of life by relieving symptoms. B) eliminating CHF through curing the disease. C) maintaining higher oxygen levels to decrease the work of breathing. D) placing a stent for fluid drainage from the heart.

A) improving quality of life by relieving symptoms.

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

A) moist, gurgling respirations

The nurse completes an assessment of a client admitted with a diagnosis of right-sided heart failure. What will be a significant clinical finding related to right-sided heart failure? A) pitting edema B) oliguria C) S4 ventricular gallop sign D) decreased O2 saturation levels

A) pitting edema

A client with heart failure is having a decrease in cardiac output. What indication does the nurse have that this is occurring? A) Heart rate of 72 beats/minute B) Respiratory rate of 20 breaths/minute C) Blood pressure 80/46 mm Hg D) Oxygen saturation 94%

C) Blood pressure 80/46 mm Hg

What conclusion should the nurse draw when a client's digoxin level is reported to be 2.2 ng/mL? A) The medication is at a subtherapeutic drug level. B) A therapeutic drug level has been achieved. C) Digitalis toxicity is a possibility. D) A loading dose of digoxin has been given.

C) Digitalis toxicity is a possibility.

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.

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

A client is admitted to the ICU with a diagnosis of heart failure. The client is exhibiting symptoms of weakness, ascites, weight gain, and jugular vein distention. The nurse would know that the client is exhibiting signs of what kind of heart failure? A) Left-sided heart failure B) Chronic heart failure C) Acute heart failure D) Right-sided heart failure

D) Right-sided heart failure

The nurse is conducting a morning assessment of an 80-year-old female patient who has a longstanding diagnosis of heart failure (HF). The nurse notes an elevation in jugular venous pressure (JVP) greater than 4 cm above the woman's sternal angle, a finding that did not exist the day before. What conclusion should the nurse draw from this assessment finding? A) The woman is demonstrating the early signs of cardiogenic shock. B) The woman has left-sided heart failure. C) The woman is also likely to experience shortness of breath. D) The woman may be experiencing an exacerbation of right-sided HF.

D) The woman may be experiencing an exacerbation of right-sided HF.

A total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it different from an LVAD? A) An LVAD only supports a failing left ventricle. B) It is specifically designed for long-term use. C) It never needs batteries. D) It is designed for extremely active patients.

A) An LVAD only supports a failing left ventricle.

The nurse explains to the client that with heart failure, the client may experience which symptom? (Select all that apply.) A) Anxiety B) Tremors C) Weakness D) Fatigue E) Shortness of breath

A) Anxiety C) Weakness D) Fatigue E) Shortness of breath

What is the most accurate method for preventing adverse effects associated with the use of digoxin? A) Teach clients to take their digoxin in divided doses with each meal. B) Assess the client's heart rate and hold administration if it is less than 60. C) Teach clients the signs and symptoms of heart failure. D) Monitor therapeutic effects based on echocardiogram results.

B) Assess the client's heart rate and hold administration if it is less than 60.

When describing how vasodilators help alleviate heart failure, which would the nurse include? A) Increase cardiac workload B) Decrease afterload C) Increase preload D) Decrease blood volume

B) Decrease afterload

A nurse is caring for a patient admitted to the intensive care unit because of heart failure. The patient is prescribed digoxin. Which nursing diagnosis would be appropriate for this patient? A) Risk for Hyperthyroidism related to adverse effects of drug therapy B) Decreased Cardiac Output related to altered cardiac function C) Acute Pain and Headache related to adverse effects of the drug therapy D) Risk of Constipation related to adverse effects of the drug therapy

B) Decreased Cardiac Output related to altered cardiac function

In heart failure, what causes the increase in renal secretion of renin? A) Increased metabolic demand B) Decreased cardiac output C) Increased renal perfusion D) Hypertension

B) Decreased cardiac output

The diagnosis of heart failure is usually confirmed by which of the following? A) Chest x-ray B) Echocardiogram C) Electrocardiogram (12-lead) D) Ventriculogram

B) Echocardiogram

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

B) Potassium levels

A triage nurse in the emergency department suspects that a 78-year-old patient is experiencing severe digoxin toxicity with significant cardiac dysrhythmia. If the nurse is correct, which action is likely to be taken? A) The patient's digoxin dosage will be reduced. B) The patient will be given digoxin immune fab. C) The patient will be given sodium chloride. D) The patient will be monitored to see if symptoms resolve without action.

B) The patient will be given digoxin immune fab.

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. C) cardiogenic shock.

B) acute pulmonary edema.

A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient's heart rate, the nurse should prioritize assessment of the patient's A) intake and output. B) blood pressure. C) cognition. D) exercise tolerance.

B) blood pressure.

On a holiday trip home, the nurse's mother states that the nurse's father was diagnosed with right-sided heart failure. Which manifestation exhibited by the father does the nurse know might have preceded this diagnosis? A) Vertigo, headache B) Weakness, palpitations C) Dyspnea, cough D) Peripheral edema, weight gain

D) Peripheral edema, weight gain

The nursing instructor is teaching their clinical group how to assess a client for congestive heart failure. How would the instructor teach the students to assess a client with congestive heart failure for nocturnal dyspnea? A) By collecting the client's urine output B) By observing the client's diet during the day C) By measuring the client's abdominal girth D) By questioning how many pillows the client normally uses for sleep

D) By questioning how many pillows the client normally uses for sleep

A client develops cardiogenic pulmonary edema and is extremely apprehensive. What medication can the nurse administer with physician orders that will relieve anxiety and slow respiratory rate? A) Furosemide B) Nitroglycerin C) Dopamine D) Morphine sulfate

D) Morphine sulfate