Heart Failure - ML8

A patient is being administered digoxin (Lanoxin) for treatment of heart failure. At what level should the serum potassium level be maintained? 1.5-2.0 mEq/L 3.5-5.0 mEq/L 6.0-8.0 mEq/L 8.5-10 mEq/L

3.5-5.0 mEq/L Electrolyte imbalance must be monitored during digoxin therapy, and the potassium level should be maintained at 3.5-5.0 mEq/L. A potassium level of 1.5-2.0 mEq/L is too low. Potassium levels of 6.0-80 and 8.5-10 mEq/L are too high.

A client has had an echocardiogram to measure ejection fracton. The nurse explains that ejection fraction is the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects? 55% 50% 45% 40%

55% Normally, a healthy heart ejects 55% or more of the blood that fills the left ventricle during diastole.

A nurse is caring for a client with left-sided heart failure. During the nurse's assessment, the client is wheezing, restless, tachycardic, and has severe apprehension. The nurse knows that these are symptoms of what? Acute pulmonary edema Progressive heart failure Pulmonary hypertension Cardiogenic shock

Acute pulmonary edema Clients with acute pulmonary edema exhibit sudden dyspnea, wheezing, orthopnea, restlessness, cough (often productive of pink, frothy sputum), cyanosis, tachycardia, and severe apprehension. These symptoms do not indicate progressive heart failure, pulmonary hypertension, or cardiogenic shock.

All of the following interventions are ordered STAT for a client stung by a bee who is experiencing severe respiratory distress and faintness. Which priority intervention will the nurse administer first? Epinephrine Normal saline infusion Dexamethasone Diphenhydramine

Epinephrine Treatment includes immediate discontinuation of the inciting agent; close monitoring of CV and respiratory function; and maintenance of respiratory gas exchange, cardiac output, and tissue perfusion. Epinephrine is given in an anaphylactic reaction because it constricts blood vessels and relaxes the smooth muscle in the bronchioles.

Splenomegaly occurs with left-sided heart failure. True False

False Splenomegaly occurs with right-sided heart failure.

A 65-year-old client presents to the health care provider's office with reports of shortness of breath on exertion, edema in the ankles, and waking up in the middle of the night unable to breathe. The nurse suspects that the symptoms are indicative of which condition? Asthmatic bronchitis Pulmonary edema Heart failure Myocardial infarction

Heart failure Cardinal manifestations of HF are dyspnea and fatigue, which can lead to exercise intolerance and fluid retention resulting in pulmonary congestion and peripheral edema.

A nurse is assessing a client with congestive heart failure for jugular vein distension (JVD). Which observation is important to report to the physician? No JVD is present. JVD is noted at the level of the sternal angle. JVD is noted 2 cm above the sternal angle. JVD is noted 4 cm above the sternal angle.

JVD is noted 4 cm above the sternal angle. JVD is assessed with the client sitting at a 45° angle. Jugular vein distention greater than 4 cm above the sternal angle is considered abnormal and is indicative of right ventricular failure.

The nurse identifies which symptom as a characteristic of right-sided heart failure? Jugular vein distention (JVD) Dyspnea Pulmonary crackles Cough

Jugular vein distention (JVD) JVD is a characteristic of right-sided heart failure. Dyspnea, pulmonary crackles, and cough are manifestations of left-sided heart failure.

The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following? Left ventricular function Right ventricular function Left atrial function Right atrial function

Left ventricular function The signs and symptoms of cardiogenic shock reflect the circular nature of the pathophysiology of HF. The degree of shock is proportional to the extent of left ventricular dysfunction.

The client's digoxin level is 0.125. How does the nurse interpret this level? Normal Elevated Toxic Low

Low The normal digoxin level is 0.5 to 2.0 ng/mL. Serum levels greater than 2 ng/mL are toxic; however, toxicity may occur at any serum level.

The nurse is caring for a patient receiving cardiotonic drugs. The patient has edema. Which intervention should be taken to alleviate edema? Auscultation of the lungs Measurement of intake and output Observation of respiratory rate Observation of pulse rate

Measurement of intake and output Measurement of intake and output is a nursing intervention related to the edema in the patient receiving cardiotonic drugs. Auscultation of the lungs, observation of respiratory rate, and observation of pulse rate are interventions not related to edema in the patient.

A nurse is caring for a 66-year-old female client who is receiving digoxin. When preparing to administer a dose, the nurse observes that the client's apical pulse rate is 55 bpm. What is the appropriate action to take? Omit the dose and contact the health care provider. Give the dose and contact the health care provider. Reduce the dose and contact the health care provider. Omit the dose and inform the oncoming nurse at the next shift change.

Omit the dose and contact the health care provider. Bradycardia is a potential adverse effect of digoxin. Nurses should assess the client's apical pulse before each dose. If the rate is lower than 60 bpm in an adult client, the nurse should omit the dose and notify the provider.

A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which assessment finding for this client? Pulmonary congestion Pedal edema Nausea Jugular venous distention

Pulmonary congestion When the left ventricle cannot effectively pump blood out of the ventricle into the aorta, the blood backs up into the pulmonary system and causes congestion, dyspnea, and shortness of breath. All the other choices are symptoms of right-sided heart failure. They are all symptoms of systolic failure.

Which condition would least likely contribute to the development of heart failure? Coronary artery disease Renal failure Valvular disease Hypertension

Renal failure Renal failure would be least likely to contribute to the development of heart failure. Coronary artery disease, valvular disease, hypertension, and cardiomyopathy are commonly associated with heart failure.

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

Spironolactone Spironolactone is a potassium-sparing diuretic. Chlorothiazide is a thiazide diuretic is Diuril. Bumetanide and ethacrynic acid are loop diuretics.

Which health condition can contribute to diastolic dysfunction heart failure? ischemic heart disease chronic bradycardia anemia myocardial hypertrophy

myocardial hypertrophy Conditions that reduce the heart's ability to adequately fill during diastole, such as myocardial hypertrophy and tachycardia, can lead to diastolic heart failure. Valvular insufficiency, anemia, and ischemic heart disease are associated with systolic heart failure, or impaired contractile performance.

To maximize absorption of digoxin, the nurse would instruct the patient to take the drug: on an empty stomach. with an antacid. after a meal. with a small glass of water.

on an empty stomach. Digoxin is absorbed best on an empty stomach.

A nurse in a nursing home is concerned that a resident may be developing left-sided heart failure. Manifestations of left-sided heart failure would include which symptom? Diarrhea, nausea, vomiting Dyspnea, cough Fatigue, headache Weakness, peripheral edema

Dyspnea, cough In left failure, dyspnea and cough, especially at night, result from blood backing up in the pulmonary circulation. The other manifestations listed are not characteristic of left-sided failure.

A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient? Vasculitis Potassium levels Flexion contractures Enlargement of joints

Potassium levels A key concern associated with digoxin therapy is digitalis toxicity. Clinical manifestations of toxicity include anorexia, nausea, visual disturbances, confusion, and bradycardia. The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur.

An instructor is teaching a class about vasodilators and their action for alleviating heart failure. The instructor determines that the class has understood the material when they identify what as being involved? Reducing afterload Decreasing blood volume Increasing preload Increasing myocardial oxygen use

Reducing afterload Vasodilators decrease cardiac workload, relax vascular smooth muscle to decrease afterload, and allow pooling in the veins thereby decreasing preload. Decreased blood volume results from the use of diuretics.

The nurse monitors which client for an increased risk of digoxin toxicity? The client with liver dysfunction The client with renal dysfunction The client with an integumentary dysfunction The client with a peripheral vascular dysfunction

The client with renal dysfunction The client with renal dysfunction is at an increased risk for digoxin toxicity.

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

An LVAD only supports a failing left ventricle. A TAH is considered an extension of LVADs, which only support a failing left ventricle. TAHs are targeted for clients who are unlikely to live more than a month without further interventions.

Which dosage forms are used for digoxin (Lanoxin) maintenance therapy? (Select all that apply.) Capsule Injection Ointment Patch Tablet

Capsule Injection Tablet Capsules and tablets are used for maintenance therapy, injections are used for rapid digitalization, and digoxin patches and ointment do not exist.

Heart failure was once called dropsy. True False

True

Vasodilators used to treat heart failure include nitrates and ACE inhibitors.. True False

True Drug therapies used to treat heart failure include vasodilators, such as angiotensin-converting enzyme (ACE) inhibitors and nitrates, which decrease cardiac workload, relax vascular smooth muscle to decrease afterload, and allow pooling in the veins, thereby decreasing preload of the heart and helping to improve function.

A nurse suspects that a client has digoxin toxicity. The nurse should assess for: hearing loss. vision changes. decreased urine output. gait instability.

vision changes. Vision changes, such as halos around objects, are signs of digoxin toxicity. Hearing loss can be detected through hearing assessment; however, it isn't a common sign of digoxin toxicity. Intake and output aren't affected unless there is nephrotoxicity, which is uncommon. Gait changes are also uncommon.

A nurse is assessing a client in shock for complications of acute renal failure. Which assessment is priority for the nurse to obtain? Evaluating the blood for a decreased creatinine level Evaluating the blood for a decrease in the blood urea nitrogen level (BUN) Continuously measuring urine output Asking the client if he or she is experiencing bilateral flank pain

Continuously measuring urine output Continuous monitoring of urine output during shock provides a means of assessing renal blood flow. The BUN and creatinine levels would increase in shock. Pain would not be a manifestation of acute renal failure.

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

Assess the client's heart rate and hold administration if it is less than 60. Clients should be taught to hold their digoxin if their heart rate is less than 60 (or some other defined heart rate). Divided doses are not normally used and an awareness of heart failure does not preclude adverse effects of digoxin.

The nurse is administering digoxin to a client with heart failure. What laboratory value may predispose the client to digoxin toxicity? magnesium level of 2.5 mg/dL calcium level of 7.5 mg/dL sodium level of 152 mEq/L potassium level of 2.8 mEq/L

potassium level of 2.8 mEq/L Conditions that may predispose a client to digoxin toxicity include hypokalemia (evidenced by a potassium level less than 3.5 mEq/L), hypomagnesemia (evidenced by a magnesium level less than 1.5 mEq/L), hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia (evidenced by a magnesium level greater than 2.5 mEq/L), hypercalcemia (evidenced by an ionized calcium level greater than 5.3 mg/dl), and hypernatremia (evidenced by a sodium level greater than 145 mEq/L) aren't associated with a risk of digoxin toxicity.

A client with chronic heart failure is receiving digoxin 0.25 mg by mouth daily and furosemide 20 mg by mouth twice daily. The nurse should assess the client for what sign of digoxin toxicity? visual disturbances. taste and smell alterations. dry mouth and urine retention. nocturia and sleep disturbances.

visual disturbances. Digoxin toxicity may cause visual disturbances (e.g., flickering flashes of light, colored or halo vision, photophobia, blurring, diplopia, and scotomata), central nervous system abnormalities (e.g., headache, fatigue, lethargy, depression, irritability and, if profound, seizures, delusions, hallucinations, and memory loss), and cardiovascular abnormalities (e.g., abnormal heart rate, arrhythmias). Digoxin toxicity doesn't cause taste and smell alterations. Dry mouth and urine retention typically occur with anticholinergic agents, not inotropic agents such as digoxin. Nocturia and sleep disturbances are adverse effects of furosemide — especially if the client takes the second daily dose in the evening, which may cause diuresis at night.

A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement? "I sleep on three pillows each night." "My feet are bigger than normal." "My pants don't fit around my waist." "I don't have the same appetite I used to."

"I sleep on three pillows each night." Orthopnea is a classic sign of left-sided heart failure. The client commonly sleeps on several pillows at night to help facilitate breathing. Swollen feet, ascites, and anorexia are signs of right-sided heart failure.

A client is receiving digoxin. The nurse monitors the client's digoxin level. Which level should the nurse interpret as therapeutic? 1.5 ng/mL 2.2 ng/mL 2.5 ng/mL 3.1 ng/mL

1.5 ng/mL Therapeutic digoxin levels range from 0.5 ng/mL to 2.0 ng/mL. A level of 1.5 ng/mL would be considered therapeutic.

A patient is receiving milrinone IV. The nurse would administer the bolus over which time frame? 10 minutes 2 minutes 5 minutes 15 minutes

10 minutes Milrinone is administered by IV bolus over 10 minutes.

The nurse is gathering data from a client recently admitted to the hospital. The nurse asks the client about experiencing orthopnea. What question would the nurse ask to obtain this information? "Are you only able to breathe when you are sitting upright?" "How far can you walk without becoming short of breath?" "Are you coughing up blood at night?" "Are you urinating excessively at night?"

"Are you only able to breathe when you are sitting upright?" To determine if a client is having orthopnea, the nurse needs to ask about the inability to breathe unless sitting upright. Determining how far the client can walk without becoming short of breath would indicate exertional dyspnea. Coughing up blood would indicate hemoptysis. Urinating excessively at night can be indicative of different factors such as taking a diuretic late in the evening causing the client to urinate often at night. This question would be vague.

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

Decrease afterload Vasodilators decrease cardiac workload, relax vascular smooth muscle to decrease afterload, and allow pooling in the veins thereby decreasing preload. Decreased blood volume results from the use of diuretics.

A client experiences nausea and visual disturbances when taking digoxin (Lanoxin). The nurse would anticipate the client's digitalis level to be: 0.2 nanograms/mL 1.3 nanograms/mL 2.7 nanograms/mL 1.7 nanograms/mL

2.7 nanograms/mL Therapeutic drug levels of digoxin are between 0.8 and 2 nanograms/ mL. Plasma digoxin levels greater than 2 nanograms/mL are considered toxic and the client may experience signs and symptoms of toxicity.

In hypovolemic shock, renal perfusion and urinary output decline. The nurse will monitor urinary output and knows that output below which level indicates inadequate renal perfusion? 80—60 mL/hour 60—40 mL/hour 40—20 mL/hour 20 mL/hour

20 mL/hour In hypovolemia, renal vasculature is constricted in a compensatory attempt to circulate blood to more vital organs. Urinary output at 20 mL/hour or below indicates that renal perfusion is too inadequate.

A male client states that he is seeing halos around lights. The client takes digoxin (Lanoxin) by mouth every day. The health care provider orders the client to have serum digoxin level drawn. Which of the digoxin levels indicate the client is experiencing toxicity? 0.5 nanograms per milliliter 1.0 nanograms per milliliter 2.0 nanograms per milliliter 4.0 nanograms per milliliter

4.0 nanograms per milliliter Therapeutic serum levels of digoxin are 0.5 to 2 nanograms per milliliter; toxic serum levels are above 2.0.

A nurse is administering digoxin intravenously as ordered. The nurse would administer the drug over which time frame? 2 minutes 3 minutes 4 minutes 5 minutes

5 minutes Intravenous digoxin must be administered slowly over at least 5 minutes to prevent cardiac arrhythmias and adverse effects.

A client is transported to the emergency department in respiratory distress after eating peanuts. The following interventions are ordered by the health care provider. Which intervention should the nurse complete first? Start a normal saline infusion. Administer epinephrine (adrenaline). Complete a 12-lead ECG. Administer diphenhydramine.

Administer epinephrine (adrenaline). Treatment includes immediate discontinuation of the inciting agent or institution of measures to decrease its absorption; close monitoring of cardiovascular and respiratory function; maintenance of respiratory gas exchange, cardiac output, and tissue perfusion. Epinephrine is given in an anaphylactic reaction because it constricts blood vessels and relaxes the smooth muscle in the bronchioles, thus restoring cardiac and respiratory function.

A 70-year-old man has been living with a diagnosis of heart failure (HF) for several years and has been vigilant about monitoring the trajectory of disease and adhering to his prescribed treatment regimen. The man has scheduled an appointment with his primary care provider because he has noted a weight gain of 6 pounds over the past week. The nurse should anticipate that this patient may benefit from which of the following treatment measures? A further reduction in his dietary sodium intake An increase in the dose of his prescribed diuretic A decrease in his daily activity level Thoracentesis

An increase in the dose of his prescribed diuretic If a patient with HF experiences a significant change in weight (ie, 2- to 3-lb increase in a day or 5-lb increase in a week), the patient is instructed to notify his or her provider or to adjust the medications (eg, increase the diuretic dose) per provider's directions. Thoracentesis is not relevant, and decreased activity may exacerbate the patient's condition. Decreased sodium intake may be of some benefit, but diuretics will have a greater effect.

A client is rushed to the emergency department with assessment findings of urticaria, wheezing, chest tightness, and difficulty breathing. The client is most likely experiencing which type of shock? Neurogenic Septic Cardiogenic Anaphylactic

Anaphylactic Signs and symptoms associated with impending anaphylactic shock include abdominal cramps; apprehension; warm or burning sensation of the skin; itching; urticaria (i.e., hives); coughing; choking; wheezing; chest tightness; and difficulty in breathing. The other types of shock do not have these clinical manifestations.

A client arrives at the ED with an exacerbation of left-sided heart failure and reports shortness of breath. Which is the prioritynursing intervention? Administer angiotensin II receptor blockers Assess oxygen saturation Administer diuretics Administer angiotensin-converting enzyme inhibitors

Assess oxygen saturation Assessment is priority to determine the severity of the exacerbation. It is important to assess the oxygen saturation in a client with heart failure because below-normal oxygen saturation can be life-threatening. Treatment options vary according to the severity of the client's condition and may include supplemental oxygen, oral and IV medications, major lifestyle changes, implantation of cardiac devices, and surgical approaches. The overall goal of treatment of heart failure is to relieve symptoms and reduce the workload on the heart by reducing afterload and preload.

The nurse is teaching a group of clients with heart failure about how to decrease leg edema. What dietary advice will the nurse give to clients with severe heart failure? Avoid the intake of processed and commercially prepared foods. Avoid the intake of canned fruit and fruit juices. Encourage increased intake of vegetables with natural sodium. Encourage increased intake of red meat.

Avoid the intake of processed and commercially prepared foods. Until edema resolves, a client with severe heart failure requires restriction of sodium to 500 to 1,000 mg/day. Therefore, processed and commercially prepared foods are eliminated. Vegetables with natural sodium, for example, beets, carrots, and "greens," should be avoided. Fresh, frozen, and canned fruit and fruit juices are not restricted. Increased intake of red meat should not be encouraged; it should be restricted to 6 oz per day.

The nurse is developing a plan of care for a client with heart failure. The most important information for the nurse to consider would be: Decreased cardiac output Increased ejection fraction Increased renal blood flow Decreased retention of sodium

Decreased cardiac output In heart failure with a reduced ejection fraction, a decrease in cardiac output and renal blood flow leads to increased sodium and water retention by the kidney with a resultant increase in vascular volume and venous return to the heart, as well as an increase in ventricular end-diastolic volume.

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

Decreased cardiac output Low cardiac output results in decreased renal perfusion, which activates the renin-angiotensin-aldosterone system (RAAS). The resultant vasoconstriction due to angiotensin II and the retention of sodium and water due to aldosterone attempt to support cardiac output. Hypertension and increased metabolic needs do not activate the RAAS.

A female older adult client has presented with a new onset of shortness of breath, and the client's physician has ordered measurement of her brain natriuretic peptide (BNP) levels along with other diagnostic tests. What is the most accurate rationale for the physician's choice of bloodwork? BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the client's dyspnea from a respiratory pathology. BNP is an indirect indicator of the effectiveness of the renin-angiotensin-aldosterone (RAA) system in compensating for heart failure. BNP levels correlate with the client's risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia. BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects.

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the client's dyspnea from a respiratory pathology. BNP is released to compensate for heart failure and elevated levels help confirm the diagnosis of heart failure as opposed to respiratory etiologies. It does not measure the effectiveness of the RAA system, the risk of cognitive deficits, or the specific severity of pulmonary symptoms of heart failure.

A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client? Intubation of the airway BP and pulse measurements every 15 to 30 minutes Insertion of a central venous catheter Hourly administration of a fluid bolus

BP and pulse measurements every 15 to 30 minutes Bedside ECG monitoring is standard, as are continuous pulse oximetry, automatic BP, and pulse measurements approximately every 15 to 30 minutes.

A client has been diagnosed with heart failure. The client's cardiac contractility will be primarily affected by which factor? Intracellular K+ levels Ca2+ levels in the myocardium The gradient between intracellular and extracellular H+ levels Serum Na+ levels

Ca2+ levels in the myocardium Calcium is responsible for allowing actin and myosin to interact due to its binding to troponin. The levels of hydrogen ions do not directly influence cardiac contractility. Sodium and potassium levels are important, but it is variations in extracellular potassium levels that cause variations in contractility. Serum sodium levels affect contractility to a lesser degree than calcium.

Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate 112, respiratory rate 36, and pulse oximeter reading of 81%. He starts coughing up frothy, pink sputum. The priority intervention is: Have medical supply department bring up suction equipment. Apply oxygen via nasal cannula at 3 pm. Page respiratory therapy to come give him a breathing treatment. Call for emergency assistance utilizing hospital protocol.

Call for emergency assistance utilizing hospital protocol. Mr. V. is experiencing acute pulmonary edema. This is a life-threatening condition. The person is seen sitting and gasping for air. The pulse is rapid, skin moist, lips/nail beds cyanotic. Dyspnea and air hunger are accompanied by productive cough with frothy and often blood-tinged sputum (pink). The client needs the emergency responder team (including ICU nurses, physicians, respiratory therapy, etc) to intervene. Applying O2 by mask will not increase his oxygen level fast enough and he is probably mouth breathing (gasping for air). Suction equipment may be needed, but getting a physician to give orders for diuretics and inotropic medications is the priority. Of course, respiratory therapy will arrive with the emergency assistance team.

A client has been prescribed furosemide 80 mg twice daily. The asymptomatic client begins to have rare premature ventricular contractions followed by runs of bigeminy with stable signs. What action will the nurse perform next? Notify the health care provider. Check the client's potassium level. Calculate the client's intake and output. Administer potassium.

Check the client's potassium level. The client is asymptomatic but has had a change in heart rhythm. More information is needed before calling the health care provider. Because the client is taking furosemide, a potassium-wasting diuretic, the next action would be to check the client's potassium level. The nurse would then call the health care provider with a more complete database. The health care provider will need to be notified after the nurse checks the latest potassium level. The intake and output will not change the heart rhythm. Administering potassium requires a health care provider's order.

Which statement regarding heart failure is true? Aortic stenosis is a major cause of congestive heart failure. A frequent symptom of right-sided heart failure is dyspnea. The average client with congestive heart failure has a normal lifespan. Compensated congestive heart failure may be clinically asymptomatic.

Compensated congestive heart failure may be clinically asymptomatic. Aortic stenosis occasionally causes congestive heart failure. Dyspnea is a frequent symptom of left-sided heart failure as blood backs up in the pulmonary circulation. The average client with congestive heart failure is at risk of early death unless the failure can be compensated. Compensated failure may be asymptomatic if compensatory mechanisms are able to support cardiac output.

For clients with heart failure, which pathophysiologic response helps maintain the cardiac reserve? Aortic hypertrophy Compensatory mechanisms Electrical conductivity Parasympathetic system

Compensatory mechanisms The pathophysiology of heart failure involves a decrease in pumping ability of the heart with a consequent decrease in the cardiac output, and activation of compensatory mechanisms that attempt to maintain cardiac output but also contribute to the progression of heart failure. Stimulation of the sympathetic nervous system plays an important role in the compensatory mechanisms and the pathogenesis of heart failure. Heart failure is a muscle contractility problem, unrelated to the electrical conduction that stimulates it.

The nurse has completed a head-to-toe assessment of a patient who was admitted for the treatment of heart failure (HF). Which of the following assessment findings should signal to the nurse a possible exacerbation of the patient's condition? Crackles are audible on chest auscultation. The patient's blood pressure (BP) is 144/99. The patient has put out 600 mL of dilute urine over the past 8 hours. Blood glucose testing reveals a glucose level of 158 mg/dL.

Crackles are audible on chest auscultation. Patients with HF often exhibit crackles, which are produced by the sudden opening of edematous small airways and alveoli that have adhered together by exudate. These may be heard at the end of inspiration and are not cleared with coughing. A widened pulse pressure, increased BP, and production of dilute urine are not characteristic of HF. Changes in blood glucose levels are not normally symptomatic of HF.

A client has developed constrictive pericarditis and myocardial hypertrophy. Select the most likely cause. Diastolic dysfunction Frontward failure Backward failure Systolic dysfunction

Diastolic dysfunction The conditions that cause diastolic dysfunction are those that impede expansion of the ventricles (i.e., pericarditis), those that increase ventricular wall thickness and reduce chamber size (i.e., myocardial hypertrophy), and those that delay diastolic relaxation (i.e., aging).

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

Digitalis toxicity is a possibility. The normal digoxin level is 0.5 to 2.0 ng/mL. Toxic serum levels are greater than 2 ng/mL; however, toxicity may occur at any serum level. None of the other options would result in a digoxin level above normal serum levels.

A nurse is planning an in-service program for a group of staff nurses about heart failure and its treatment. The nurse would identify which agent as the most commonly used drug for treatment? Digoxin ACE inhibitors Hydrochlorothiazide Human B type natriuretic peptide

Digoxin Digoxin is the drug most often used to treat heart failure. Human B-type natriuretic peptide, ACE inhibitors, or hydrochlorothiazide also may be used, but these drugs are not the most common ones used.

A 58-year-old man is admitted to the emergency department. A diagnosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which drug? Furosemide Digoxin immune fab Captopril Dopamine

Digoxin immune fab Digoxin immune fab is used as the antidote to digoxin toxicity. The other drugs would not be used to treat digoxin toxicity. The patient could be taking furosemide as part of the drug regimen for heart failure.

A nurse is administering morning medications to a number of clients on a medical unit. Which medication regimen is most suggestive that the client has a diagnosis of heart failure? Antihypertensive, diuretic, antiplatelet aggregator Diuretic, ACE inhibitor, beta-blocker Anticoagulant, antihypertensive, calcium supplement Beta-blocker, potassium supplement, anticoagulant

Diuretic, ACE inhibitor, beta-blocker Diuretics, ACE inhibitors, and beta-blockers are all commonly used in the treatment of heart failure. Antiplatelet aggregators, calcium and potassium supplements, and anticoagulants are less likely to relate directly to a diagnosis of heart failure.

Which is a cerebrovascular manifestation of heart failure? Tachycardia Ascites Nocturia Dizziness

Dizziness Cerebrovascular manifestations of heart failure include dizziness, lightheadedness, confusion, restlessness, and anxiety. Tachycardia is a cardiovascular manifestation. Ascites is a gastrointestinal manifestation. Nocturia is a renal manifestation.

The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure? Decreased urinary output Dyspnea on exertion Hypotension Tachycardia

Dyspnea on exertion Left-sided heart failure produces hypoxemia as a result of reduced cardiac output of arterial blood and respiratory symptoms. Many clients notice unusual fatigue with activity. Some find exertional dyspnea to be the first symptom. An increase in urinary output may be seen later as fluid accumulates. Hypotension would be a later sign of decompensating heart failure as well as tachycardia.

Which diagnostic study is usually performed to confirm the diagnosis of heart failure? Electrocardiogram (ECG) Echocardiogram Serum electrolytes Blood urea nitrogen (BUN)

Echocardiogram An echocardiogram is usually performed to confirm the diagnosis of heart failure. ECG, serum electrolytes, and a BUN are usually completed during the initial workup.

The nurse is caring for a client with heart failure. What procedure should the nurse prepare the client for in order to determine the ejection fraction to measure the efficiency of the heart as a pump? Echocardiogram A pulmonary arteriography A chest radiograph Electrocardiogram

Echocardiogram The heart?'s ejection fraction is measured using an echocardiogram or multiple gated acquisition scan. A pulmonary arteriography is used to confirm corpulmonale. A chest radiograph can reveal the enlargement of the heart. An electrocardiogram is used to determine the activity of the heart?s conduction system.

The nurse is caring for a client with suspected right-sided heart failure. What would the nurse know that clients with suspected right-sided heart failure may experience? Increased urine output Gradual unexplained weight gain Increased perspiration Sleeping in a chair or recliner

Gradual unexplained weight gain Clients with right-sided heart failure may have a history of gradual, unexplained weight gain from fluid retention. Left-sided heart failure produces paroxysmal nocturnal dyspnea, which may prompt the client to use several pillows in bed or to sleep in a chair or recliner. Right-sided heart failure does not cause increased perspiration or increased urine output.

Anaphylactic shock causes severe hypoxia very quickly because of which reason? Generalized vasoconstriction reduces venous return. Metabolic rate is greatly increased. Histamine release causes massive vasodilation. Heart rate and contractility are reduced.

Histamine release causes massive vasodilation. Anaphylactic shock, a severe allergic reaction, rapidly causes severe hypoxia as histamine release results in massive vasodilation. The volume of blood is no longer able to fill the greatly dilated vascular compartment. The other answers are not part of anaphylaxis.

Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells? Hyperplasia Atrophy Hypertrophy Dysplasia

Hypertrophy Myocardial hypertrophy is a compensatory mechanism in heart failure as the heart attempts to maintain adequate pumping ability. Paradoxically, hypertrophy can gradually decrease cardiac efficiency.

Which adverse effect might occur in a client receiving milrinone? Hypoglycemia Confusion Hypotension Hyperkalemia

Hypotension Adverse effects of phosphodiesterase inhibitors such as milrinone include hypotension, ventricular dysrhythmias, and headache.

The nurse is assessing a patient who reports no symptoms of heart failure at rest but is symptomatic with increased physical activity. Under what classification does the nurse understand this patient would be categorized? I II III IV

II Classification II of heart failure is indicated by the patient being comfortable at rest, but experiencing fatigue, palpitation, or dyspnea during ordinary physical activity.

A client with a history of heart failure has been assessed and the care team has determined that a reduction in myocardial workload would benefit his prognosis. Which intervention is most likely to meet this client's needs? Cardioversion Regular administration of inotropic drugs An implantable defibrillator Implantation of a ventricular assist device (VAD)

Implantation of a ventricular assist device (VAD) VADs support ventricular function, reducing the workload of the myocardium. Cardioversion, inotropes, and defibrillators do not directly reduce the workload that is placed on the myocardium.

Which statement regarding heart failure is true? The most common cause of left-sided heart failure is right-sided heart failure. The most common cause of congestive heart failure is angina pectoris. In compensated heart failure, an increase of end-diastolic volume causes increased force of left ventricular contraction. The edema of right-sided heart failure is associated with low plasma osmotic pressure.

In compensated heart failure, an increase of end-diastolic volume causes increased force of left ventricular contraction. In compensated failure, the increase in diastolic filling and stretch on the left ventricle exert an increase in the force of contraction (Frank-Starling Law) until the stretch becomes too great and ventricular efficiency declines. Right-sided failure does not cause left-sided failure: the opposite is true, that left-sided failure can cause right-sided failure. Edema occurs when capillary hydrostatic pressure becomes greater than plasma osmotic pressure and fluid leaks out of the circulatory system. Angina pectoris does not cause heart failure.

The pharmacology instructor is discussing cardiac glycosides with a class of pre-nursing students. According to the instructor, what physiologic effect do cardiac glycosides trigger? Decreased cardiac output Decreased afterload Increased ventricular rate Increased force of heart contraction

Increased force of heart contraction Cardiac glycosides increase the force of cardiac contraction, which increases cardiac output.

An 86-year-old client is disappointed to learn that he or she has class II heart failure despite a lifelong commitment to exercise and healthy eating. Which age-related change predisposes older adults to the development of heart failure? Increased vascular stiffness Orthostatic hypotension Increased cardiac contractility Loss of action potential

Increased vascular stiffness Increased vascular stiffness in older adults causes a progressive increase in systolic blood pressure with advancing age, which in turn contributes to the development of left ventricular hypertrophy and altered diastolic filling. A loss of action potential does not typically accompany aging, and contractility tends to decrease as a result of cardiac stiffness. Orthostatic hypotension is neither a normal age-related change nor a cause of heart failure.

A client asks the nurse about how his prescribed digoxin helps his heart. The nurse would include which response? Select all that apply. Increases force of contraction Slows the conduction velocity through the atrioventricular (AV) node Decreases heart rate Decreases cardiac output Increases heart rate

Increases force of contraction Slows the conduction velocity through the atrioventricular (AV) node Decreases heart rate Digoxin exerts the following effects on the heart: increases cardiac output via increased force of contraction, slows the conduction velocity through the AV node, and decreases heart rate.

A 22-year-old man is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. Which immediate treatments are likely to most benefit the man? Resolution of compensatory pulmonary edema and heart dysrhythmias. Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility. Infusion of normal saline or Ringer's lactate to maintain the vascular space. Administration of oxygen and epinephrine to promote perfusion.

Infusion of normal saline or Ringer's lactate to maintain the vascular space. Maintenance of vascular volume is the primary goal in the treatment of hypovolemic shock and can be achieved in the short term through intravenous administration of saline solution or Ringer's lactate. Resolution of pulmonary edema and heart dysrhythmias and infusion of vasodilators are associated with treatment of cardiogenic shock, while oxygen and epinephrine would address anaphylactic shock.

A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are most likely to benefit the man? Resolution of compensatory pulmonary edema and heart dysrhythmias. Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility. Infusion of normal saline or Ringer's lactate to maintain the vascular space. Administration of oxygen and epinephrine to promote perfusion.

Infusion of normal saline or Ringer's lactate to maintain the vascular space. Maintenance of vascular volume is the primary goal in the treatment of hypovolemic shock, and can be achieved in the short term through intravenous administration of saline solution of Ringer's lactate. Resolution of pulmonary edema and heart dysrhythmias and infusion of vasodilators are associated with treatment of cardiogenic shock, while oxygen and epinephrine would address anaphylactic shock.

A client in the hospital informs the nurse he "feels like his heart is racing and can't catch his breath." What does the nurse understand occurs as a result of a tachydysrhythmia? It causes a loss of elasticity in the myocardium. It reduces ventricular ejection volume. It increases afterload. It increases preload.

It reduces ventricular ejection volume. Reducing ventricular ejection volume because diastole, during which the ventricle fills withblood (preload), is shortened as a result of a tachydsrhythmia. Causing a loss of elasticity in the muscle is a result of cardiomyopathy. Afterload is decreased not increased.

A new client has been admitted with right-sided heart failure. When assessing this client, the nurse knows to look for which finding? Pulmonary congestion Cough Dyspnea Jugular venous distention

Jugular venous distention When the right ventricle cannot effectively pump blood from the ventricle into the pulmonary artery, the blood backs up into the venous system and causes jugular venous distention and congestion in the peripheral tissues and viscera. All the other choices are symptoms of left-sided heart failure.

You are talking about heart failure to a local community group. What would you explain is the major cause of right-sided heart failure? COPD Left-sided heart failure Venous insufficiency Pulmonary hypertension

Left-sided heart failure The major cause of right-sided heart failure is left-sided heart failure. Neither COPD, venous insufficiency, nor pulmonary hypertension is the main cause of right-sided heart failure.

The nurse is preparing a client for a multiple gated acquisition (MUGA) scan. What would be an important instruction for the nurse to give a client who is to undergo a MUGA scan? Avoid any activity at least 2 hours before the test. Drink plenty of fluids during the test. Avoid dairy products a day before and a day after the test. Lie very still at intermittent times during the test.

Lie very still at intermittent times during the test. The nurse should instruct the client, who is to undergo a MUGA scan, to lie very still at intermittent times during the 45-minute test. The client need not drink plenty of fluids, avoid activities before/after the test, or avoid dairy products during the test.

A client has a diagnosis of right-sided heart failure. Which body organ should the nurse assess regularly? Liver Stomach Brain Kidneys

Liver As right-sided heart failure occurs, blood backs up in the venous circulation, including the hepatic veins that drain into the inferior vena cava. The liver becomes engorged, and with prolonged right-sided failure, hepatic cell death occurs. The kidneys are further down in the venous circulation and are less affected. The jugular veins and gastrointestinal tract are affected, but are not organs.

A client presents to the emergency department with signs and symptoms of acute congestive heart failure. Assessment findings and tests confirm the diagnosis. Which type of diuretic would be the drug of choice to treat the client? Thiazide Loop Potassium sparing Calcium wasting

Loop For acute HF, the first drugs of choice may include an IV loop diuretic, a cardiotonic-inotropic agent (e.g., digoxin, dobutamine, milrinone), and vasodilators (e.g., nitroglycerin and hydralazine or nitroprusside).

A client is in the early stage of heart failure. During this time, which compensatory mechanism occurs? Decreased renal blood flow causes the renin-angiotensin-aldosterone system to reduce secretion of aldosterone and antidiuretic hormone. Low blood pressure triggers the baroreceptors to increase sympathetic nervous system stimulation. Decreased renal blood flow causes the renin-angiotensin-aldosterone system to increase aldosterone secretion. Low blood pressure triggers the baroreceptors to decrease sympathetic nervous system stimulation.

Low blood pressure triggers the baroreceptors to increase sympathetic nervous system In the early stage of heart failure, low blood pressure triggers baroreceptors in the carotid sinus and aortic arch to increase sympathetic nervous system stimulation, causing an increased heart rate, vasoconstriction, and increased myocardial oxygen consumption. Decreased renal blood flow causes the renin-angiotensin-aldosterone system to increase, not reduce, secretion of aldosterone and antidiuretic hormone, causing sodium and water retention and arterial vasoconstriction.

Which description sums up the basic pathophysiology of heart failure that the nurse would include when educating a client? Low cardiac output due to reduced pumping ability Reduced tissue perfusion, especially to the kidney Activated sympathetic (adrenergic) reflexes Myocardial remodeling of scar tissue

Low cardiac output due to reduced pumping ability There are many reasons for heart failure but the basic pathophysiology is a loss of ventricular efficiency with a decrease in cardiac output. As a result, blood flow to body tissues declines, and sympathetic reflexes of vasoconstriction and increase in heart rate attempt to compensate. The renin-angiotensin-aldosterone system is activated, and aldosterone, which causes myocardial remodeling, is released.

Which feature is the hallmark of systolic heart failure? Low ejection fraction (EF) Pulmonary congestion Limited activities of daily living (ADLs) Basilar crackles

Low ejection fraction (EF) A low EF is a hallmark of systolic heart failure (HF); the severity of HF is frequently classified according to the client's symptoms.

The nurse is providing discharge instructions to a client with heart failure preparing to leave the following day. What type of diet should the nurse request the dietitian to discuss with the client? Low-fat diet Low-potassium diet Low-cholesterol diet Low-sodium diet

Low-sodium diet Medical management of both left-sided and right-sided heart failure is directed at reducing the heart?s workload and improving cardiac output primarily through dietary modifications, drug therapy, and lifestyle changes. A low-sodium diet is prescribed, and fluids may be restricted. Because the client will be on a diuretic such as Lasix, he may become potassium depleted and would need potassium in the diet. A low-cholesterol and low-fat diet may be ordered but are not specific to the heart failure.

A group of students are reviewing the drugs used to treat heart failure. The students demonstrate understanding of the information when they identify which agent as a phosphodiesterase inhibitor? Milrinone Captopril Digoxin Hydrochlorothiazide

Milrinone Milrinone is a phosphodiesterase inhibitor. Captopril is an ACE inhibitor. Digoxin is a cardiac glycoside. Hydrochlorothiazide is a diuretic.

Which action will the nurse include in the plan of care for a client admitted with acute decompensated heart failure (ADHF) who is receiving milrinone? Monitor blood pressure frequently Encourage the client to ambulate in room Titrate milrinone rate slowly before discontinuing Teach the client about safe home use of the medication

Monitor blood pressure frequently Milrinone is a phosphodiesterase inhibitor that delays the release of calcium from intracellular reservoirs and prevents the uptake of extracellular calcium by the cells. This promotes vasodilation, resulting in decreased preload and afterload and reduced cardiac workload. Milrinone is administered intravenously to clients with severe HF, including those who are waiting for a heart transplant. Because the drug causes vasodilation, the client's blood pressure is monitored before administration because if the client is hypovolemic the blood pressure could drop quickly. The major side effects are hypotension and increased ventricular dysrhythmias. Blood pressure and the electrocardiogram (ECG) are monitored closely during and after infusions of milrinone.

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

Morphine sulfate Morphine seems to help relieve respiratory symptoms by depressing higher cerebral centers, thus relieving anxiety and slowing respiratory rate. Morphine also promotes muscle relaxation and reduces the work of breathing. Furosemide is a loop diuretic and will decrease fluid accumulation but will not reduce anxiety. Nitroglycerin will promote smooth muscle relaxation in the vessel walls and will relieve pain but not reduce anxiety. Dopamine is an inotrope that will increase the force of ventricular contraction but will not alleviate anxiety.

A client has developed cardiogenic shock. The most frequent cause of this type of shock is: Hypertension Heart failure Myocardial infarction Allergic reaction

Myocardial infarction Cardiogenic shock is a loss of cardiac pumping ability. The most frequent cause of this shock is myocardial infarction, as ischemic damage greatly reduces left ventricular contractility.

A client with heart failure tells the nurse that he is frustrated and is unable to get "a good night's rest." The client relates that he falls asleep and is suddenly awakened and feels as though he is having a hard time breathing and is suffocating. The nurse recognizes this assessment as: Paroxysmal nocturnal dyspnea Orthopnea Cardiac asthma Sleep apnea

Paroxysmal nocturnal dyspnea Paroxysmal nocturnal dyspnea is a sudden attack of dyspnea that occurs during sleep. It disrupts sleep, and the person awakens with a feeling of extreme suffocation that resolves when he or she sits up. Orthopnea is shortness of breath that occurs when a person is supine. Cardiac asthma is a bronchospasm due to congestion of the bronchial mucosa that may cause wheezing and difficulty in breathing. In obstructive sleep apnea, the upper airway collapses, which leads to the complete cessation of airflow (apnea) or partial cessation of air flow (hypopnea) during sleep.

Which would a nurse expect to assess if a client is experiencing right-sided heart failure? Wheezing Peripheral edema Hemoptysis Dyspnea

Peripheral edema Peripheral edema would be noted in clients with right-sided heart failure. Wheezing, hemoptysis, and dyspnea would suggest left-sided heart failure.

The client with cardiac failure is taught to report which symptom to the physician or clinic immediately? Increased appetite Persistent cough Weight loss Ability to sleep through the night

Persistent cough Persistent cough may indicate an onset of left-sided heart failure. Loss of appetite, weight gain, interrupted sleep, unusual shortness of breath, and increased swelling should also be reported immediately.

The pharmacology instructor is describing medications that increase the contractile force of the heart. Which term describes this effect? Positive chronotropic Positive inotropic Negative inotropic Negative dromotropic

Positive inotropic A positive inotropic effect improves the contractility and pumping ability of the heart.

Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole? Afterload Preload Ejection fraction Stroke volume

Preload Preload is the the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. Afterload is the amount of resistance to ejection of blood from a ventricle. The ejection fraction is the percentage of blood volume in the ventricles at the end of diastole that is ejected during systole. Stroke volume is the amount of blood pumped out of the ventricle with each contraction.

A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.) Jugular vein distention Ascites Pulmonary crackles Dyspnea Cough

Pulmonary crackles Dyspnea Cough The clinical manifestations of pulmonary congestion associated with left-sided heart failure include dyspnea, cough, pulmonary crackles, and low oxygen saturation levels, but not ascites or jugular vein distention.

A hospitalized client with heart failure puts on the call light and states, "I've become very short of breath, and I've been coughing up this pink frothy sputum." The nurse immediately suspects which of the following complications? Pulmonary edema Hepatomegaly Decreased renal perfusion pressure Decreased cardiac workload

Pulmonary edema When the left ventricle fails, blood backs up into the pulmonary system. Large quantities of frothy sputum, which is sometimes blood-tinged, may be produced, indicating severe pulmonary congestion or pulmonary edema.

A client with heart failure reports a sudden change in the ability to perceive colors. The client reports nausea, and assessment reveals an irregular pulse of 39 beats per minute. What is the nurse's bestaction? Report the possibility of digitalis toxicity to the care provider promptly Withhold the client's next scheduled dose of furosemide and report to the care provider Monitor the client's vital signs every 30 minutes Facilitate an ophthalmology referral promptly

Report the possibility of digitalis toxicity to the care provider promptly This client's presentation is characteristic of digitalis toxicity, which must be promptly reported. This constellation of symptoms is less likely to result from furosemide. Close monitoring is necessary; vital signs every 30 minutes is insufficient. Referrals are not the most time-dependent priority.

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

Right-sided heart failure Signs and symptoms of Right Ventricular Failure include: Weakness; Ascites; Weight gain; Nausea, vomiting; Dysrhythmias; Elevated central venous pressure; Jugular vein distention. The scenario does not indicate whether the heart failure is chronic or acute. Therefore, options A, B, and C are incorrect.

Which is a manifestation of right-sided heart failure? Accumulation of blood in the lungs Systemic venous congestion Reduction in forward flow Reduction in cardiac output

Systemic venous congestion Right-sided heart failure causes systemic venous congestion and a reduction in forward flow. Left-sided heart failure causes an accumulation of blood in the lungs and a reduction in forward flow or cardiac output that results in inadequate arterial blood flow to the tissues.

A nurse suspects that a client is experiencing left-sided heart failure. Which would the nurse assess? (Select all that apply.) Tachypnea Hemoptysis Peripheral edema Hepatomegaly Orthopnea Polyuria

Tachypnea Hemoptysis Orthopnea Polyuria Left-sided heart failure would be indicated by tachypnea, hemoptysis, orthopnea, increased urine output (polyuria), nocturia, dyspnea, and cough. Peripheral edema and hepatomegaly suggest right-sided heart failure.

The health care provider is reviewing lab results of a client diagnosed with heart failure. The provider notes that the client's ANP and BNP levels have been increasing and remain significantly elevated. These results would be interpreted as: The condition is getting progressively worse. The client is improving. Results are not significant assessment data. The more the results continue to increase, the better outcome for the client.

The condition is getting progressively worse. Circulating levels of both ANP and BNP are elevated in persons with heart failure. The concentrations are well correlated with the extent of ventricular dysfunction, increasing up to 30-fold in persons with advanced heart disease. Assays of BNP are used clinically in the diagnosis of heart failure and to predict the severity of the condition.

A client has an elevated BUN. The client has been prescribed digoxin for heart failure. What aspect of care is the priority regarding this client? The client should be taught to increase sodium in the diet. The dose should be increased when the heart rate is below 60. The dose should be decreased in this client. The dosage should be 1.0 mg per mouth daily.

The dose should be decreased in this client. The dose must be reduced in the presence of renal failure because most of the digoxin is excreted unchanged by the kidneys, leading to drug accumulation and toxicity. The client should be taught to limit sodium intake in the diet. The client's heart rate should remain above 60. If the heart rate falls below 60, the digoxin should be held. The dose of 1.0 mg is too large for a client with altered renal function.

Mrs. Houston is a 78-year-old woman who resides in an assisted living facility. Her provider prescribed digoxin at her last visit to the clinic and she has approached the nurse about this new drug. What teaching point should the nurse emphasize to Mrs. Houston? The importance of having required laboratory work performed on time The need to take the medication at the same time each day regardless of her heart rate The correct technique for using a home blood pressure cuff Timing household activities to coincide with the administration times of her digoxin

The importance of having required laboratory work performed on time Clients taking digoxin need to know the importance of having all laboratory work (serum drug levels; electrolytes) performed on time. Digoxin is not taken if the client is bradycardic, and it does not provide an immediate or short-term increase in exercise tolerance. Blood pressure monitoring is not normally required for clients who are taking digoxin.

What is the main difference between Class I and Class II heart failure as defined by the New York Heart Association (NYHA)? The level of physical activity each allows Duration of symptoms There is a marked limitation of physical activity. The client is unable to carry out any physical activity.

The level of physical activity each allows Both Class I and Class II levels of heart failure are considered Mild under the New York Heart Association (NYHA) guidelines. The difference is that in Class II, the client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea, whereas in Class I, the client is comfortable both at rest and during ordinary physical activity. A marked limitation of physical activity would be a sign of Moderate heart failure, and inability to carry out any physical activity is a sign of Severe heart failure.

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

The patient will be given digoxin immune fab. Digoxin is stopped, not merely reduced, in patients experiencing toxicity. If digoxin toxicity is accompanied by serious dysrhythmias, several drugs may be used, including potassium chloride (if serum potassium is low) and digoxin immune fab (if toxicity is serious).

Which is true about digoxin? Digoxin decreases the mortality associated with heart failure. Digoxin is used to treat paroxysmal atrial fibrillation. Digoxin improves the quality of life for patients with heart failure in the absence of atrial fibrillation. The therapeutic range for digoxin is 0.5 to 2 ng/mL.

The therapeutic range for digoxin is 0.5 to 2 ng/mL. The therapeutic range for digoxin is generally considered to be 0.5 to 2 ng/mL. (A lower range of 0.5 to 0.8 ng/mL has been suggested to minimize adverse effects without sacrificing efficacy.) Digoxin has been shown to improve symptoms, increase the quality of life, and increase the exercise tolerance of patients with CHF. These benefits occur regardless of the underlying heart rhythm (normal sinus or atrial fibrillation), the etiology of the heart failure, or other drugs used in therapy (e.g., ACE inhibitors, beta-blockers). Digoxin does not decrease mortality from heart failure. Digoxin is also used in treating chronic atrial fibrillation to maintain a satisfactory resting ventricular rate; it is no longer recommended to prevent paroxysmal (recurrent episodes of) atrial fibrillation.

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

The woman may be experiencing an exacerbation of right-sided HF. Increased JVP is associated with right-sided HF. Dyspnea may or may not be present, but is more closely associated with left-sided HF. Increased JVP is not necessarily indicative of impending shock.

A client is told that she has cardiac valve leaflets, or cusps, that are floppy and fail to shut completely, permitting blood flow even when the valve should be completely closed. The nurse knows that this condition can lead to heart failure and is referred to as: Pericardial effusion Infective endocarditis Valvular regurgitation Valvular stenosis

Valvular regurgitation When cardiac valves such as the aortic or mitral fail to close properly, blood does not efficiently exit from the left ventricle. This condition is valvular regurgitation. Valvular stenosis is a narrowing of the lumen of the valve. Pericardial effusion, an accumulation of fluid in the pericardial sac, causes obstructive shock, as it impedes ventricular filling. Infective endocarditis could trigger septic shock.

An older adult client asks the nurse why so many older people develop heart failure. The best response would be increased: Vascular stiffness Response to beta-adrenergic stimulation Cardiac tone and compliance Myocardial metabolism

Vascular stiffness There are four changes associated with aging that contribute to the development of heart failure in the older adults. Reduced responsiveness to beta-adrenergic stimulation limits the heart's capacity to maximally increase heart rate and contractility during an increase in activity or stress. A second major effect of aging is increased vascular stiffness; third, in addition to increased vascular stiffness, the heart itself becomes stiffer and less compliant with age. Fourth, aging alters myocardial metabolism at the level of the mitochondria.

Levels of endothelins may be increased in clients with heart failure. Which of the following is the primary action of endothelins? Vasoconstriction Vasodilation Diuretic Natriuretic

Vasoconstriction Endothelins are secreted by many cell types, including the endothelial lining of the circulatory system. Clients with heart failure may have increased blood levels of endothelins as the body tries to compensate for a decrease in cardiac output. However, most actions of endothelins—for example, vasoconstriction and sodium and water retention—are counterproductive in heart failure.

A person with blood pressure of 68/38 fainted after donating a unit of blood. The blood bank technician stated that the person was experiencing low preload from loss of blood volume. The nurse knows that preload refers to which of the following? Blood ejected from each ventricle with each contraction Venous return to the heart Blood pumped by each ventricle in 1 minute Resistance to ventricular emptying

Venous return to the heart Preload refers to the volume of blood in the ventricle at the end of diastole. This is directly related to venous return, the amount of blood returning to the heart. Blood ejected with each left ventricular contraction is stroke volume. Blood pumped in 1 minute is cardiac output.

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

Visual disturbances Adverse reactions associated with cardiotonic medications include headache, weakness, drowsiness, visual disturbances, nausea, anorexia, and arrhythmias. Diarrhea, constipation, and restlessness are not adverse reactions of cardiotonic medications.

A telehealth nurse is talking with a client who has a history of right-sided heart failure. The nurse should question the client about which assessment finding that would indicate the client's condition is worsening? Weight gain Copious urination Shortness of breath Decreased blood pressure

Weight gain In right-sided heart failure, blood backs up into the venous system and increased capillary hydrostatic pressure forces plasma out of the circulatory system, resulting in edema. The accumulation of fluid is evidenced by rapid weight gain. Shortness of breath and decreased renal perfusion and output are characteristic of left-sided failure.

A nurse assessing a client on digoxin suspects toxicity. Which visual disturbances would the nurse expect to assess? Complete loss of vision Double vision Yellow or green vision Difficulty of near vision

Yellow or green vision The visual disturbance the nurse should assess for is yellow or green vision with a white halo. Visual disturbances occur in digoxin toxicity. Blurring of vision and borders around dark objects are the other visual disturbances. Double vision, difficulty of near vision, and complete loss of vision do not occur in digitalis toxicity.

While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). How should the nurse document this sound? a first heart sound (S1). a third heart sound (S3). a fourth heart sound (S4). a murmur.

a third heart sound (S3). An S3 is heard following an S2, which commonly occurs in clients experiencing heart failure and results from increased filling pressures. An S1 is a normal heart sound made by the closing of the mitral and tricuspid valves. An S4 is heard before an S1 and is caused by resistance to ventricular filling. A murmur is heard when there is turbulent blood flow across the valves.

A client with left-sided heart failure reports increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of what condition? right-sided heart failure. acute pulmonary edema. pneumonia. cardiogenic shock.

acute pulmonary edema. Shortness of breath, agitation, and pink-tinged, foamy sputum signal acute pulmonary edema. This condition results when decreased contractility and increased fluid volume and pressure in clients with heart failure drive fluid from the pulmonary capillary beds into the alveoli. In right-sided heart failure, the client would exhibit hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia, the client would have a temperature spike and sputum that varies in color. Cardiogenic shock is indicated by signs of hypotension and tachycardia.

A 77-year-old client with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of "impending doom." Based on pathophysiologic principles, the nurse knows the rapid heart rate could: decrease renal perfusion and result in development of ascites. be a result of catecholamines released from SNS, which could increase the myocardial oxygen demand. Desensitize the alpha-adrenergic receptors leading to increase in norepinephrine levels. prolong the electrical firing from the SA node resulting in development of a heart block.

be a result of catecholamines released from SNS, which could increase the myocardial oxygen demand. An increase in sympathetic activity by stimulation of the beta-adrenergic receptors of the heart leads to tachycardia, vasoconstriction, and dysrhythmias. Acutely, tachycardia significantly increases the workload of the heart, thus increasing myocardial O2 demand and leading to cardiac ischemia, myocyte damage, and decreased contractility. Decrease renal perfusion would activate the RAAS system, increasing heart rate and BP further. Ventricular dysrhythmias are primarily seen at this stage of HF.

An older adult client has been diagnosed with chronic heart failure. He is prescribed an ACE inhibitor to treat the symptoms and improve his quality of life. This drug will alleviate the client's symptoms of heart failure by: selectively blocking the synthesis of renin in the kidneys. blocking the conversion of angiotensin I to angiotensin II. enhancing inotropy by maximizing calcium channel function. promoting cardiac output through a reduction in afterload.

blocking the conversion of angiotensin I to angiotensin II. ACE inhibitors block the conversion of angiotensin I to angiotensin II. They do not directly affect renin synthesis, calcium channel function, or afterload.

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

blood pressure. Fluid balance, cognition, and exercise tolerance are all affected by CHF and should be regularly assessed as part of thorough nursing care. However, the combination of an ACE inhibitor, a beta blocker, and a diuretic constitutes a significant risk for hypotension and indicates a need for frequent blood pressure monitoring.

A client is being treated for heart failure. Which is most indicative of improved health status? decreased pitting edema increased skin turgor heart rate of 52 improved sensorium

decreased pitting edema The absence of pitting edema, decreased size of ankles and abdominal girth, and decreased weight improves circulation and increases renal blood flow. The diminished fluid volume is indicative of an improved blood supply to the body tissues. Increased skin turgor indicates that the client is well hydrated and does not have fluid volume excess. A heart rate of 52 is too slow to provide good contractility. Improved sensorium indicates adequate perfusion but is not the most indicative of improved heart failure status.

The nurse is assessing a client admitted with cardiogenic shock. What medication will the nurse tritrate to improve blood flow to vital organs? dopamine enalapril furosemide metoprolol

dopamine Dopamine, a sympathomimetic drug, is used to treat cardiogenic shock. It increases perfusion pressure to improve myocardial contractility and blood flow through vital organs. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic blocker that slows heart rate and lowers blood pressure, undesirable effects when treating cardiogenic shock.

A client has been having cardiac symptoms for several months and is seeing a cardiologist for diagnostics to determine the cause. How will the client's ejection fraction be measured? echocardiogram electrocardiogram cardiac catheterization cardiac ultrasound

echocardiogram The heart's ejection fraction is measured using an echocardiogram or multiple gated acquisition scan, not an electrocardiogram or cardiac ultrasound. Cardiac catheterization is not the diagnostic tool for this measurement.

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

improving quality of life by relieving symptoms. A primary treatment goal for a client with CHF is to improve the quality of life through symptom management. CHF will not be cured, and maintaining a higher oxygen level will assist with dyspnea associated with CHF. A stent is not an option for treatment of CHF.

A client presents to the ED with wheezing and blood-tinged sputum. The nurse suspects the client is experiencing pulmonary edema. The nurse should suspect the cause of the pulmonary edema is most likely: cardiomyopathy. right ventricular failure. valvular heart disease. left ventricular failure.

left ventricular failure. Pulmonary edema occurs when left ventricular failure (or dysfunction) results in accumulation of blood and fluid in pulmonary veins and tissues.

A client diagnosed with heart failure presents with a temperature of 99.1° F, pulse 100 beats/minute, respirations 42 breaths/minute, BP 110/50 mm Hg; crackles in both lung bases; nausea; and pulse oximeter reading of 89%. Which finding indicates a need for immediate attention? lung congestion nausea temperature blood pressure

lung congestion Because pulmonary edema can be fatal, lung congestion needs to be relieved as quickly as possible. Supplemental oxygen or mechanical ventilation is used to support breathing. Inotropic medications, which improve myocardial contractility, are administered to relieve symptoms.

A client is receiving captopril for heart failure. During the nurse's assessment, what sign indicates that the medication therapy is ineffective? skin rash peripheral edema dry cough postural hypotension

peripheral edema Peripheral edema is a sign of fluid volume excess and worsening heart failure. A skin rash, dry cough, and postural hypotension are adverse reactions to captopril, but they don't indicate that therapy is ineffective.

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

pitting edema The presence of pitting edema is a significant sign of right-sided heart failure because it indicates fluid retention of about 10 lbs. Sodium and water are retained because reduced cardiac output causes a compensatory neurohormonal response. Oliguria is a sign of kidney failure or dehydration. The S4 heart sound is from a thickened left ventricle, seen with aortic stenosis or hypertension. The decreased oxygen saturation levels are from hypoexemia.

After teaching a group of students about conditions that can lead to heart failure, the instructor determines that additional teaching is needed when the students identify: renal failure. valvular disease. coronary artery disease. hypertension.

renal failure. Renal failure would be least likely to contribute to the development of heart failure. Coronary artery disease, cardiomyopathy, valvular disease, and hypertension are commonly associated with heart failure.

Assessment of an older adult client reveals bilateral pitting edema of the client's feet and ankles; difficult to palpate pedal pulses; breath sounds clear on auscultation; oxygen saturation level of 93% (0.93); and vital signs normal. What is this client's most likely health problem? right-sided heart failure pericarditis cardiogenic shock cor pulmonale

right-sided heart failure A major effect of right-sided heart failure is the development of peripheral edema. A client who is in shock would not have stable vital signs. Cor pulmonale would be accompanied by manifestations of lung disease. Pericarditis is an inflammation of the pericardium exhibited by fever, precordial pain, dyspnea, and palpitations.