Cv4 ch 35 & 36

12 The nurse is interviewing a patient with history of high blood pressure and heart problems. Which statement by the patient causes the nurse to suspect the patient may have heart failure?

"I had to take off my wedding ring last week."

42. The nurse is teaching a patient about the treat- ment regimen for heart failure. Which state- ment by the patient indicates a need for further instruction?

"I must weigh myself once a month and watch for fluid retention" a.

35. A patient with heart failure is anxious to recover quickly. After the patient ambulates with the UAP, the nurse observes that the patient has dyspnea. The nurse asks the patient to rate her exertion on a scale of 1 to 20, and the patient says, "I can keep going. It's only about a 15." What is the nurse's best response?

"Slow down a bit; ideally you should be less than 12." a.

91. Which priority medical surgical concept applies to a patient with heart failure?

- C. Perfusion

7. The nurse is counseling a group of women about cholesterol-lowering drugs. Which drug will decrease blood pressure while decreasing triglycerides (TGs), increasing high-density lipoprotein (HDL), and lowering low-density lipoprotein (LDL)?

- b. Caduet

. The nurse educates and advises a patient to follow the Dietary Approaches to Stop Hyper- tension (DASH) diet. Which instructions does the nurse give to the patient? Select all that apply.

- b. Consume low-fat dairy products, poultry, and fish. C. Lower sodium intake to no more than 2400 mg per day. Limit intake of sweets and red meats. -e. - £. Eat legumes, nontropical vegetable oils (e.g., canola), and nuts.

41. A patient is prescribed bumetanide. What is an important teaching point for the nurse to include about this medication?

- b. Information about potassium-rich foods to include in the diet

58. A patient is scheduled for valve surgery. Which medication does the nurse instruct the patient to discontinue at least 72 hours before the procedure?

- c. Anticoagulants

cates an understanding of fat sources and the The nurse is conducting dietary teaching with a patient. Which statement by the patient indi- 8. need to limit saturated fats?

1 "Canola oil has monounsaturated fat and is recommended."

Which blood pressure is considered normal for an adult patient over 60 years of age? 4.

144/88 mm Hg d.

An African-American male is being seen for a blister on the right toe. What factors increase this patient's risk for developing atherosclero- sis? Select all that apply. 2.

20-year history of type 1 diabetes b. Sedentary lifestyle 35 lbs overweight Grandmother who died after myocardial - a. d. infarction

What is the common treatment for rheumatic carditis? 78.

Antibiotics for 10 days b.

49. A patient with a history of valvular heart disease requires an invasive dental procedure. The nurse notifies the health care provider to obtain a pa- tient prescription for which type of medication?

Antibiotics С.

48. The nurse is assessing the pulses of a patient with valvular disease and finds "bounding" arterial pulses. What is this finding most characteristic of?

Aortic regurgitation a.

33. A patient has an ejection fraction of less than 30%. The nurse prepares to provide patient education about which potential treatment?

Automatic implantable cardioverter/ defibrillator

55. The nurse is caring for a patient who had a valvuloplasty. The nurse monitors for which common complication in the postprocedural period?

C. Bleeding and emboli

1. Which definition best describes left-sided heart failure?

C. There is decreased tissue perfusion from poor cardiac output and pulmonary congestion from increased pressure in the pulmonary vessels.

The patient has excess fluid in the pericardial cavity seen on echocardiogram. For which complication is the patient at increased risk? 62.

Cardiac tamponade C.

82. Which is a characteristic of dilated cardiomyopathy?

Causes symptoms of left ventricular failure C.

46. The nurse hears in report that a patient has been diagnosed with mitral regurgitation (insufficiency). Which early symptom is most likely to be first reported by the patient?

Chronic weakness b.

39. What is the expected outcome for a patient with the collaborative problem of preventing and managing pulmonary edema?

Clear lung sounds

Which factors can increase systemic arterial pressure? Select all that apply. 3.

Increased heart rate b. Increased peripheral vascular resistance d. Increased stroke volume с.

51. The nurse is assessing a patient at risk for valvular disease and finds pitting edema. This is a sign for which type of valvular disease?

Mitral valve stenosis and insufficiency

90. Which patient meets the criteria for selection as a candidate for heart transplant surgery?

Patient who is New York Heart Association (NYHA) class III

The nurse assesses a patient and notes red, flat, pinpoint spots on the mucous membranes. Which finding has the nurse assessed? 61.

Petechiae c.

73. The nurse is assessing a patient with pericardi- tis. In order to hear a pericardial friction rub, which stethoscope technique does the nurse use?

Place the diaphragm at the left lower sternal border. b.

88. A patient has received a heart transplant for dilated cardiomyopathy. Because the patient has a high risk for cardiac tamponade, for which signs/symptoms does the nurse imme- diately notify the health care provider?

Pulsus paradoxus and muffled heart sounds b.

59. What is the most common problem for the patient with valvular heart disease?

Reduced cardiac output a.

A patient is diagnosed with new-onset infevtive endocarditis. Which recent procedure is the patient most likely to report?

Teeth cleaning a.

36. Why does the nurse document the precise location of crackles auscultated in the lungs of a patient with heart failure?

The level of the fluid ascends as the pulmonary edema worsens.

A patient with heart failure has inadequate tis- sue perfusion. Which nursing interventions are included in the plan of care for this patient? Select all that apply. 21.

a. Monitor respiratory rate, rhythm, and quality every 1-4 hours b. Auscultate breath sounds every 4-8 hours. c. Provide supplemental oxygen to maintain oxygen saturation at 90% or greater. e. Assist the patient in performing coughing and deep-breathing exercises every 2 hours.

85. The cause of dilated cardiomyopathy may include which factors? Select all that apply.

a. Alcohol abuse c. Infection d. Chemotherapy e. Poor nutrition

28. A patient is receiving digoxin therapy for heart failure. What assessment does the nur hea form before administering the medicatr.

a. Auscultate the apical pulse rate and heart rhythm.

A patient is admitted with a vascular problem. 5. Based on the pathophysiology of systemic are rial pressure, the systemic arterial pressure is product of what factors? Select all that apple

a. Cardiac output d. Total peripheral vascular resistance

79. Which are signs and symptoms of rheumatic carditis? Select all that apply.

a. Cardiomegaly (enlarged heart) c. New murmur development d. Existing streptococcal infection f. Pericardial friction rub

81. A patient had an emergency pericardiocente- sis for cardiac tamponade. Which nursing interventions are included in the postproce- dural care of this patient? Select all that apply.

a. Closely monitor for the recurrence of tamponade. b. Be prepared to provide adequate fluid volumes to increase cardiac output. c. Prepare the patient for emergency sternotomy if tamponade recurs. e. Send the pericardial effusion specimen to the laboratory for culture.

7. The nurse is assessing a patient with right-sided heart failure. Which assessment findings does the nurse expect to see in this patient? Select all that apply.

a. Dependent edema c. Jugular venous distention e. Hepatomegaly

45. A patient is diagnosed with moderate mitral valve stenosis. Which findings is the nurse most likely to encounter during the physical assessment of this patient? Select all that apply.

a. Dyspnea on exertion b. Orthopnea c. Palpitations e. Neck vein distention

20. Which test is the best tool for diagnosing heart failure?

a. Echocardiography

The health care provider recommends to a patient that diagnostic testing be performed to esess for valvular heart disease. The nurse teaches the patient about which test that is commonly used for this purpose? 52.

a. Echocardiography

76. A patient is admitted for pericarditis. How will the patient likely describe his pain?

a. Grating substernal pain that is aggravated by inspiration

An older adult patient with heart failure is vol- ume depleted and has a low sodium level. The health care provider has ordered valsartan, an angiotensin receptor blocker (ARB). After the initial dose, for what complication does the nurse carefully monitor in this patient? 23.

a. Hypotension

64. Which patients are at greatest risk of developing infective endocarditis? Select all that apply.

a. IV drug user c. Patient with a prosthetic mitral valve replacement, postoperative d. Patient with mitral stenosis who recently had an abscessed tooth removed e. Older adult patient with urinary tract infection and valve damage

47. A patient is diagnosed with mitral valve stenosis. Which finding warrants immediate notification of the health care provider because of the potential for decompensation?

a. Irregular heart rhythm signifying atrial fibrillation

13. A patient who was admitted for newly diagnosed heart failure is now being discharged The nurse instructs the patient and family on how to manage heart failure at home. What major self-management categories should the nurse include? Select all that apply.

a. Medications b. Weight d. Activity e Diet. f. What to do when symptoms get worse

31. A patient is receiving an infusion of nesiritide for treatment of heart failure. What is the priority nursing assessment while administering this medication?

a. Monitor for hypotension.

38. A patient is treated for acute pulmonary edema. Which medications does the nurse prepare to administer to this patient? Select all that apply.

a. Nitroglycerin SL b. Furosemide IV c. Morphine sulfate IV e. Nitroglycerin IV

77. Which are proposed criteria for diagnosis of acute pericarditis? Select all that apply.

a. Pericardial chest pain c. Presence of pericardial friction rub d. New ST elevation on all ECG leads f. New or worsening pericardial effusion

Which descriptions accurately characterize restrictive cardiomyopathy? Select all that apply. 86.

a. Prognosis is poor. b. Symptoms are similar to left- or right- sided heart failure. e. It is the rarest of cardiomyopathies. f. Filling is restricted during diastole.

Atherosclerosis affects which larger arteries? Select all that apply. 1.

a. Renal b. Femoral c. Coronary е. Aorta f. Carotid

57. A patient is a candidate for a xenograft valve. The nurse emphasizes that this type of valve does not require anticoagulant therapy but will require which intervention?

a. Replacement in about 7-10 years

87. A patient who reports having a sore throat 2 weeks ago now reports chest pain. On physi- cal assessment, the nurse hears a new murmur, pericardial friction rub, and tachycardia. The electrocardiogram (ECG) shows a prolonged P-R interval. What condition does the nurse suspect in this patient?

a. Rheumatic carditis

The nurse is assessing a patient who has re- ceived a heart transplant. Which clinical mani festations suggest transplant rejection? Select all that apply.

a. Shortness of breath d. New bradycardia e. Hypotension f. Decreased activity tolerance

22. Which interventions are effective for a patient with a potential for pulmonary edema caused by heart failure? Select all that apply.

a. Sodium and fluid restriction d. Administration of loop diuretics e. Position in semi-Fowler's to high Fowler's position

3. When heart failure develops, what is the initial compensatory mechanism of the heart that maintains cardiac output?

a. Sympathetic stimulation

19. The nursing student is assisting in the care of a patient with advanced right-sided heart failure. In addition to bringing a stethoscope, what additional piece of equipment does the student bring in order to assess this patient?

a. Tape measure

72. Which signs/symptoms occur with chronic constrictive pericarditis? Select all that apply.

a. Thick, rigid pericardium c. Jugular venous distention e. Exertional fatigue and dyspnea f. Dependent edema

17 The home health nurse is evaluating a patient being treated for heart failure. Which statement by the patient is the best indicator of hope and well-being as a desired psychological outcome?

b. "Im looking forward to dancing with my wife on our wedding anniversary."

37. A patient comes to the emergency department (ED) extremely anxious, tachycardic, struggling for air, and with a moist cough productive of frothy, blood-tinged sputum. What is the priority nursing intervention?

b. Administer high-flow oxygen therapy via face mask.

Assessment findings for a patient with acute pericarditis include neck vein distention, clear lungs, muffled heart sounds, tachycardia, tachypnea, and a greater than 10 mm Hg difference in systolic pressure on inspiration than on expiration. What is the nurse's first 80. response to these assessment findings?

b. Administer oxygen and immediately report the findings to the health care provider.

56. A patient with a prosthetic valve replacement must understand that postoperative care will include lifelong therapy with which type of medication?

b. Anticoagulants

Which type of cardiomyopathy results from replacement of myocardial tissue with fibrous and fatty tissue? 83.

b. Arrhythmogenic right ventricular cardiomyopathy

18. The nurse is reviewing the laboratory results for a patient who was admitted with dyspnea. Which diagnostic test best differentiates between heart failure and lung dysfunction?

b. B-type natriuretic peptide

In what way does arterial embolization to the 68. brain manifest itself in a patient with infective endocarditis?

b. Dysphagia

69. Which treatment intervention applies to a patient with infective endocarditis?

b. Hospitalization for initial IV antibiotics; then home to continue IV therapy

44. Which characteristics describe mitral valve prolapse? Select all that apply.

b. Leaflets enlarge and fall back into left atrium during systole. c. Most patients are asymptomatic. d. Patients have normal heart rate and blood pressure. f. A midsystolic click and late systolic murmur can be heard at the apex of the heart.

54. The surgical noninvasive intervention of a bal- loon valvuloplasty is often used for which type of patient?

b. Older adults who are nonsurgical candidates

The patient has infective endocarditis. Which findings does the nurse expect when assessing this patient? Select all that apply. 63.

b. Osler's nodes C. Petechiae d. A new regurgitant murmur f. Fever associated with chills and night sweats

Which characteristics describe mitral valve stenosis? Select all that apply. 43.

b. Rumbling apical diastolic murmur. d. Right-sided failure results in neck vein distention. f. Mild mitral stenosis is usually asymptomatic.

The nurse is assessing a patient with left-sided heart failure. Which assessment findings does the nurse expect to see in this patient? Select all that apply. 8.

b. S3 heart sound c. Paroxysmal nocturnal dyspnea e. Oliguria during the day f. Wheezes or crackles

15. The nurse is reviewing the ECG of a patient admitted for acute pericarditis. Which ECG change does the nurse anticipate?

b. ST-T spiking

26. A patient is prescribed diuretics for treatment. of heart failure. Because of this therapy, the nurse pays particular attention to which laboratory test level?

b. Serum potassium

70. What is the definitive treatment for a patient with chronic constrictive pericarditis?

b. Surgical excision of the pericardium

34. The nurse identifies a priority problem of fatigue and weakness for the patient with heart failure. After the patient ambulates 200 feet down the hall, the patient's blood pressure change is decreased by more than 20 mm Hg. failure. How does the nurse interpret this data?

b. The activity is too stressful.

The nurse is giving discharge instructions to a patient who had valve surgery. Which home care instructions does the nurse include in the teaching plan? Select all that apply. 60.

b. Use an electric razor to avoid skin cuts. c. Report any bleeding or excessive bruising. d. Watch for and report any fever, drainage, or redness at the site f. Report dyspnea, syncope, dizziness, edema, and palpitations.

65. A patient with aortic valve endocarditis re- ports fatigue and shortness of breath. Crackles are heard on lung auscultation. What do these assessment findings most likely indicate?

b. Valve incompetence resulting in heart failure

53. Long-term anticoagulant therapy for a patient with valvular heart disease and chronic atrial fibrillation includes which drug?

b. Warfarin sodium

4. When is B-type natriuretic peptide (BNP) produced and released for a patient with heart failure?

b. When a patient has fluid overload

5. The nurse is taking a history on a patient recently diagnosed with heart failure. The patient admits to "sometimes having trouble catching my breath" but is unable to provide more specific details. What question does the nurse ask to gather more data about the patient's symptoms?

c. "What was your most strenuous activity in the past week?"

A patient is admitted for possible infective 66. endocarditis. Which test does the nurse anticipate will be performed to confirm a positive diagnosis?

c. Blood cultures

6. The night shift nurse is listening to report and hears that a patient has paroxysmal nocturnal dyspnea. What does the nurse plan to do next?

c. Check on the patient several hours after bedtime and assist the patient to sit upright and dangle the feet when dyspnea оccurs.

40. The nurse is teaching a patient with heart fail- ure about signs and symptoms that suggest a return or worsening of heart failure. What does the nurse include in the teaching? Select all that apply.

c. Cold symptoms (cough) lasting more than 3-5 days d. Excessive awakening at night to urinate e. Development of dyspnea or angina at rest or worsening angina f. Increased swelling in the feet, ankles, or hands

27. An older adult patient is taking digoxin for treatment of heart failure. What is the priority nursing action for this patient related to the medication therapy?

c. Monitor for early signs of toxicity such as bradycardia on the ECG tracing.

A patient with heart failure has excessive aldosterone secretion and is experiencing thirst and continuously asking for water. What instruction does the nurse give the unlicensed assistive personnel (UAP)? 25.

c. Restrict fluid to 2 L daily, with accurate intake and output.

Which laboratory test does the nurse monitor for potential cardiac problems and digoxin toxicity? 30.

c. Serum potassium

74. A patient is admitted for pericarditis. In order to assist the patient to feel more comfortable, what does the nurse instruct the patient to do?

c. Sit up and lean forward.

50. The patient is admitted with aortic stenosis. Diagnostic testing reveals that the surface area of the valve is less than 1 cm. Which urgent intervention is required at this time?

c. Surgical heart valve replacement

14. A patient's bilateral radial pulses are occasionally weak and irregular. Which assessment technique does the nurse use first to investigate this finding?

c. Take the apical pulse for 1 minute, noting any irregularity in heart rhythm.

The health care provider has ordered an angio- tensin receptor blocker (ARB) for a patient with heart failure. The parameters are to maintain a systolic blood pressure ranging from 90 to 110 mm Hg. Today the patient has a blood pressure of 110/80 mm Hg but feels dizzy and lightheaded. What is the nurse's first priority action? 24.

d. Assess the patient for other symptoms of decreased tissue perfusion.

71. A patient is admitted to the unit with assess- ment findings that include substernal pain that radiates to the left shoulder. The pain is described by the patient as grating, and is worse with inspiration and coughing. What likely is the cause of this patient's symptoms?

d. Acute pericarditis

15. A patient is at risk for heart failure but currently has no official medical diagnosis. While assessing the patient's lungs, the nurse hears profuse fine crackles. What does the nurse do next?

d. Ask the patient to cough and reauscultate the lungs.

32. A patient has recently been diagnosed with acute heart failure. Which medication order does the nurse question?

d. Carvedilol, a beta blocker

84. A patient may die without any symptoms from which type of cardiomyopathy?

d. Hypertrophic cardiomyopathy

29. The nurse is reviewing the ECG of a patient on digoxin therapy. What early sign of digitalis toxicity does the nurse look for?

d. Loss of P wave

What is an early sign of left ventricular failure that a patient is most likely to report? 10.

d. Nocturnal coughing

9. Based on the etiology and the main cause of heart failure, which patient has the greatest need for health promotion measures to prevent heart failure?

d. Patient with hypertension

11. The nurse is reviewing diagnostic test results for a patient who is hypertensive. Which laboratory result is an early warning sign of decreased heart compliance and prompts the nurse to immediately notify the health care provider?

d. Presence of microalbuminuria

2. During assessment of a patient with heart failure, the nurse notes that the patient's pulses alternate in strength. What does this assessment indicate to the nurse?

d. Pulsus alternans

16. A patient is admitted for heart failure and has edema, neck vein distention, and ascites. What is the most reliable way to monitor fluid gain or loss in this patient?

d. Weigh the patient daily at the same time with the same scale.

A patient's cholesterol screening shows a low. density lipoprotein cholesterol (LDI-C) value greater than 190 mg/dL. What is the nurse's best interpretation of these results? 6.

results? All patients with LDL-C equal to or greater than 190 mg/dL should be evaluated for secondary causes of hyperlipidemia and treated with statin therapy. a.