Heart Failure
What effect does nitroglycerin have on the body that benefits a patient with acute decompensated heart failure (ADHF)? Select all that apply.
1Reduces preload Correct 2Prevents dysrhythmias 3Prevents thromboembolism 4Dilates the coronary arteries Correct 5Increases myocardial oxygen supply Correct
A patient is admitted to the hospital with heart failure (HF). The nurse should monitor the patient for what complications? Select all that apply.
Pleural effusion 2 Dysrhythmias 3 Hepatomegaly 4 Renal failure pleural effusion occurs when excess fluid builds up in the pleural cavity of the lungs secondary to increasing pressure in the pleural capillaries. Fluid then moves from these capillaries into the pleural space. Chronic HF causes enlargement of the chambers of the heart. This enlargement can cause changes in the normal electrical pathways. HF can lead to severe hepatomegaly. The liver becomes congested with venous blood. The decreased cardiac output (CO) that accompanies chronic HF results in decreased perfusion to the kidneys and can lead to renal insufficiency or failure.
The nurse provides information to a group pf nursing students about primary causes of heart failure (HF). The nurse should include what interventions that are associated with the primary causes and that are aimed at reducing the risk of patients developing HF?? Select all that apply. Blood transfusions for anemia Taking blood pressure medication as prescribed Decreasing dysrhythmias by reducing caffeine intake Initiating lifestyle changes to avoid coronary artery disease (CAD) Taking aspirin every day to reduce the incidence of pulmonary embolism
aking blood pressure medication as prescribed Initiating lifestyle changes to avoid coronary artery disease (CAD) Hypertension and coronary artery disease (CAD) are considered primary causes of heart failure (HF). Anemia, dysrhythmias, and pulmonary embolism are precipitating causes of heart failure.
A patient that received a prescription for a diuretic experiences worsening heart failure. During history-taking, the patient tells the nurse, "I quit taking my medication because I was frequently disrupting church services to go to the restroom." What suggestion by the nurse is most likely to increase the patient's compliance with the medication regimen? "Perhaps you should watch a church service on the television instead." "You need to follow your health care provider's recommendations if you want to get well." "Ask your health care provider to switch your medication to one that does not result in frequent urination." "Let's determine if we can adjust your medication schedule, such as taking the diuretic after church services."
"Let's determine if we can adjust your medication schedule, such as taking the diuretic after church services." Collaborating with the patient to identify an acceptable plan of care will increase compliance with the medication regimen. Diuretics are prescribed for prevention of congestive heart failure episodes, and there is no alternative medication without the effect of increased urination. Telling the patient to "follow the health care provider's recommendations" is not a therapeutic approach to establishing medication compliance. Although watching a televangelist in the home setting would make accessing the restroom easier, the patient may not find this to be an acceptable alternative.
The nurse recognizes what indications for cardiac transplantation? Select all that apply.
1 Angina pectoris 2 Myocardial ischemia 3 Severe, decompensated, inoperable, valvular disease Correct 4 End stage heart failure (HF) refractory to medical care Correct 5 Cardiac abnormality that has a mortality rate of more than 50% within two years Correct 6 Recurrent life-threatening dysrhythmias not responsive to maximal interventions Correct Severe valvular disease may compromise the vital functions of the heart. End-stage heart failure refractory to medical care may prove to be fatal if the heart is not transplanted. Cardiac transplantation would be the only option left for a cardiac abnormality that has a mortality rate of more than 50% within two years. Recurrent life-threatening dysrhythmias not responsive to maximal interventions may prove to be fatal. Angina pectoris is a transient blockage of coronary blood vessels and may not be severe enough to require a cardiac transplantation. Myocardial ischemia is an inadequate oxygen supply to the myocardial tissue and also may not be severe enough to require a cardiac transplantation.
The nurse is preparing to administer digoxin to a patient with heart failure (HF). The nurse should suspect digitalis toxicity if the patient reports which symptom?
1 Anorexia Correct 2 Constipation 3 Restlessness 4 Muscle aches Anorexia, nausea and vomiting, fatigue, headache, depression, and visual changes are early signs of toxicity. The nurse should become concerned and notify the health care provider if the patient exhibits any of these symptoms. Muscle aches, constipation, and restlessness are not signs of digitalis toxicity.
A patient receives immunosuppressive therapy after cardiac transplantation. The nurse identifies that the patient is at risk for what? Select all that apply.
1 Cancer Correct 2 Cataracts 3 Deep vein thrombosis Correct 4 Cytomegalovirus (CMV) infection Correct 5Epstein-Barr virus (EBV) infection Correct
An acutely ill patient develops unexplained, new-onset heart failure (HF) that is unresponsive to usual care. The nurse anticipates a prescription for which diagnostic procedure that is commonly done as part of a heart catheterization??
1 Chest x-ray 2Intraarterial BP 3Endomyocardial biopsy (EMB) Correct 4Multigated acquisition (MUGA) scan Endomyocardial biopsy is an investigation to find out the cause of new-onset heart failure that is unresponsive to routine care. Hemodynamic monitoring (e.g., intraarterial BP) is included in the care plan for a patient with acute decompensated heart failure (ADHF). A chest x-ray and MUGA scan are common diagnostic studies used for many types of patients suspected of having cardiac problems; they are not done as part of a cardiac catheterization.
A male patient with chronic heart failure develops enlarged breasts. The nurse reviews the patient's medication profile and suspects that which medication is the cause of the patient's condition?
1 Digoxin 2Captopril 3Carvedilol 4Spironolactone Correct Spironolactone, if used for a prolonged period, may cause breast enlargement or gynecomastia in males. Digoxin may cause bradycardia and atrioventricular block. Captopril may cause conditions such as hypotension and hyperkalemia. Carvedilol may cause side effects of profound bradycardia, hypotension, and bronchospasm.
A patient with acute decompensated heart failure (ADHF) develops hypotension and thiocyanate toxicity after 48 hours of prescribed drug therapy. The nurse suspects that which medication is responsible for this condition?
1 Nesiritide 2 Milrinone 3 Spironolactone 4 Sodium nitroprusside Correct Hypotension and thiocyanate toxicity are complications of sodium nitroprusside; they can develop after 48 hours of use. Nesiritide causes symptomatic hypotension. Milrinone complications include dysrhythmias, thrombocytopenia, and hepatotoxicity. Spironolactone complications include hyperkalemia and gynecomastia in males (with long-term use). Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options.
A patient with chronic heart failure asks the nurse about heart transplantation. The nurse identifies that the surgery is absolutely contraindicated if the patient has what history findings? Select all that apply.
1 Severe obesity 2Age over 70 years Correct 3Recurrent life-threatening dysrhythmias 4Cardiac abnormalities that severely limit normal function 5Advanced cerebral or vascular disease not amenable to correction Correct
The nurse identifies that which intervention is the most suitable for a patient with worsening acute decompensated heart failure (ADHF) that is hemodynamically unstable?
1 Ultrafiltration (UF) 2 Endotracheal intubation 3 Intraaortic balloon pump (IABP) Correct 4Bilevel positive airway pressure (BiPAP) The IABP uses a process called counterpulsation to increase coronary blood flow and decrease the heart's workload. Ultrafiltration is a process to remove excess salt and water from the blood. Endotracheal intubation and BiPAP (bilevel positive airway pressure) help maintain an open airway
What is the priority assessment of the nurse caring for a patient receiving intravenous nesiritide to treat heart failure?
1 Urine output 2 Lung sounds 3 Blood pressure Correct 4 Respiratory rate Although urine output, lung sounds, and respiratory rate are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.
The nurse is caring for a patient with acute decompensated heart failure (ADHF) who is receiving intravenous (IV) milrinone. The nurse recognizes that this medication is beneficial because of what effects it has on the body? Select all that apply.
1. Increased diuresis 2 Dilation of renal blood vessels 3 Increased myocardial contractility Correct 4 Promotion of peripheral vasodilation Correct 5 Increased systemic vascular resistance Milrinone is a phosphodiesterase inhibitor (also known as an inodilator). It increases myocardial contractility (inotropic effect) and promotes peripheral vasodilation. Milrinone does not dilate renal blood vessels and promote diuresis, nor does it increase systemic vascular resistance.
A patient dies of irreversible brain injury. The nurse recognizes that which assessments must be performed to determine the suitability of harvesting the heart for cardiac transplantation? Select all that apply. Gram stain Bronchoscopy ABO blood type Body size and heart size Human leukocyte antigen typing Panel of reactive antibody (PRA) level
ABO blood type Body size and heart size Human leukocyte antigen typing Panel of reactive antibody (PRA) level In order to avoid complications after cardiac transplantation, a careful selection of the donor's heart must be performed. The donor's organ must fulfill certain matching criteria with the recipient. These assessments include: ABO blood type, body size, heart size, human leukocyte antigen, and panel antibody reactive level. Gram stain and bronchoscopy findings are the matching criteria to be fulfilled for lung transplantation
A patient is diagnosed with heart failure, which was caused by thyrotoxicosis. The nurse identifies what other precipitating causes of heart failure? Select all that apply. Anemia Myocarditis Paget's disease Pulmonary embolism Coronary artery disease
Anemia Paget's disease Pulmonary embolism The precipitating causes of heart failure include anemia, in which the oxygen-carrying capacity of the blood is reduced. Hypoxemia leads to an increase in cardiac output, which then increases the workload on the heart. In Paget's disease, there is an increase in the vascular bed in the skeletal muscles, which causes an increase in the cardiac workload. In pulmonary embolism, an increase in pulmonary pressure decreases cardiac output. Myocarditis and coronary artery disease are the primary causes of heart failure but are unlikely in this patient.
The nurse reviews compensatory mechanisms associated with heart failure (HF). The nurse recalls that the sequence of events in the renin-angiotensin-aldosterone system (RAAS) occur in what order? 1. Renin is released. 2. Cardiac output falls. 3. Vasoconstriction occurs. 4. Angiotensinogen is activated. 5. Angiotensin I is converted to angiotensin II.
Cardiac output falls Renin is released Angiotensin is activated Aingiotensin I is converted to II Vasoconstriction occurs In the RAAS, decreased cardiac output leads to release of renin from the kidneys. Renin causes activation of angiotensinogen, which is the enzyme that changes angiotensin I into angiotensin II, which is a potent vasoconstrictor.
The nurse presents information to a group of nursing students about heart transplantation. When listing major causes of death after the first year posttransplantation, what should the nurse include? Infection Acute rejection Immunosuppression Cardiac vasculopathy
Cardiac vasculopathy Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated coronary artery disease [CAD]) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increase the patient's risk of an infection.
A patient is prescribed an angiotensin-converting enzyme (ACE) inhibitor for the treatment of heart failure (HF). The nurse recognizes that this type of medication benefits patients with HF because it blocks what action? 1 Secretion of aldosterone 2 Conversion of pro-renin to renin 3 Conversion of angiotensin I to angiotensin II 4 Conversion of angiotensinogen to angiotensin I
Conversion of angiotensin I to angiotensin II When renal blood flow is reduced, the juxtaglomerular cells secrete renin into circulation. Renin carries out the conversion of angiotensinogen released by the liver to angiotensin I. Angiotensin I is subsequently converted to angiotensin II by the angiotensin-converting enzyme found in the lungs. Angiotensin II also stimulates the secretion of the hormone aldosterone; it causes the reabsorption of sodium and water into the blood, which increases blood pressure.
A patient diagnosed with heart failure is treated with an angiotensin-converting enzyme (ACE) inhibitor. The nurse should monitor the patient for what side effect? Cough Anemia Hyperpigmentation Increased body temperature
Cough Patients treated with angiotensin-converting enzyme (ACE) inhibitors have an increased risk for medication-related cough. Methyldopa causes anemia. Beta blockers alter body temperature. Aspirin can increase melanin production and can cause hyperpigmentation.
A patient with heart failure is hospitalized with a diagnosis of digitalis toxicity. The nurse expects what assessment findings? Select all that apply. Depression Poor appetite Heart rate (HR) of 52 Distant heart sounds Seeing halos around lights Weight gain of 3 pounds in the past two days
Depression Poor appetite Heart rate (HR) of 52 Seeing halos around lights
A patient presents with edema of the legs, dyspnea, and fatigue. The patient is diagnosed with acute decompensated heart failure (ADHF). The nurse expects that which medications will be included in the patient's immediate treatment plan? Select all that apply. Digitalis Dopamine Furosemide Morphine sulfate Sodium nitroprusside
Dopamine Furosemide Morphine sulfate Sodium nitroprusside ADHF should be treated immediately to prevent complications. Furosemide is a loop diuretic used to promote sodium and water loss. Water loss decreases the preload and enhances the cardiac contractility. Sodium nitroprusside is a potent vasodilator and reduces both the preload and afterload. This results in improved cardiac contractility. Dopamine is a beta-adrenergic agonist and is used to dilate the renal vessels and promote water loss. Morphine sulfate reduces preload and afterload; it is frequently used in the treatment of HF and acute coronary syndrome. It dilates pulmonary and systemic blood vessels, resulting in decreased pulmonary pressure and increased gas exchange. Digitalis is a positive inotrope that improves the myocardial contractility. Because it requires a loading dose and time to work, it is not recommended for the initial treatment of ADHF.
The nurse is caring for a patient with right-sided heart failure. Which assessment findings should the nurse expect? Select all that apply. Edema Ascites Crackles Anasarca Wheezes
Edema Ascites Anasarca Edema, ascites, and anasarca are manifestations of right-sided heart failure caused by fluid retention. Crackles and wheezes are manifestations of left-sided heart failure because fluid moves from the pulmonary capillary bed into the pulmonary interstitium and alveoli.
The nurse reviews a patient's medical history and identifies what risk factors for heart failure (HF)? Select all that apply. Cirrhosis Hypertension Multiple sclerosis Marfan's syndrome Metabolic syndrome
Hypertension Metabolic syndrome Hypertension and coronary artery disease (CAD are the primary risk factors for HF. Other co-morbidities, such as diabetes, metabolic syndrome, advanced age, tobacco use, and vascular disease, also contribute to the development of HF. Cirrhosis, multiple sclerosis, and Marfan's syndrome are not precipitating causes of HF.
The nurse reviews the teaching plan that has been created for a patient with chronic heart failure that is being discharged from the hospital. The nurse should question which item that is listed on the plan? Eat small, frequent meals. Obtain the annual flu vaccine. Avoid extremes of heat and cold. Immediately report a weight gain of 5 pounds in 2 days.
Immediately report a weight gain of 5 pounds in 2 days. The patient should be instructed to immediately report a weight gain of 3 pounds in 2 days, or 3-5 pounds in a week. Eating small, frequent meals is a component of the dietary therapy. The patient should be instructed to receive the annual flu vaccination for health promotion. The patient should be instructed to avoid extremes of heat and cold, to prevent stress on the heart.
A patient has undergone cardiac transplantation. The nurse expects that which treatment will be prescribed? Antibiotic therapy Antifungal therapy Immunosuppressive therapy Intravenous immunoglobulin (IVIG) therapy
Immunosuppressive therapy Immunosuppressive therapy is used to suppress the immune system and prevent rejection of the transplanted heart. Intravenous immunoglobulin (IVIG) is a blood product that is administered intravenously. It contains the pooled, polyvalent, and IgG antibodies extracted from the plasma of over one thousand blood donors and is used to boost the immune system. Antibiotic therapy is used to prevent infection. Antifungal therapy is used to treat fungal infections.
A patient with heart failure (HF) receives a prescription for digoxin. The nurse recognizes that this medication benefits patients with HF because of what positive inotropic effect? Increased heart rate Increased stroke volume Increased cardiac output Increased myocardial contractility
Increased myocardial contractility Increase in myocardial contractility is called positive inotropic effect. Increase in heart rate is called positive chronotropic effect. Positive inotropic effect results in an increase in stroke volume and cardiac output.
A patient is diagnosed with early left ventricular heart failure (HF). The nurse recalls that the changes involved in the development of dyspnea associated with the failure occur in what order? Inadequate alveolar gas exchange Ineffective ventricular contractility Elevated pressure in the left atrium Fluid leaking into interstitial spaces
Ineffective ventricular contractility Elevated pressure in the left atrium Fluid leaking into interstitial spaces Inadequate alveolar gas exchange In left ventricular HF, ineffective ventricular contractions impair the normal forward flow of blood to the body. As a result, fluid returning to the heart from the lungs backs up in the heart and increases the pressure in the left atrium. If contractility continues to falter, the blood continues to back up into the pulmonary vasculature and eventually can result in fluid leaking into the interstitial spaces and alveoli of the lungs. This abnormal fluid in the parenchyma and alveoli impairs gas exchange, which causes dyspnea.
The nurse is caring for a patient with worsening heart failure (HF) that is hemodynamically unstable. What is likely to be included in the patient's treatment plan to increase coronary blood flow to the heart muscle? Vasodilators Ultrafiltration Intraaortic balloon pump (IABP) Ventricular assist device (VAD)
Intraaortic balloon pump (IABP) The IABP is a device that increases coronary blood flow to the heart muscle and decreases the heart's workload through a process called counterpulsation. Vasodilators improve the coronary artery circulation by dilating the coronary arteries. Ultrafiltration is the process of removing excess salt and water from the patient's blood. Ventricular assist devices (VADs) are used to maintain the pumping action of the blood, because the contracting ability of the heart decreases, thereby affecting its ability to function.
patient has been diagnosed with dilated cardiomyopathy (DCM). The nurse identifies that the patient is at risk for what condition? 1 Systolic failure 2 Diastolic failure 3 Left ventricular hypertrophy 4 Mixed systolic and diastolic failure
Mixed systolic and diastolic failure Dilated cardiomyopathy is a condition in which already compromised systolic function is further compromised by dilated left ventricular walls, which are unable to relax. With this condition, patients usually have very low ejection factor, as well as biventricular failure, which is a characteristic of mixed systolic and diastolic failure. Systolic failure is characterized by a decrease in left ventricular ejection factor because of the heart's inability to pump blood effectively. Diastolic failure is referred to as a heart failure with normal ejection factor. Left ventricular hypertrophy is the thickening of the left ventricle muscle, which may result in heart failure, but left ventricular hypertrophy is not a type of heart failure itself.
A patient with valvular heart disease has not experienced any symptom of heart failure. How should the nurse classify this patient according to the American College of Cardiology/American Heart Association (ACC/AHA) stages of heart failure (HF)? Stage A Stage B Stage C Stage D
Stage B According to ACC/AHA the nurse should classify this patient as stage B. Stage B patients have structural heart disease without any sign or symptom. Stage A patients are at high risk for HF, but without structural heart disease or symptoms of HF. Stage C patients have prior or current symptoms of HF associated with a known structural heart disease. Stage D patients have refractory HF requiring specialized interventions.
Diagnostic results of a patient reveal an ejection fraction (EF) of 32%. The nurse recognizes that the finding may be indicative of what conditions? Select all that apply. Systolic failure Diastolic failure Myocardial infarction Coronary heart disease Mixed systolic and diastolic failure
Systolic failure Mixed systolic and diastolic failure Ejection factor (EF) is defined as the amount of blood ejected from the left ventricle after each contraction. Normal EF is 55-60%. The hallmark of systolic failure is a decrease in EF (less than 45%). Patients with mixed systolic and diastolic failure have extremely low EF (less than 35%). The EF in diastolic failure is normal. Myocardial infarction is the damage to the heart muscle due to decreased blood flow and oxygen supply, which may or may not result in low EF. Coronary heart disease, if not severe, may not affect the EF.
A patient presents to the emergency department with acute decompensated heart failure (ADHF) and indications of alveolar edema. The nurse expects what assessment findings? Select all that apply. Tachypnea Lower PaO2 Increased glucose levels Changes in metabolic status Increased partial pressure of CO2 in arterial blood (PaCO2)
Tachypnea Lower PaO2 ncreased partial pressure of CO2 in arterial blood (PaCO2) When the pulmonary venous pressure increases, the alveoli lining cells are disrupted and a fluid containing red blood cells moves into the alveoli (alveolar edema). As the disruption becomes worse from further increases in the pulmonary venous pressure, the alveoli and airways are flooded with fluid. This is accompanied by a worsening of the arterial blood gases (i.e., lower PaO2 and possible increased partial pressure of CO2 in arterial blood and progressive respiratory alkalosis). Abnormalities in the glucose levels and metabolic status of the patient do not indicate alveolar edema
The nurse is providing discharge education for a patient with moderate heart failure. What physical activity is recommended and should be included in the plan of care? Walking briskly every day for two hours Staying on bed rest as much as possible Taking frequent rest breaks during activities Holding all activity until prescribed by the doctor
Taking frequent rest breaks during activities A patient with moderate heart failure should be encouraged to participate in daily moderate physical activity as tolerated and to take frequent breaks to prevent fatigue. Bed rest is not recommended for patients with moderate heart failure. Walking briskly is too strenuous for this patient. Activity is standardized for patients with heart failure and is included in the plan of care.
Which is considered decisional capacity for informed consent related to treatment decisions? The patient must be able to read the treatment consent. The patient must be able to communicate his or her decisions. The health care provider strongly encourages the patient to choose a specific option for treatment. The patient must have an advance directive listing the patient's decisions for life-sustaining treatment.
The patient must be able to communicate his or her decisions. Decisional capacity for informed consent related to treatment requires that the patients must be able to communicate their decisions. Information provided about possible treatments must be understandable to patients, but patients do not have to read the consent form themselves. An advance directive is not reflective of a patient's decisional capacity; it is a written document. The patient's decisions must be freely chosen and made without coercion.
Which compensatory mechanisms are initially effective in maintaining adequate cardiac output (CO)? Select all that apply. Ventricular dilation Ventricular hypertrophy Production of endothelin Release of renin by the kidneys Activation of the sympathetic nervous system (SNS)
Ventricular dilation Ventricular hypertrophy Activation of the sympathetic nervous system (SNS) Increased contraction due to dilation initially leads to increased CO and maintenance of BP and perfusion. The increased contractile power of the heart's muscle fibers due to hypertrophy initially leads to an increase in CO and maintenance of tissue perfusion. The SNS responds by releasing catecholamines (epinephrine and norepinephrine), which enhance peripheral vasoconstriction and cause an increase in HR and myocardial contractility. Initially, this compensatory mechanism is beneficial with a result of increased CO. Endothelin is a potent vasoconstrictor; it contributes to the development of HF. The release of renin by the kidneys starts a cascade of events, which results in further water and sodium retention in an already overloaded state