Heart Failure

A patient with chronic heart failure receives a prescription for an angiotensin-converting enzyme (ACE) inhibitor. The nurse should monitor the patient for what major side effect? Hypokalemia Angioedema Inability to swallow Symptomatic hypertension

A major side effect of ACE inhibitors is angioedema, which is an allergic condition involving edema of face and airways. It is a life-threatening condition. Other major side effects include symptomatic hypotension, intractable cough, hyperkalemia, and renal insufficiency. An inability to swallow is not a major side effect. p. 747

A patient with heart failure complains of fatigue. The nurse understands that which causes of fatigue are associated with heart failure? Anemia Increased cardiac output Increased oxygen to tissues Increased perfusion to organs

Anemia related to heart failure is caused by poor nutrition, renal disease, and angiotensin-converting enzyme. This leads to fatigue

A patient who underwent cardiac transplantation has a blood pressure of 150/98 mm Hg. The nurse anticipates that which medication will be prescribed to prevent excessive workload on the transplanted heart? Captopril Tacrolimus Cyclosporine Mycophenolate mofetil

Angiotensin-converting enzyme (ACE) inhibitors, such as captopril, are the first-line drug therapy prescribed for hypertension in patients after cardiac transplantation. ACE inhibitors dilate venules and arterioles, improve renal blood flow, and relieve symptoms of heart failure. Tacrolimus, cyclosporine, and mycophenolate mofetil are immunosuppressants that are administered to prevent acute rejection. p. 745

The nurse provides education about a 2-gram sodium diet to a patient with heart failure. Which statement made by the patient indicates the need for further teaching? "I can eat fresh fruits, such as bananas and peaches." "I will limit my intake of milk products to two cups a day." "Bread is a good food choice because it has a very low salt content." "When I eat canned soups, I will need to choose soups low in sodium."

"Bread is a good food choice because it has a very low salt content." Bread has a high sodium content and should be avoided or limited. One slice of whole wheat bread has 149 mg of sodium. Fresh fruits have very little sodium. One medium banana has a sodium content of 1 mg, and one medium peach has a sodium content of 7 mg. Milk products are limited to two cups daily to adhere to a low sodium diet. Canned soups have high sodium content. If canned soup is used, choose a low sodium soup. p. 749

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 2. Cataracts 3. Deep vein thrombosis 4. Cytomegalovirus (CMV) infection 5. Epstein-Barr virus (EBV) infection

1. Cancer 4. Cytomegalovirus (CMV) infection 5. Epstein-Barr virus (EBV) infection The risk of cancer is increased following long-term immunosuppressive therapy. In the first year after transplantation, the major causes of death are infection and acute rejection. CMV infection may occur within the first few months after transplantation. EBV infection may happen in the first year, and it is a major cause of death after immunosuppressive therapy. Cataracts are not a consequence of reduced immunity. Deep vein thrombosis usually arises as a result of surgical complications.

A patient is suspected of having heart failure. The nurse recognizes that which diagnostic tests are commonly used to make this diagnosis? Select all that apply. 1. Chest x-ray 2. Echocardiogram 3. Pulmonary function tests 4. Electrocardiogram (ECG) 5. Electroencephalogram (EEG)

1. Chest x-ray 2. Echocardiogram 4. Electrocardiogram (ECG) Heart failure can be determined by diagnostic tests such as ECG, echocardiogram, and chest x-ray. An ECG is useful in examining the electrical conduction system of the heart, which becomes impaired during heart failure. An echocardiogram is used to assess the functioning of the cardiac chambers. A chest x-ray may show cardiomegaly. An EEG is useful in diagnosing diseases of the brain, especially seizures. Pulmonary function tests are usually advised in lung diseases associated with cardiac symptoms. pp. 743-744

A patient that is admitted to the emergency department is diagnosed with acute decompensated heart failure (ADHF), manifesting as pulmonary edema. The nurse expects to observe which clinical manifestations? Select all that apply. 1. Dyspnea 2. Dry, warm skin 3. Rapid heart rate 4. Decreased respiratory rate 5. Frothy, blood-tinged sputum

1. Dyspnea 3. Rapid heart rate 5. Frothy, blood-tinged sputum The clinical manifestations of pulmonary edema include dyspnea, rapid heart rate, and frothy, blood-tinged sputum. The skin usually becomes clammy and cold from the vasoconstriction caused by the stimulation of the sympathetic nervous system. The respiratory rate is often greater than 30 breaths per minute.

The nurse is caring for a patient admitted to the intensive care unit with heart failure. The patient is prescribed IV sodium nitroprusside. Which actions should the nurse take when administering the medication? Select all that apply. 1. Monitor arterial BP. 2. Ensure a slow rate of administration. 3. Place the patient in high Fowler's position. 4. Monitor the IV site carefully since the patient is at high risk of extravasation. 5. Record baseline blood pressure and continuously throughout administration.

1. Monitor arterial BP. 2. Ensure a slow rate of administration. 5. Record baseline blood pressure and continuously throughout administration. Hypotension is the main adverse effect. When preparing to administer the vasodilator nitroprusside, the nurse should assess the patient's blood pressure before and during the administration. Arterial BP monitoring is also recommended during drug infusion. The nurse should ensure a slow rate of IV administration to prevent a sudden reduction in blood pressure. The patient is not at an increased risk of extravasation when receiving this medication. A patient with dyspnea is placed in high Fowler's position. p. 745

A patient is admitted to the hospital with heart failure (HF). The nurse should monitor the patient for what complications? Select all that apply. 1. Pleural effusion 2. Dysrhythmias 3. Hepatomegaly 4. Renal failure 5. Thyrotoxicosis

1. Pleural effusion 2. Dysrhythmias 3. Hepatomegaly 4. Renal failure A 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.

A patient is diagnosed with heart failure. The nurse identifies that which factors may influence the patient's cardiac output? Select all that apply. 1. Stroke volume 2. Portal pressure 3. Respiratory rate 4. Myocardial contractility 5. Decreased filling of the ventricles

1. Stroke volume 4. Myocardial contractility 5. Decreased filling of the ventricles Cardiac output depends on various factors such as stroke volume, decreased filling of the ventricles, and myocardial contractility. Stroke volume x heart rate = cardiac output (CO). Decreased filling of the ventricles decreases cardiac output. Impaired myocardial contractility decreases cardiac output. Respiratory rate and portal pressure do not alter cardiac output. pp. 738, 740

What events occur as a result of ventricular remodeling? Select all that apply. 1. Increased contractility 2. Increased wall tension 3. More effective pumping 4. Increased ventricular mass 5. Increased O 2 consumption

2,4,5 Increased wall tension Increased ventricular mass Increased O 2 consumption Remodeling involves hypertrophy of the ventricular myocytes. This results in large, abnormally shaped contractile cells. This altered shape of the ventricles eventually leads to increased ventricular mass, increased wall tension, increased O 2consumption, and impaired contractility. Although the ventricles become larger, they become less effective pumps. p. 740

The nurse reviews a patient's medical history and identifies what risk factors for heart failure (HF)? Select all that apply. 1. Cirrhosis 2. Hypertension 3. Multiple sclerosis 4. Marfan's syndrome 5. Metabolic syndrome

2. Hypertension 5. 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. pp. 737-738

The nurse reviews a patient's medical history and identifies what risk factors for heart failure (HF)? Select all that apply. 1. Cirrhosis 2. Hypertension 3. Multiple sclerosis 4. Marfan's syndrome 5. Metabolic syndrome

2. Hypertension 5. 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. pp. 737-738

What events occur as a result of ventricular remodeling? Select all that apply. 1. Increased contractility 2. Increased wall tension 3. More effective pumping 4. Increased ventricular mass 5. Increased O 2 consumption

2. Increased wall tension 4. Increased ventricular mass 5. Increased O 2 consumption Remodeling involves hypertrophy of the ventricular myocytes. This results in large, abnormally shaped contractile cells. This altered shape of the ventricles eventually leads to increased ventricular mass, increased wall tension, increased O 2 consumption, and impaired contractility. Although the ventricles become larger, they become less effective pumps. p. 740

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. 1. Gram stain 2. Bronchoscopy 3. ABO blood type 4. Body size and heart size 5. Human leukocyte antigen typing 6. Panel of reactive antibody (PRA) level

3. ABO blood type 4. Body size and heart size 5. Human leukocyte antigen typing 6. Panel of reactive antibody (PRA) level

A patient with a history of left-sided heart failure arrives in the emergency department reporting extreme shortness of breath and a persistent cough with pink, frothy sputum. On auscultation of the heart, the nurse notes an S 3 gallop. The nurse recognizes those symptoms as being caused by what? Pneumonia An asthma attack A myocardial infarction Acute pulmonary edema

Acute pulmonary edema Extreme shortness of breath and a persistent cough with pink, frothy sputum are symptoms of pulmonary edema. Pneumonia, an asthma attack, and a myocardial infarction are not correct because pink frothy sputum and an S 3 gallop are not symptoms of any of these. p. 742

The nurse recognizes that a primary goal for a patient with chronic heart failure is what? Maximizing cardiac output Maintaining an ideal body weight Performing daily aerobic exercises Maintaining a steady pulse oximetry reading

An increase in cardiac output helps overcome chronic heart failure, thereby maintaining the blood flow to meet the body's demand. Being overweight is just one risk factor for chronic heart failure; maintaining ideal body weight may not be a goal for some patients. Performing daily aerobic exercises may be too strenuous on the heart. There are many risk factors to consider when determining treatment goals. Pulse oximetry is used to monitor the effectiveness of oxygen therapy, and achievement of a steady reading is not a practical or primary goal. p. 746

The nurse provides medication education to a patient with heart failure. The nurse explains that the drug's mechanism of action is to reverse ventricular remodeling and to decrease cardiac workload by inhibiting catecholamines. Which drug is the nurse referring to? Digitalis Carvedilol Dopamine Furosemide

Carvedilol is a β-adrenergic blocker that inhibits the sympathetic nervous system, preventing the release of catecholamines. (Catecholamines increase heart rate and myocardial contractility, which increases the workload of the heart.) Carvedilol also promotes reverse remodeling and decreases afterload. Furosemide is a diuretic and does not have those sympathetic nervous system (SNS)-blocking effects. Digitalis and dopamine are inotropic drugs that serve to increase contractility and do not block SNS stimulation. p. 745

Epinephrine and norepinephrine are released in response to decreased cardiac output that occurs in patients with heart failure. These catecholamines can cause what physiologic change? Vasodilation Decreased heart rate Decreased blood pressure Increased myocardial oxygen demand

Increased myocardial oxygen demand Catecholamines increase heart rate and contractility, which increase myocardial workload and oxygen demand. Catecholamines cause vasoconstriction (not vasodilation), an increased heart rate (not decreased), and an increase in blood pressure (not decrease). pp. 739-740

process to remove excess salt and water from the blood

Ultrafiltration

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

The nurse recalls that many disease conditions predispose a patient to heart failure. Which patients need further assessment to evaluate their risk of developing heart failure? Select all that apply. 1. A patient with anemia 2. A patient with thyrotoxicosis 3. A patient with Paget's disease 4. A patient with a fracture of ribs 5. A patient with bacterial endocarditis

1. A patient with anemia 2. A patient with thyrotoxicosis 3. A patient with Paget's disease 5. A patient with bacterial endocarditis Many diseases can increase the risk of heart failure in patients. In anemia, decreased oxygen-carrying capacity of the blood stimulates an increase in cardiac output to meet the demands of the body. This causes an increase in the cardiac workload, leading to an increase in the size of the left ventricle. Thyrotoxicosis increases the tissue metabolic rate, leading to an increase in heart rate and workload of the heart. The increased workload results in heart failure. The infection in bacterial endocarditis increases metabolic demands and oxygen requirements. The valvular dysfunction in bacterial endocarditis may lead to stenosis and regurgitation. All of these factors lead to enlargement of the ventricle, resulting in heart failure. Paget's disease causes increased workload of the heart due to an increased vascular bed in the skeletal muscles. A fracture of the ribs does not affect heart function. p. 738

The nurse is preparing a discharge plan for a patient with heart failure (HF). The patient does not drive and does not have family members or friends to assist with transportation. What actions should the nurse take related to post-discharge care? Select all that apply. 1. Arranging for home health care 2. Providing printed medication instructions 3. Arranging for transportation for follow-up appointments. 4. Discussing the importance of eating three large meals per day. 5. Coordinating equipment for at-home monitoring, including an electronic scale, a blood pressure cuff, and a pulse oximeter

1. Arranging for home health care 2. Providing printed medication instructions 3. Arranging for transportation for follow-up appointments. 5. Coordinating equipment for at-home monitoring, including an electronic scale, a blood pressure cuff, and a pulse oximeter Effective discharge planning for a patient with HF is critical to prevent hospitalization. Providing the patient with necessary resources in order to manage his or her health helps to reduce any health care disparity. Home health nursing care of HF patients is vital in reducing the number of hospitalizations, increasing functional capacity, and improving the quality of life. Teaching the patient to take medications as prescribed is important to manage HF at home and prevent readmission. Providing transportation resources for the patient increases the patient's access to care. Telehealth monitoring technology to collect physiologic data can prevent future hospitalizations and help manage patients with HF at home. Patients with heart failure should be taught to eat small, frequent meals, not three large meals per day.

A patient with heart failure is hospitalized with a diagnosis of digitalis toxicity. The nurse expects what assessment findings? Select all that apply. 1. Depression 2. Poor appetite 3. Heart rate (HR) of 52 4. Distant heart sounds 5. Seeing halos around lights 6. Weight gain of 3 pounds in the past two days

1. Depression 2. Poor appetite 3. Heart rate (HR) of 52 5. Seeing halos around lights Poor appetite (e.g., anorexia), decreased heart rate (due to digitalis preparations causing a decrease in HR), depression, and visual changes (e.g., seeing halos around lights) are all symptoms of digitalis toxicity. "Distant heart sounds" is not a correct answer; they are a symptom of pericarditis. Weight gain of 3 pounds in the past two days is not correct; it is a symptom of possible exacerbation of heart failure and fluid retention. p. 748

While performing cardiac assessment, the nurse finds that a patient's right atrial pressure is 12 mm Hg. Which other findings will the nurse most likely observe? Select all that apply. 1. Distended neck veins 2. Enlarged cardiac muscle 3. Engorged or enlarged liver 4. Decreased afterload in the ventricle 5. Decreased resistance to blood ejection

1. Distended neck veins 2. Enlarged cardiac muscle 3. Engorged or enlarged liver The normal right atrial pressure is in the range of 2 to 6 mm Hg. A right atrial pressure of 12 mm Hg is elevated. The veins of the neck reflect venous tone, blood volume, and right atrial pressure. Therefore distention of neck veins is indicative of elevated right atrial pressure. Elevated arterial blood pressure gives the ventricles increased resistance to eject blood and thus increases the work demand, resulting in ventricular hypertrophy, an enlargement of the cardiac muscle tissue without an increase in cardiac output. Elevated right atrial pressure increases resistance to blood flow and can result in liver engorgement. Elevated right atrial pressure can increase afterload and resistance to blood ejection. pp. 737-739

While performing cardiac assessment, the nurse finds that a patient's right atrial pressure is 12 mm Hg. Which other findings will the nurse most likely observe? Select all that apply. 1. Distended neck veins 2. Enlarged cardiac muscle 3. Engorged or enlarged liver 4. Decreased afterload in the ventricle 5. Decreased resistance to blood ejection

1. Distended neck veins 2. Enlarged cardiac muscle 3. Engorged or enlarged liver The normal right atrial pressure is in the range of 2 to 6 mm Hg. A right atrial pressure of 12 mm Hg is elevated. The veins of the neck reflect venous tone, blood volume, and right atrial pressure. Therefore distention of neck veins is indicative of elevated right atrial pressure. Elevated arterial blood pressure gives the ventricles increased resistance to eject blood and thus increases the work demand, resulting in ventricular hypertrophy, an enlargement of the cardiac muscle tissue without an increase in cardiac output. Elevated right atrial pressure increases resistance to blood flow and can result in liver engorgement. Elevated right atrial pressure can increase afterload and resistance to blood ejection pp. 737-739

The nurse is caring for a patient with right-sided heart failure. Which assessment findings should the nurse expect? Select all that apply. 1. Edema 2. Ascites 3. Crackles 4. Anasarca 5. Wheezes

1. Edema 2. Ascites 4. 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 assesses a patient with a family history of heart failure. Which primary causes of heart failure are linked to specific genes and gene mutations? Select all that apply. 1. Hypertension 2. Hyperthyroidism 3. Cardiomyopathy 4. Rheumatic heart disease 5. Coronary artery disease (CAD)

1. Hypertension 3. Cardiomyopathy 5. Coronary artery disease (CAD) Primary causes of heart failure linked to specific genes and gene mutations include coronary artery disease, cardiomyopathy, and hypertension. Hyperthyroidism and rheumatic heart disease are primary causes of heart failure that are not linked to specific genes and gene mutation. Some of the precipitating causes of heart failure include anemia, hypothyroidism, and infection. p. 738

What effect does nitroglycerin have on the body that benefits a patient with acute decompensated heart failure (ADHF)? Select all that apply. 1. Reduces preload 2. Prevents dysrhythmias 3. Prevents thromboembolism 4. Dilates the coronary arteries 5. Increases myocardial oxygen supply

1. Reduces preload 4. Dilates the coronary arteries 5. Increases myocardial oxygen supply Nitroglycerin is a vasodilating medication that improves blood flow to the myocardium and, by vasodilating, decreases preload as well. Nitroglycerin has no dysrhythmic properties and does not prevent thromboembolism. p. 745

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. 1. Systolic failure 2. Diastolic failure 3. Myocardial infarction 4. Coronary heart disease 5. Mixed systolic and diastolic failure

1. Systolic failure 5. 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. pp. 738-739

Which compensatory mechanisms are initially effective in maintaining adequate cardiac output (CO)? Select all that apply. 1. Ventricular dilation 2. Ventricular hypertrophy 3. Production of endothelin 4. Release of renin by the kidneys 5. Activation of the sympathetic nervous system (SNS)

1. Ventricular dilation 2. Ventricular hypertrophy 5. 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 pp. 739-740

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. 1. Digitalis 2. Dopamine 3. Furosemide 4. Morphine sulfate 5. Sodium nitroprusside

2. Dopamine 3. Furosemide 4. Morphine sulfate 5. 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. pp. 745-746

The nurse recognizes what indications for cardiac transplantation? Select all that apply. 1. Angina pectoris 2. Myocardial ischemia 3. Severe, decompensated, inoperable, valvular disease 4. End stage heart failure (HF) refractory to medical care 5. Cardiac abnormality that has a mortality rate of more than 50% within two years 6. Recurrent life-threatening dysrhythmias not responsive to maximal interventions

3. Severe, decompensated, inoperable, valvular disease 4. End stage heart failure (HF) refractory to medical care 5. Cardiac abnormality that has a mortality rate of more than 50% within two years 6. Recurrent life-threatening dysrhythmias not responsive to maximal interventions 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. p. 753

The nurse recognizes that which condition is an absolute contraindication for cardiac transplantation? Morbid obesity Irreversible kidney dysfunction Uncontrolled diabetes mellitus with vascular complications Advanced cerebral or peripheral vascular disease not amenable to correction

Advanced cerebral or peripheral vascular disease not amenable to correction For cardiac transplantation, the absolute contraindication is advanced cerebral or peripheral vascular disease not amenable to correction. It may result in life-threatening complications after the transplantation. Other conditions such as morbid obesity, irreversible kidney dysfunction, and uncontrolled diabetes mellitus are relative contraindications.

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? Secretion of aldosterone Conversion of pro-renin to renin Conversion of angiotensin I to angiotensin II 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 states, "For my heart failure, I take hydrochlorothiazide. I take a second medication that helps improve my heart's contractility." The patient's assessment findings include hypokalemia, headache, and anorexia. The nurse suspects that the second medication the patient is referring to is what drug? Digoxin Captopril Carvedilol Metolazone

Digitalis preparations increase the force of cardiac contractility. Patients taking a digitalis preparation are at risk for digitalis toxicity. Early signs of toxicity include anorexia and headache. Hypokalemia, secondary to the use of potassium-depleting diuretics (e.g., thiazides), is one of the most common causes of digitalis toxicity. Severe hypotension and hypokalemia is seen with captopril. Carvedilol may cause profound bradycardia, hypotension, and cardiogenic shock. Metolazone causes severe reduction in potassium levels and inhibits sodium reabsorption.

The nurse recognizes the need for more frequent monitoring of electrolytes when a patient that takes digitalis receives a prescription for what type of medication? Nitrate Diuretic β-adrenergic blocker Angiotensin-converting enzyme (ACE) inhibitor

Diuretic

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?? Chest x-ray Intraarterial BP Endomyocardial biopsy (EMB) Multigated acquisition (MUGA) scan

Endomyocardial biopsy (EMB) 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. p. 744

The nurse is assessing a patient with a diagnosis of left-sided heart failure (HF). The nurse should monitor the patient for which characteristic symptom that occurs exclusively with this disorder? Fatigue Anxiety Anorexia Frothy, pink-tinged sputum

Frothy, pink-tinged sputum Frothy, pink-tinged sputum is a characteristic symptom associated with left-sided HF. Fatigue and anxiety are present as a common symptom both in right-sided and left-sided HF. Anorexia is exclusively a symptom of right-sided HF. P.742

The nurse is assessing a patient with a diagnosis of left-sided heart failure (HF). The nurse should monitor the patient for which characteristic symptom that occurs exclusively with this disorder? Fatigue Anxiety Anorexia Frothy, pink-tinged sputum

Frothy, pink-tinged sputum is a characteristic symptom associated with left-sided HF. Fatigue and anxiety are present as a common symptom both in right-sided and left-sided HF. Anorexia is exclusively a symptom of right-sided HF. p. 742

A patient newly diagnosed with heart failure is being discharged from the hospital. Which health care team member frequently works with protocols set up with the patient's health care provider to identify problems and start interventions? Physical therapist Home health nurse Occupational therapist Social services provider

Home health nurses frequently work with protocols set up with the patient's health care provider. The protocols help the patient to identify problems, such as an increase in weight or dyspnea, both of which are symptoms of worsening heart failure. Physical therapy or occupational therapy may not be needed. Social services can assist with obtaining community resources the patient may need. p. 752

What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure? Acute anxiety Hypotension and tachycardia Peripheral edema and weight gain Paroxysmal nocturnal dyspnea (PND)

Hypotension & Tachycardia Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine

The nurse is educating a patient about diastolic failure and should include what characteristic feature? High pulmonary pressures Decrease in ejection fraction (EF) Inability of the ventricles to relax and fill Inability of the ventricles to pump blood effectively

Inability of the ventricles to relax and fill Diastolic failure is the inability to relax and fill the ventricles during diastole. Systolic failure is the inability of the heart to pump blood effectively. Patients with mixed systolic and diastolic failure experience high pulmonary pressures. The EF is normal with diastolic failure. p. 738

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. P. 746, 748

A patient attends a follow-up visit at a clinic, six months after receiving a heart transplant. The nurse recognizes that the patient is at risk for what major cause of death? Infection Malignancy Vasculopathy Sudden cardiac death

Infection Because of the use of immunosuppressive therapy, infection is a primary complication after transplant surgery. Malignancy (especially lymphoma) and cardiac vasculopathy are major causes of death later, after the first year following the transplant. Sudden cardiac death rarely occurs posttransplant. p. 754

The nurse identifies that which intervention is the most suitable for a patient with worsening acute decompensated heart failure (ADHF) that is hemodynamically unstable? Ultrafiltration (UF) Endotracheal intubation Intraaortic balloon pump (IABP) Bilevel positive airway pressure (BiPAP)

Intraaortic balloon pump (IABP)

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. P. 744-745

The nurse reviews the laboratory results of a patient with heart failure (HF) who receives a prescription for digoxin. The nurse decides to withhold the medication based on abnormal findings of what blood study? Potassium Thyroid function tests White blood cells (WBCs) Blood urea nitrogen (B.U.N.)

Low serum potassium enhances the actions of digitalis, causing a therapeutic dose to reach toxic levels. Similarly, hyperkalemia inhibits the actions of digitalis, resulting in subtherapeutic dose. Monitor serum potassium levels of all patients taking digitalis. The results of a B.U.N., WBCs, or thyroid function tests do not affect the nurse's decision to administer or to withhold digoxin. p. 748

A nurse is caring for a patient with pleural effusion who is not responding to conventional medical treatment. Assessment findings include S 3 and S 4 heart sounds, crackles, and an increased heart rate. Which condition is most likely affecting the patient? Cor pulmonale Pulmonary edema Left-sided heart failure Right-sided heart failure

Manifestations of left-sided heart failure include pleural effusion, S 3 and S 4 heart sounds, crackles, and increased heart rate. These symptoms indicate a low cardiac output. Cor pulmonale is the dilation of the right ventricle caused by pulmonary diseases. It manifests as right heart failure. Right-sided heart failure causes edema, murmurs, and jugular vein distention. Pulmonary edema manifests as dyspnea, orthopnea, anxiety, and cold and clammy skin. p. 742

The nurse expects that which drug will be prescribed to a patient with heart failure (HF), to treat the compensatory increase in the heart rate and the renin release that occurs as a result of the failure? Digoxin Milrinone Metoprolol Dobutamine

Metoprolol is a β-adrenergic blocker, which helps prevent an increase in the heart rate and renin release by inhibiting the sympathetic nervous system. Digoxin decreases the heart rate but does not decrease the renin release. Milrinone increases the heart's contractility and decreases the pulmonary vascular resistance. Dobutamine is a β-adrenergic agonist that increases cardiac contractility. p. 745

A patient has been diagnosed with dilated cardiomyopathy (DCM). The nurse identifies that the patient is at risk for what condition? Systolic failure Diastolic failure Left ventricular hypertrophy 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. p. 738

The nurse would suspect digitalis toxicity when the patient reports which symptom? Nausea Diarrhea Ringing in the ears Shortness of breath

Nausea Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias all are signs of digitalis toxicity. The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms. Shortness of breath, ringing in the ears, and diarrhea are not symptoms associated with digoxin toxicity.

A patient is diagnosed with left ventricular hypertrophy that resulted from untreated hypertension. The nurse should monitor the patient for symptoms of what condition? Poor contractility Less O 2 requirement Decreased ventricular irritability Rich coronary arterial circulation

Poor contractility is a complication seen in patients who have hypertrophy of the cardiac walls. The heart muscle, which undergoes hypertrophy, increases in muscle mass and cardiac wall thickness, due to overwork and strain. As a result, the hypertrophic heart muscle exhibits poor contractility over time. Hypertrophic heart muscle is more irritable and, thus, prone to dysrhythmias. A hypertrophic heart requires more oxygen (O 2) to perform work. Because the tissue in a hypertrophic heart becomes ischemic more easily, there is poor coronary artery circulation. p. 740

The nurse notices that a patient with pulmonary edema experiences shortness of breath while lying down. What is the most likely reason for the development of orthopnea in this patient? Heart failure Hypertension Pulmonary failure Pulmonary congestion

Pulmonary congestion In pulmonary edema, there is congestion in the lungs, which causes inadequate oxygenation. In a recumbent position, the congestion is further increased, causing further hypoxemia, which causes orthopnea, or shortness of breath while lying down. Orthopnea does not indicate heart failure but is an early sign of heart failure. Hypertension and pulmonary failure are found in later stages of heart failure. p. 742

A patient is diagnosed with left-sided heart failure. The nurse should carefully monitor the patient for what complication? Hepatomegaly Splenomegaly Vascular congestion Pulmonary congestion

Pulmonary congestion The most common form of heart failure is left-sided heart failure. It results from left ventricular dysfunction. This prevents normal, forward blood flow and causes blood to back up into the left atrium and pulmonary veins. There would be fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli; this manifests as pulmonary congestion and edema. Right-sided heart failure occurs when the right ventricle fails to contract effectively. p. 742

A patient with a recent diagnosis of heart failure (HF) has been prescribed furosemide. The nurse recognizes that the medication is appropriate for the patient because of what physiologic effect it has on the body? Reduces preload Decreases afterload Increases contractility Promotes vasodilation

Reduce preload Diuretics such as furosemide are used in the treatment of heart failure to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not influence directly afterload, contractility, or vessel tone. p. 745

A patient in heart failure experiences a neurohormonal response of the renin-angiotensin-aldosterone system (RAAS). What does this response trigger? Vasodilation Decreased cardiac output Retention of sodium and water Decreased release of the antidiuretic hormone (ADH)

Retention of sodium and water When activated repeatedly, the RAAS triggers retention of fluid and sodium. It causes vasoconstriction to increase blood pressure, not vasodilation. Cardiac output is increased, not decreased, and ADH release is increased, not decreased. p. 739

The assessment findings of a patient with myocardial infarction (MI) include jugular venous distention, weight gain, peripheral edema, and a heart rate of 108/minute. The nurse suspects what complication? Left-sided HF Right-sided HF Chronic heart failure (HF) Acute decompensated heart failure (ADHF)

Right-sided HF

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? Digoxin Captopril Carvedilol Spironolactone

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 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. p. 741

The nurse reviews the pathophysiology of heart failure. Which compensatory mechanism results in increased heart rate, increased myocardial contractility, and peripheral vasoconstriction? Ventricular dilation Ventricular hypertrophy Neurohormonal response Sympathetic nervous system (SNS) activation

Sympathetic nervous system (SNS) activation SNS activation is often the first mechanism triggered in low-cardiac output states. In response to an inadequate stroke volume and cardiac output, SNS activation increases, resulting in the increased release of catecholamines (epinephrine and norepinephrine). This results in increased heart rate, increased myocardial contractility, and peripheral vasoconstriction. Initially, this increase in heart rate and contractility improves cardiac output. However, over time these factors are harmful because they increase the already failing heart's workload and need for oxygen. Ventricular dilation, ventricular hypertrophy, and neurohormonal response do not cause increased heart rate, increased myocardial contractility, and peripheral vasoconstriction. pp. 739-740

A patient with cardiac failure is scheduled to receive sodium nitroprusside. The nurse should monitor what parameter while administering the drug to the patient? Blood pressure Body temperature Heart rate and pulse rate Central venous pressure

Symptomatic hypotension is a major adverse effect of sodium nitroprusside; therefore, blood pressure is continuously monitored in patients taking sodium nitroprusside. Body temperature, heart rate, and central venous pressure are not altered due to administration of this drug. p. 745

The nurse recalls that symptoms of right-sided heart failure are caused by what condition? Decreased preload Increased cardiac output Fluid congestion in the lungs Systemic venous congestion

Systemic venous congestion The symptoms of right-sided heart failure are caused by the backup of blood into the venous system. Fluid congestion in the lungs is a symptom of left-sided heart failure. Decreased preload is not correct; preload in right-sided heart failure is increased. Increased cardiac output is not correct; cardiac output is decreased in right-sided heart failure

A patient who underwent cardiac transplantation exhibits signs of acute rejection. The nurse recognizes that which medication is often used as posttransplantation therapy to prevent this type of response? Ibuprofen Metoprolol Tacrolimus Acetaminophen

Tacrolimus is a calcineurin that is included in most immunosuppressive regimens. Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) used to treat pain. Metoprolol is a beta-blocker that is used to treat hypertension. Acetaminophen is a nonsteroidal antiinflammatory drug (NSAID) that is used to treat pain and fever. p. 754

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. p. 746

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.

A patient is admitted to the hospital with heart failure. Following an assessment, the primary health care provider classifies the patient as NYHA II. The nurse recognizes that what is the most likely reason for this classification? The patient is unable to perform daily chores, like dressing oneself. The patient experiences dyspnea even at rest, and discomfort increases with activities. The patient experiences no dyspnea when resting or when performing daily routine activity. The patient reports feeling comfortable at rest but that ordinary physical activity causes fatigue.

The patient reports feeling comfortable at rest but that ordinary physical activity causes fatigue. According to the NYHA functional classification of heart disease, the patient belongs to Class II, in which there are no symptoms at rest. The patient can perform daily routine activities but tires easily and experiences palpitations and dyspnea. In Class I, ordinary physical activity does not cause fatigue or dyspnea, and there is no limitation of physical activity. In Class III, there is inability to perform daily chores like dressing oneself. The patient may be comfortable at rest. In Class IV, the patient has symptoms even at rest and is unable to carry out any activity without discomfort. p. 741

The nurse is caring for a patient with manifestations of acute decompensated heart failure (ADHF). What is the prioritynursing assessment? Lung sounds Facial swelling Level of anxiety Intake and output

The priority nursing assessment is auscultation of lung sounds. Excess fluid volume often leads to pulmonary congestion. ADHF can manifest as pulmonary edema. Facial swelling is a possible side effect with prescribed renin-angiotensin-aldosterone inhibitors for heart failure. It is important to assess the patient's anxiety, but it is not the priority. Assessing intake and output is important for right-sided heart failure. p. 741

Which device is approved as a bridge to transplantation (BTT) and as destination therapy (DT) for those patients who do not meet criteria for a heart transplant? HeartWare Thoratec HeartMate II AB5000 Circulatory Support System BVS 5000 Biventricular Support System

Thoratec HeartMate II The Thoratec HeartMate II is approved as a bridge to transplantation (BTT) and as destination therapy (DT) for those patients who do not meet criteria for a heart transplant. The AB 5000 Circulatory Support System and the BVS 5000 Biventricular Support System provide temporary support for one or both sides of the heart in situations in which the heart has failed but has the potential to recover. The HeartWare device is currently only approved as a BTT.

The nurse encourages the patient diagnosed with chronic heart failure to obtain physical and emotional rest. What is the rationale that is offered by the nurse to the patient? To relieve dyspnea and fatigue To increase oxygen saturation of blood To involve the patient in cardiac rehabilitation To decrease the need for additional oxygen

To decrease the need for additional oxygen Physical and emotional activities may cause additional utilization of oxygen. Therefore the patient is advised to take rest to conserve energy and prevent additional use of oxygen. Administration of oxygen relieves dyspnea and fatigue. Taking physical and emotional rest do not affect oxygen saturation of the blood. Asking the patient to take rest may help conserve energy but would not motivate the patient to participate in cardiac rehabilitation. p 746

The nurse reviews the assessment findings of a patient with acute decompensated heart failure (ADHF) and notes a pulmonary artery wedge pressure (PAWP) of 28 mm Hg, an intake of 1000 mL more than the output in 24 hours, and resistance to diuretics. The nurse anticipates a prescription for which clinical intervention? Oxygen therapy Ultrafiltration (UF) Biventricular pacing Cardiac transplantation

Ultrafiltration (UF) In a patient with acute decompensated heart failure, the pulmonary artery wedge pressure (PAWP) can be as high as 30 mm Hg. A normal PAWP is generally between 18 and 12mm Hg. The ideal patients for ulrafiltration (UF) are those with major pulmonary or systemic overload who have shown resistance to diuretics and are hemodynamically stable. UF helps decrease the fluid overload in the lungs and, therefore, decreases the pulmonary artery wedge pressure. Oxygen therapy may improve perfusion, but it does not cause a decrease in pulmonary artery wedge pressure (PAWP). Biventricular pacing and cardiac transplantation are preferred in cases of chronic heart failure but are not the best options in cases of ADHF. pp. 744-745

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? Anorexia Constipation Restlessness Muscle aches

anorexia 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. p. 748

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. 1. Anemia 2. Myocarditis 3. Paget's disease 4. Pulmonary embolism 5. Coronary artery disease

1. Anemia 3. Paget's disease 4. 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. p. 738

The Heart Failure Society of America (HFSA) has developed the acronym FACES that a nurse can use to teach patients about the symptoms of heart failure. What are the symptoms that are included in FACES? Select all that apply. 1. Fatigue 2. Edema 3. Asphyxia 4. Chest congestion 5. Shortness of breath 6. Limitation of activities

1. Fatigue 2. Edema 4. Chest congestion 5. Shortness of breath 6. Limitation of activities The acronym FACES includes the symptoms fatigue, limitation of activities, chest congestion/cough, edema, and shortness of breath. In heart failure, inadequate oxygenation of the blood causes fatigue even while performing routine activities. Edema is due to change in cardiac output, which leads to accumulation of fluid in the interstitial spaces. This causes shortness of breath and chest congestion. All these factors lead to limitation of activities in the patient. Asphyxia is not associated with HF. pp. 742, 751

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 - accelerated coronary artery disease [CAD]) are the major causes of death 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.

The nurse recalls that the decreased filling of the ventricles that is associated with diastolic failure results in what primary manifestation? Decreased afterload Decreased left ventricular ejection fraction Decreased left ventricular end-diastolic pressure Decreased stroke volume and cardiac output (CO)

Decreased stroke volume and cardiac output (CO) Diastolic failure often is referred to as heart failure with normal ejection fraction. Decreased filling of the ventricles results in decreased stroke volume and CO. Diastolic failure is characterized by high filling pressures because of stiff ventricles. This results in venous engorgement in both the pulmonary and systemic vascular systems.

The nurse is caring for a patient with chronic heart failure and atrial fibrillation that takes digoxin and a thiazide diuretic. Which statement made by the patient indicates that the patient is experiencing a complication related to the medication? "My ankles are still slightly swollen." "I have to urinate a lot after I take those pills!" "I'm not really hungry for lunch. I feel so nauseated and tired." "I check my heart rate regularly. It is usually 80-90 beats per minute."

"I'm not really hungry for lunch. I feel so nauseated and tired." Drug therapy with digoxin and potassium-losing diuretics (thiazides or loop diuretics) may lead to hypokalemia. The presence of hypokalemia while the patient is on digoxin may lead to digoxin toxicity. Signs of early digoxin toxicity include anorexia, nausea and vomiting, fatigue, headache, depression, and visual changes. Slightly swollen ankles are an expected finding with chronic heart failure; frequent urination is an expected effect of the diuretic. The heart rate of 90 beats/minute is normal. p. 748

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. 1. Systolic failure 2. Diastolic failure 3. Myocardial infarction 4. Coronary heart disease 5. Mixed systolic and diastolic failure

1. Systolic failure 5. 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. pp. 738-739

The nurse is caring for a patient with right-sided heart failure. Which assessment findings should the nurse expect? Select all that apply. 1. Edema 2. Ascites 3. Crackles 4. Anasarca 5. Wheezes

1. Edema 2. Ascites 4. 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. p. 742

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. 1. Tachypnea 2. Lower PaO 2 3. Increased glucose levels 4. Changes in metabolic status 5. Increased partial pressure of CO 2 in arterial blood (PaCO 2)

1. Tachypnea 2. Lower PaO 2 5. Increased partial pressure of CO 2 in arterial blood (PaCO 2) 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 PaO 2 and possible increased partial pressure of CO 2 in arterial blood and progressive respiratory alkalosis). Abnormalities in the glucose levels and metabolic status of the patient do not indicate alveolar edema. p. 741

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. 1. Tachypnea 2. Lower PaO 2 3. Increased glucose levels 4. Changes in metabolic status 5. Increased partial pressure of CO 2 in arterial blood (PaCO 2)

1. Tachypnea 2. Lower PaO 2 5. Increased partial pressure of CO 2 in arterial blood (PaCO 2) 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 PaO 2 and possible increased partial pressure of CO 2 in arterial blood and progressive respiratory alkalosis). Abnormalities in the glucose levels and metabolic status of the patient do not indicate alveolar edema. p. 741

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 2. Age over 70 years 3. Recurrent life-threatening dysrhythmias 4. Cardiac abnormalities that severely limit normal function 5. Advanced cerebral or vascular disease not amenable to correction

2. Age over 70 years 5. Advanced cerebral or vascular disease not amenable to correction Absolute contraindications for heart transplant include chronologic age over 70 and advanced cerebral or vascular disease not amenable to correction. Indications for heart transplant include recurrent life-threatening dysrhythmias not responsive to maximal interventions and cardiac abnormalities that severely limit normal function. Severe obesity is a relative contraindication. p. 753

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. 1. Gram stain 2. Bronchoscopy 3. ABO blood type 4. Body size and heart size 5. Human leukocyte antigen typing 6. Panel of reactive antibody (PRA) level

3. ABO blood type 4. Body size and heart size 5. Human leukocyte antigen typing 6. 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. p. 753

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 4. Promotion of peripheral vasodilation 5. Increased systemic vascular resistance

3. Increased myocardial contractility 4. Promotion of peripheral vasodilation 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. p. 746

What is the priority assessment of the nurse caring for a patient receiving intravenous nesiritide to treat heart failure? Urine output Lung sounds Blood pressure Respiratory rate

BP 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. p. 745-746

The nurse is caring for a patient with chronic heart failure. What is appropriate to be included on the patient's plan of care? Ultrafiltration (UF) Hemodynamic monitoring Intraaortic balloon pump (IABP) Cardiac resynchronization therapy (CRT)

Cardiac resynchronization therapy (CRT) In chronic HF, neurohormonal effects and cardiac remodeling can result in dyssynchrony of the left ventricle (LV) and the right ventricle (RV). This contributes to poor cardiac output (CO). CRT is ventricular pacing. During the procedure, an extra lead is placed, which allows for normal electrical conduction between the RV and LV, which increases left ventricular function and CO. Hemodynamic monitoring, UF, and IABP are included in the plan of care for patients with acute decompensated heart failure (ADHF). Patients with ADHF need continuous monitoring and assessment. The patient may have hemodynamic monitoring, including arterial BP and pulmonary artery pressure. The ideal patients for UF are those with major pulmonary or systemic volume overload. The IABP is helpful in hemodynamically unstable patients. pp. 744, 746

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. P. 754

A patient's assessment findings include an ejection fraction of 34%, high pulmonary pressures, and biventricular failure. The nurse suspects that the patient is experiencing what condition? Systolic failure Diastolic failure Myocardial ischemia Mixed systolic and diastolic failure

Mixed systolic and diastolic failure Mixed systolic and diastolic failure results in low ejection fraction, high pulmonary pressures, and biventricular failure. Systolic failure results only in low ejection fraction. Diastolic failure is characterized by high filling pressures due to a stiff ventricle. Myocardial ischemia is a condition of insufficient blood flow to the heart muscle. pp. 738-739

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.

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. P. 751

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."

The nurse assesses a patient with a family history of heart failure. Which primary causes of heart failure are linked to specific genes and gene mutations? Select all that apply. 1. Hypertension 2. Hyperthyroidism 3. Cardiomyopathy 4. Rheumatic heart disease 5. Coronary artery disease (CAD)

1. Hypertension 3. Cardiomyopathy 5. Coronary artery disease (CAD) Primary causes of heart failure linked to specific genes and gene mutations include coronary artery disease, cardiomyopathy, and hypertension. Hyperthyroidism and rheumatic heart disease are primary causes of heart failure that are not linked to specific genes and gene mutation. Some of the precipitating causes of heart failure include anemia, hypothyroidism, and infection. p. 738

Which compensatory mechanisms are initially effective in maintaining adequate cardiac output (CO)? Select all that apply. 1. Ventricular dilation 2. Ventricular hypertrophy 3. Production of endothelin 4. Release of renin by the kidneys 5. Activation of the sympathetic nervous system (SNS)

1. Ventricular dilation 2. Ventricular hypertrophy 5. 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 pp. 739-740

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. 1. Blood transfusions for anemia 2. Taking blood pressure medication as prescribed 3. Decreasing dysrhythmias by reducing caffeine intake 4. Initiating lifestyle changes to avoid coronary artery disease (CAD) 5. Taking aspirin every day to reduce the incidence of pulmonary embolism

2. Taking blood pressure medication as prescribed 4. 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. p. 738

The nurse reviews the medical record of a patient with heart failure (HF). The nurse should question which assessment finding, recognizing that it does not correlate with the patient's diagnosis? Fatigue Bradycardia Clammy and cold skin Paroxysmal nocturnal dyspnea

Bradycardia Bradycardia is not related to ADHF or chronic heart failure. Fatigue is an indication associated with chronic heart failure. Clammy and cold skin is a result of vasoconstriction during ADHF. Paroxysmal nocturnal dyspnea is also associated with chronic heart failure. pp. 742-743

The nurse is caring for a patient with chronic heart failure. What is appropriate to be included on the patient's plan of care? Ultrafiltration (UF) Hemodynamic monitoring Intraaortic balloon pump (IABP) Cardiac resynchronization therapy (CRT)

Cardiac resynchronization therapy (CRT) In chronic HF, neurohormonal effects and cardiac remodeling can result in dyssynchrony of the left ventricle (LV) and the right ventricle (RV). This contributes to poor cardiac output (CO). CRT is ventricular pacing. During the procedure, an extra lead is placed, which allows for normal electrical conduction between the RV and LV, which increases left ventricular function and CO. Hemodynamic monitoring, UF, and IABP are included in the plan of care for patients with acute decompensated heart failure (ADHF). Patients with ADHF need continuous monitoring and assessment. The patient may have hemodynamic monitoring, including arterial BP and pulmonary artery pressure. The ideal patients for UF are those with major pulmonary or systemic volume overload. The IABP is helpful in hemodynamically unstable patients. pp. 744, 746

A patient develops unexplained heart failure (HF) that remains unresponsive to usual therapy. For what diagnostic test does the nurse prepare the patient? Chest x-ray Echocardiogram Cardiac catheterization Electrocardiogram (ECG)

Echocardiogram An echocardiogram provides information on the ejection fraction (EF). It also provides information on the structure and function of the heart valves. Heart chamber enlargement or stiffness can also be assessed. An ECG and chest x-ray are also useful but are not as specific. Heart catheterization, such as coronary angiography, is performed to determine ejection fraction (EF) and blockages. pp. 743-744

A patient is admitted with acute decompensated heart failure. Which part of the treatment plan will increase fatigue in this patient? A 2-g sodium diet Cardiac monitoring Oxygen at 2 L by nasal cannula Intravenous (IV) furosemide 40 mg every six hours

Intravenous (IV) furosemide 40 mg every six hours Furosemide will cause diuresis and frequent trips to the bedside commode or bathroom, leading to fatigue. Oxygen will improve the patient's tolerance of activity. A cardiac monitor will monitor for electrolyte imbalances due to furosemide administration and will not affect fatigue. A 2-g sodium diet will help reduce the sodium load to the heart and reduce fatigue. p. 746

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? Nesiritide Milrinone Spironolactone Sodium nitroprusside

Sodium nitroprusside 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). p.745

An echocardiogram for a patient indicates enlarged ventricles of the heart. The nurse caring for the patient understands that this condition has occurred as a result of a chronic condition. What could be the cause of the cardiac dilation? Increased heart rate Increased muscle thickness Elevated pressure in the ventricles Increased release of catecholamine

Elevated pressure in the ventricles Cardiac dilation is an enlargement of the heart chambers, usually the ventricles; it occurs when pressure in the heart chambers is elevated over time. Hypertrophy is an increase in the muscle mass and thickness of the cardiac wall in response to overwork and strain. When the sympathetic nervous system activation is increased, there is an increased release of catecholamines, which results in an increased heart rate. p. 740

Diagnostic test to find out the cause of new-onset heart failure that is unresponsive to routine care

Endomyocardial biopsy (EMB)

A patient is admitted to the emergency department with pain, dyspnea, and lower extremity edema. The patient is diagnosed with diastolic heart failure. The nurse recognizes that which clinical finding aids in the diagnosis of diastolic heart failure? Low filling pressures Ejection fraction of 55% Impaired contractile function Ejection fraction less than 45%

EF 55% Diastolic failure is also known as heart failure with preserved EF (HFpEF), thus eluding to the finding of a normal ejection fraction (EF). A normal ejection fraction is 55-60%. In systolic heart failure, the ejection fraction is generally less than 45%. Diastolic failure is characterized by high filling pressures because of stiff ventricles. Systolic failure results from an inability of the heart to pump blood effectively, caused by impaired contractile function. p. 738

uses a process called counterpulsation to increase coronary blood flow and decrease the heart's workload

Intraaortic balloon pump (IABP)

A patient with chronic heart failure asks the nurse why ivabradine has been prescribed. What explanation should the nurse provide? It inhibits the sinus node and reduces heart rate (HR). It blocks the negative side effects of the sympathetic nervous system (SNS). It increases the force of cardiac contraction and decreases the heart rate (HR). It causes vasodilation by acting directly on the smooth muscle of the vessel wall.

It inhibits the sinus node and reduces heart rate (HR). Ivabradine is a new category of oral drug that inhibits the sinus node and reduces heart rate (HR). It is used for patients who have symptoms of chronic HF. β-adrenergic blockers directly block the negative side effects of the sympathetic nervous system (SNS). Nitrates cause vasodilation by acting directly on the smooth muscle of the vessel wall. Digitalis preparations increase the force of cardiac contraction and decrease the heart rate (HR).

A patient's apical heart rate is 45 beats/minute. The nurse should withhold which scheduled medication? Morphine Metoprolol Furosemide Rosuvastatin

Metoprolol, which is a β-adrenergic blocker, inhibits the sympathetic nervous system, causing a decrease in heart rate; therefore, this drug should be withheld and the primary health care provider notified. Diuretics, such as furosemide, are used to reduce edema, pulmonary venous pressure, and preload; pulse rate is not affected. Morphine is used to reduce pain and anxiety, and it also decreases preload and afterload; it may be given if the patient is in pain and has a heart rate of 45. Antihyperlipidemic drugs, such as rosuvastatin, are used to help control cholesterol in the patient; a heart rate of 45 does not indicate that it should be withheld. P. 745

A patient is diagnosed with left-sided heart failure. The nurse expects what assessment finding? Orthopnea Low blood pressure Pulsating neck veins Edema in the lower extremities

Orthopnea, difficulty breathing except when sitting or standing, is a symptom of advanced heart failure, especially left-sided failure. When the heart fails as a pump, blood backs up into the lungs, causing fluid to leak from the alveolar membrane. As this process continues, pulmonary edema may develop. Patients may experience hypotension or hypertension, depending on the severity of the disease. Pulsating neck veins and edema in the lower extremities are characteristics of right-sided heart failure.

A patient with acute decompensated heart failure (ADHF) experiences severe pulmonary edema. The nurse identifies that what intervention will increase the percentage of O 2 in inspired air and is effective in decreasing preload? Providing O 2 at 2-4 liters/NC Placing the patient in Trendelenburg position Providing bilevel positive airway pressure (BiPAP) Advising the patient to take physical and emotional rest

Providing bilevel positive airway pressure (BiPAP) In severe pulmonary edema, the patient may need noninvasive positive pressure ventilation (e.g., BiPAP) or intubation and mechanical ventilation. BiPAP is also effective in decreasing preload. When a patient has dyspnea, the patient should be placed in high Fowler's position. Oxygen therapy delivered at 2-4 liters/minute via nasal cannula will not be adequate for a patient experiencing severe pulmonary edema. Taking physical and emotional rest helps in conserving energy; it does not increase the percentage of inspired O 2, and it does not decrease preload. p. 744

A patient with acute decompensated heart failure (ADHF) experiences severe pulmonary edema. The nurse identifies that what intervention will increase the percentage of O 2 in inspired air and is effective in decreasing preload? Providing O 2 at 2-4 liters/NC Placing the patient in Trendelenburg position Providing bilevel positive airway pressure (BiPAP) Advising the patient to take physical and emotional rest

Providing bilevel positive airway pressure (BiPAP) In severe pulmonary edema, the patient may need noninvasive positive pressure ventilation (e.g., BiPAP) or intubation and mechanical ventilation. BiPAP is also effective in decreasing preload. When a patient has dyspnea, the patient should be placed in high Fowler's position. Oxygen therapy delivered at 2-4 liters/minute via nasal cannula will not be adequate for a patient experiencing severe pulmonary edema. Taking physical and emotional rest helps in conserving energy; it does not increase the percentage of inspired O 2, and it does not decrease preload. p. 744

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

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.

A stable patient with acute decompensated heart failure (ADHF) experiences mild dyspnea. The nurse plans to place the patient in a high Fowler's position with the feet dangling at the bedside. To ensure safety, before positioning the patient's feet, what should the nurse assess? Urine output Heart rhythm Breath sounds Blood pressure

The nurse should evaluate the blood pressure before dangling the patient's feet at the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the high Fowler's position with the feet horizontal in the bed. Urine output, heart rhythm, and breath sounds are not affected by dangling the patient's feet at the bedside. p. 744

The nurse is caring for a patient with acute decompensated heart failure (ADHF) who is experiencing volume overload. The nurse anticipates a prescription for what type of drug? Diuretic Narcotic Antidysrhythmic Positive inotrope

diuretic Diuretics are the preferred treatment for patients with ADHF experiencing volume overload because they decrease fluid volume and provide other benefits as well

A patient is diagnosed with acute decompensated heart failure (ADHF). The nurse anticipates a prescription for which medication that is a selective β-agonist, does not increase systemic vascular resistance (SVR), and that is preferred for short-term treatment of ADHF? Milrinone Dobutamine Dopamine Procainamide

dobutamine is a selective β-agonist. It does not increase systemic vascular resistance (SVR) and is preferred for short-term treatment of ADHF. Milrinone and dopamine are also used to treat ADHF but are not preferred for short-term treatment. Procainamide is a class IA antidysrhythmic drug used to treat or prevent dysrhythmias.

A patient with heart failure (HF) takes digoxin. The nurse recognizes that the patient is at risk for digitalis toxicity if what condition exists? Hypokalemia Hypocalcemia Hyperuricemia Hypermagnesemia

hypokalemia Being hypokalemic makes a patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the potassium level. The health care provider may prescribe the digoxin to be given once the potassium level has been treated and increased to the normal range. Hypercalcemia and hypomagnesemia can also trigger digitalis toxicity. Hyperuricemia does not put the patient at risk for digitalis toxicity.

A patient is admitted to the hospital with a diagnosis of acute decompensated heart failure (ACHF). The primary health care provider prescribes a continuous intravenous infusion of sodium nitroprusside. What is the priority nursing intervention? Monitor urinary output. Monitor blood pressure. Check serum potassium level. Assess the skin surrounding the intravenous (IV) site.

monitor BP