NCLEX Qs 280 Exam 2: Iggy, Saunders, La Charity, RN NCLEX Mastery, Khan (Cardio)

Which diagnostic test result is consistent with a diagnosis of heart failure (HF)? 1- Serum potassium level of 3.2 mEq/L 2- Ejection fraction of 60% 3- B-type natriuretic peptide (BNP) of 760 ng/dL 4- Chest x-ray report showing right middle lobe consolidation

3- B-type natriuretic peptide (BNP) of 760 ng/dL BNP is produced and released by the ventricles when the client has fluid overload as a result of HF; a normal value is less than 100 pg/mL. Hypokalemia may occur in response to diuretic therapy for HF, but may also occur with other conditions; it is not specific to HF. Ejection fraction of 60% represents a normal value of 50% to 70%. Consolidation on chest x-ray may indicate pneumonia.

Which are risk factors that are known to contribute to atherosclerosis-related diseases? Select all that apply. 1- Low-density lipoprotein cholesterol (LDL-C) of 160 mg/dL 2- Smoking 3- Aspirin (acetylsalicylic acid [ASA]) consumption 4- Type 2 diabetes 5- Vegetarian diet

1, 2, 4 Having an LDL-C value of less than 100 mg/dL is optimal; 100 to 129 mg/dL is near or less than optimal; with LDL-C 130 to 159 mg/dL (borderline high), the client is advised to modify diet and exercise. Smoking is a modifiable risk factor and should be avoided or terminated, and diabetes is a risk factor for atherosclerotic disease. ASA is used as prophylaxis for atherosclerotic disease/coronary artery disease to prevent platelet adhesion. A diet high in whole grains, fruits, and vegetables is desirable to prevent atherosclerosis; vegetarians usually consume fruits, vegetables, and nonanimal sources of protein.

The nurse is ambulating a cardiac surgery client whose heart rate suddenly increases to 146 beats/min. In which order will the nurse take the following actions? 1. Have the client sit down. 2. Check the client's blood pressure. 3. Administer as needed (PRN) oxygen by nasal cannula. 4. Call the client's health care provider.

1, 3, 2, 4 Because the increased heart rate may be associated with a drop in blood pressure and with lightheadedness, the nurse's first action should be to decrease risk for a fall by having the client sit down. Cardiac ischemia may be causing the client's tachycardia, and administration of supplemental oxygen should be the next action. Assessment of blood pressure should be done next. Finally, the health care provider should be notified about the client's response to activity because changes in therapy may be indicated.

A patient diagnosed with mild heart failure is prescribed hydrochlorothiazide (Microzide). The healthcare provider should determine the teaching about the medication has been successful if the patient makes which of these statements? Choose 1 answer: Choose 1 answer: 1- "It is important for me to change positions slowly because I might become dizzy." 2- "This medication might cause me to have a decrease in my appetite." 3- "I should not worry if I experience a dry cough when taking this medication." 4- "I might experience swelling in my legs when taking this medication."

1- "It is important for me to change positions slowly because I might become dizzy." First, think of why the hydrochlorothiazide can be helpful in treating the symptoms of mild heart failure. Hydrochlorothiazide inhibits sodium reabsorption, causing sodium and water (along with potassium and hydrogen ions) to be excreted. The diuretic effect and decrease in fluid volume may cause orthostatic (postural) hypotension. Position changes should be made slowly to prevent falls.

A patient who has HF has been prescribed a digitalis preparation. The patient asks the nurse how this medication will help his HF. Which response by the nurse is correct? 1- "The medication increases the force of the heart contraction." 2- "The medication decreases cardiac output." 3- "The medication increases the heart rate." 4- "The medication decreases the diameters of the arteries."

1- "The medication increases the force of the heart contraction." Digitalis preparations help treat HF by strengthening the force of the heartbeat.

The laboratory results of a patient diagnosed with heart failure shows a serum digoxin (Lanoxin) level of 2.1 ng/mL. Which medication is appropriate to administer at this time? Choose 1 answer: 1- Digoxin immune fab (DigiFab) 2- An increased dose of digoxin (Lanoxin) 3- Furosemide (Lasix) 4- Potassium chloride (K-tab)

1- Digoxin immune fab (DigiFab) A therapeutic digoxin serum concentration for heart failure is 0.5 - 0.9 ng/mL. A level of 2.1 ng/mL is considered toxic so the antidote, digoxin immune fab, is appropriate to administer at this time.

The nurse administers scheduled 0800 medications to a client eating breakfast. Which medication does the nurse withhold from the client until verifying with the health care provider (HCP)? (See exhibit.) Basic Metabolic Panel drawn at 05:00 ■ Glucose 95 mg/dL ■ Sodium 135 mEq/L ■ Potassium 2.4 mEq/L ■ BUN 42 mg/dL ■ Creatinine 1.7 mg/dL 1- Furosemide 40 mg 2- Insulin aspart 4 units 3- Metoprolol 12.5 mg 4- Lisinopril 5 mg

1- Furosemide 40 mg Furosemide causes the kidneys to excrete potassium. The nurse checks with the healthcare provider before administering lasix to a client with a potassium of 2.4. The nurse administers 4 units of insulin aspart with a meal to avoid the client becoming hypoglycemic. Insulin aspart starts acting within 15 minutes of administration, so the nurse in this scenario is careful to administer insulin aspart with meals. Metoprolol 12.5 mg is safe to administer with bp 104/58 and a HR of 64. The nurse checks with the healthcare provider before giving metoprolol to a client with a HR <60 or a systolic BP <100. Lisinopril is safe to administer with a bp of 104/58. Ace inhibitors such as lisinopril may cause hyperkalemia and renal dysfunction. The nurse checks with the health care provider before administering lisinopril to a client with high potassium or new signs of kidney failure such as decreasing urine output or incresing creatinine. Explanation Watch for potassium imbalances, such as hypo or hyperkalemia. Clients who are taking diuretics such as Furosemide are at increased risk for hypokalemia. The nurse may notice with hypokalemia symptoms such as shallow respirations, muscle weakness, weak pulses, anxiety or lethargy, and hypoactive bowel sounds.

A patient diagnosed with heart failure has a pulmonary artery catheter (PAC) in place. What information about the patient's hemodynamic functioning will the healthcare provider obtain from this monitoring device? Choose 1 answer: 1- Left ventricular functioning 2- Stroke volume 3- Pulmonary valve function 4- Coronary artery patency

1- Left ventricular functioning The tip of the PAC is wedged in a branch of the pulmonary artery. One of the primary hemodynamic measurements provided by the PAC is the pulmonary artery wedge pressure (PAWP).

The nurse is caring for a patient with a diagnosis of HF. Which diet is most appropriate for this patient? 1- Low sodium, high potassium 2- Low potassium, high sodium 3- Low fat, low calorie 4- High calorie, low fat

1- Low sodium, high potassium A low-sodium, high-potassium diet is the most appropriate because of the patient's need to prevent further fluid accumulation and replace potassium lost secondary to diuretic therapy.

A nurse cares for a client admitted for atrial fibrillation and hypertension. The client reports a new dry, non-productive cough. When speaking with the health care provider, which medication does the nurse suggest discontinuing? (See exhibit.) 1- Metoprolol 2- Enoxaparin 3- Digoxin 4- Amlodipine

1- Metoprolol Metoprolol is a beta blocker and is generally contraindicated in a client with a history of asthma. This medication may be causing the client to have bronchospasm and cough. A new, dry cough that the client reports is assessed by the nurse and the client's medication list reviewed. Enoxaparin (Lovenox) is used for DVT prophylaxis. This medication is not contraindicated with any of the medications, labs, or client history and assessment. While it is true that the client has hypokalemia, the client's potassium level is only slightly low. Hypokalemia can lead to worsening digoxin toxicity; however, the client's digoxin level is within therapeutic range and this is not a problem. Digoxin may be used in the treatment of atrial fibrillation and careful monitoring of this medication is necessary because toxic levels of this medicine is harmful and may be life-threatening. However, the normal therapeutic drug range for this medication is 0.5-2 ng/mL and the client's digoxin level is within therapeutic range. Amlodipine is a calcium channel blocker, not an ACE inhibitor. ACE inhibitors have a high risk for cough among anti-hypertensives. Explanation The nurse has many things to consider with this client. The client has a significant cardiac history, with hypertension, hyperlipidemia, and orders for digoxin, metoprolol, and low-molecular weight heparin. Digoxin is most commonly used for atrial fibrillation and congestive heart failure, which is not yet noted in the client's history, so it may be a new medication. Digoxin requires close monitoring for therapeutic levels and has a very sensitive relationship with potassium. Considering the client's potassium is slightly low, the nurse must carefully monitor or correct this. The client has a new symptom to report that is easily explained by the history of asthma and is supported by the assessment of expiratory wheezing. However, when the nurse evaluates the medication list, the metoprolol is not an asthma-friendly medication. The nurse advocates for changing this medication to a non-beta blocking drug that will do similar cardiovascular work.

The registered nurse (RN) is orienting a new RN assigned to the care of a client with a cardiac disorder and is told that the client has an alteration in cardiac output. After educating the new RN about cardiac output, which statement made by the new RN indicates the need for further instruction? 1. "A cardiac output of 2 L/min is normal." 2. "A cardiac output of 4 L/min is normal." 3. "A cardiac output of 6 L/min is normal." 4. "A cardiac output of 7 L/min is normal."

1. "A cardiac output of 2 L/min is normal." The cardiac cycle consists of contraction and relaxation of the heart muscle. In adults, the cardiac output ranges from 4 to 7 L/min. Therefore, option 1 identifies a low cardiac output.

The registered nurse (RN) is educating a new nurse about aortic regurgitation. Which statement by the new nurse indicates that the teaching has been effective? 1. "Failure of the aortic valve to close completely allows blood to flow retrograde through the aorta to the left ventricle." 2. "Failure of the aortic valve to close completely allows blood to flow retrograde through the left ventricle to the left atrium." 3. "Failure of the aortic valve to close completely allows blood to flow retrograde through the right ventricle to the right atrium." 4. "Failure of the aortic valve to close completely allows blood to flow retrograde through the pulmonary artery to the right ventricle."

1. "Failure of the aortic valve to close completely allows blood to flow retrograde through the aorta to the left ventricle." The aortic valve separates the aorta from the left ventricle. The statements in the remaining options are inaccurate

A client has been experiencing difficulty with completion of daily activities because of underlying cardiovascular disease, as evidenced by exertional fatigue and increased blood pressure. Which observation by the nurse best indicates client progress in meeting goals for this problem? 1. Ambulates 10 feet (3 meters) farther each day 2. Verbalizes the benefits of increasing activity 3. Chooses a healthy diet that meets caloric needs 4. Sleeps without awakening throughout the night

1. Ambulates 10 feet (3 meters) farther each day Each of the options indicates a positive outcome on the part of the client. Both option 2 and the correct one relate to the client problem of difficulty with completion of daily activities. However, the question asks about progress. The correct option is more action-oriented and therefore is the better choice. Option 3 would most likely indicate progress if the client had a problem of inadequate nutritional intake. Option 4 would be a satisfactory outcome for a client experiencing difficulty sleeping.

The clinic nurse is evaluating a client who had coronary artery stenting through the right femoral artery a week previously and is taking metoprolol, clopidogrel, and aspirin. Which information reported by the client is most important to report to the health care provider? 1. Stools have been black in color. 2. Bruising is present at the right groin. 3. Home blood pressure today was 104/52 mm Hg. 4. Home radial pulse rate has been 55 to 60 beats/min

1. Stools have been black in color. Dark or tarry stools may indicate gastrointestinal bleeding, which is a possible adverse effect of both aspirin and clopidogrel. The client will need to continue on the medications but may need treatment with proton pump inhibitors or histamine2 blockers to decrease risk for gastrointestinal bleeding. The other findings will also be reported to the health care provider but will not require a change in the therapeutic plan for the client.

The nurse notes bilateral 2+ edema in the lower extremities of a client with myocardial infarction who was admitted 2 days ago. Based on this observation, what should the nurse plan to do first? 1. Review intake and output records for the last 2 days. 2. Prescribe daily weights starting on the following morning. 3. Change the time of diuretic administration from morning to evening. 4. Request a sodium restriction of 1 g/day from the health care provider (HCP).

1. Review intake and output records for the last 2 days. Edema, the accumulation of excess fluid in the interstitial spaces, can be measured by intake greater than output and by a sudden increase in weight. Therefore, the nurse should review intake and output records for the last 2 days. Diuretics should be given in the morning whenever possible to avoid nocturia. Strict sodium restrictions are reserved for clients with severe symptoms.

Which medication, when given in heart failure, may improve morbidity and mortality? 1- Dobutamine (Dobutrex) 2- Carvedilol (Coreg) 3- Digoxin (Lanoxin) 4- Bumetanide (Bumex)

2- Carvedilol (Coreg) Beta-adrenergic blocking agents such as carvedilol reverse consequences of sympathetic stimulation and catecholamine release that worsen heart failure; this category of pharmacologic agents improves morbidity, mortality, and quality of life. Dobutamine and digoxin are inotropic agents used to improve myocardial contractility but have not been directly associated with improving morbidity and mortality. Bumetanide is a high-ceiling diuretic that promotes fluid excretion; it does not improve morbidity and mortality.

The nurse is caring for a patient who was just admitted to the hospital with an acute MI. What complication is the nurse most concerned will occur with this patient? 1- Hyperkalemia 2- Dysrhythmia 3- Respiratory failure 4- Hypovolemic shock

2- Dysrhythmia The most common complication following MI is dysrhythmia due to increased myocardial irritability, which can be fatal. The patient would develop cardiogenic, not hypovolemic, shock

The nurse is assessing a newly admitted patient. Which assessment finding should alert the nurse that the patient is developing right-sided HF? 1- Wheezing 2- Edema in the feet 3- Clammy skin 4- Crackles in the lungs

2- Edema in the feet Signs and symptoms of right-sided HF include fatigue; edema in sacrum, legs, feet, ankles; hepatomegaly; abdominal distention as a result of ascites; weight gain; and dyspnea. The other answer options are signs and symptoms indicative of left-sided HF.

The patient with HF is being discharged from the hospital. What will this patient's medication regimen most likely consist of? 1- Aspirin, furosemide (Lasix), and heparin 2- Furosemide (Lasix), warfarin (Coumadin), and potassium supplement 3- Heparin, aspirin, and spironolactone (Aldactone) 4- Spironolactone (Aldactone), aspirin, and potassium supplement

2- Furosemide (Lasix), warfarin (Coumadin), and potassium supplement Furosemide is a loop diuretic and is the most effective diuretic for elimination of excess fluid from the body. It is a potassium-wasting diuretic, so potassium supplements are given to prevent hypokalemia.Heparin, if administered to a patient with HF, would be given only in the hospital, where the patient could be monitored for bleeding. Adding aspirin to this regimen would increase the patient's risk of hemorrhage. Spironolactone is not as effective as furosemide and would be given only in specific circumstances. Spironolactone (Aldactone) is a potassium-sparing diuretic. Giving a potassium supplement in this case would predispose the patient to hyperkalemia.

The nurse cares for a client with heart failure and teaches the spouse. During the early stages of heart failure, what specific compensatory mechanisms occur in response to lower cardiac output? 1- Hypotension stimulates the baroreceptors to decrease sympathetic activity. 2- Hypotension stimulates baroreceptors to increase sympathetic activity. 3- Impaired renal perfusion inhibits aldosterone release. 4- Release of antidiuretic hormone (ADH) by the pituitary gland decreases.

2- Hypotension stimulates baroreceptors to increase sympathetic activity. Falling arterial BP increases sympathetic the response in order to increase heart rate. As arterial blood pressure falls, baroreceptors of the carotid and aorta are stimulated. Hypotension stimulates baroreceptors to increase sympathetic activity leading to release of catecholamines, resulting in vasoconstriction and an increased heart rate to compensate. Impaired renal perfusion will stimulate aldosterone release, leading to additional fluid and sodium retention. Decreased cardiac output will increase ADH release, leading to fluid retention. Explanation • It is important for clients and caregivers to understand why remodeling of the heart structures occur for those with heart failure. In order to maintain organ perfusion, the body uses compensatory responses to changes in blood pressure. Otherwise shock would occur. These baroreceptors reside in arteries and within the cardiopulmonary system, and when triggered, rapidly increase heart rate and contractility. In addition, systemic peripheral vascular resistence is increased, resulting in improved BP. • Over time, this compensatory mechanism ultimately increases the workload of the heart. This can worsen heart failure if not treated.

A client begins therapy with lisinopril (Prinivil, Zestril). What does the nurse consider at the start of therapy with this medication? 1- The client's ability to understand medication teaching 2- The risk for hypotension 3- The potential for bradycardia 4- Liver function tests

2- The risk for hypotension Angiotensin-converting enzyme (ACE) inhibitors are associated with first-dose hypotension and orthostatic hypotension, which are more likely in those older than 75 years. Although desirable, understanding of teaching is not essential. ACE inhibitors are vasodilators; they do not affect heart rate. Renal function, not liver function, may be altered by ACE inhibitors.

The nurse educator is lecturing new registered nurses (RNs) about serum calcium levels. Which statement by one of the new RNs indicates that teaching has been effective? 1. "Calcium has no effect on the risk for stroke." 2. "Low calcium levels can lead to cardiac arrest." 3. "Low calcium levels cause high blood pressure." 4. "Calcium has no effect on urinary stone formation."

2. "Low calcium levels can lead to cardiac arrest." The normal calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). A low calcium level could lead to severe ventricular dysrhythmias, prolonged QT interval, and ultimately cardiac arrest. Calcium is needed by the heart for contraction. Calcium ions move across cell membranes into cardiac cells during depolarization and move back during repolarization. Depolarization is responsible for cardiac contraction. Options 1 and 3 are unrelated to calcium levels. Elevated calcium levels can lead to urinary stone formation. The nurse would take action and contact the health care provider when a calcium level is abnormal.

A client with coronary artery disease is scheduled to have a diagnostic exercise stress test. Which instruction should the nurse plan to provide to the client about this procedure? 1. Eat breakfast just before the procedure. 2. Wear firm, rigid shoes, such as work boots. 3. Wear loose clothing with a shirt that buttons in front. 4. Avoid cigarettes for 30 minutes before the procedure.

3. Wear loose clothing with a shirt that buttons in front. The client should wear loose, comfortable clothing for the procedure. Electrocardiogram (ECG) lead placement is enhanced if the client wears a shirt that buttons in the front. The client should receive nothing by mouth after bedtime or for a minimum of 2 hours before the test. The client should wear rubber-soled, supportive shoes, such as athletic training shoes. The client should avoid smoking, alcohol, and caffeine on the day of the test. Inadequate or incorrect preparation can interfere with the test, with the potential for a false-positive result.

A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? 1. Glipizide 2. Metformin 3. Repaglinide 4. Regular insulin

2. Metformin Metformin needs to be withheld 24 hours before and for 48 hours after cardiac catheterization because of the injection of contrast medium during the procedure. If the contrast medium affects kidney function, with metformin in the system the client would be at increased risk for lactic acidosis. The medications in the remaining options do not need to be withheld 24 hours before and 48 hours after cardiac catheterization.

The nurse is caring for a client who has heart failure and has a new prescription for sacubitril-valsartan. Which client information is most important to discuss with the health care provider before administration of the medication? 1. The client's oxygen saturation is 92%. 2. The client receives lisinopril 10 mg/day. 3. The client's blood pressure is 150/90 mm Hg. 4. The client's potassium is 3.3 mEq/L (3.3 mmol/L)

2. The client receives lisinopril 10 mg/day. Because combination angiotensin receptor blocker-neprilysin blockers markedly increase the risk for angioedema in clients who are also taking angiotensin-converting enzyme inhibitors (e.g., lisinopril), the concomitant use of both lisinopril and sacubitril-valsartan is contraindicated. In addition, the risk for other adverse effects such as hyperkalemia and hypotension is increased. The other findings should be reported to the health care provider but do not indicate a need to withhold the sacubitril-valsartan.

The nurse in the emergency department is caring for a client with acute heart failure who is experiencing severe dyspnea; pink, frothy sputum; and crackles throughout the lung fields. The nurse reviews the medical record, which contains the following information: ■ Crackles in all fields ■ S3 present ■ Oliguria ■ Ejection fraction 30% ■ BNP 560 ■ Sodium 130 mEq/L ■ Diagnosis: heart failure ■ Enalapril 10 mg orally daily ■ Heparin 5000 units subcutaneously every 12 hours ■ Furosemide 40 mg IV daily ■ Strict I & O Which prescription does the nurse implement first? 1- Enalapril 2- Heparin 3- Furosemide 4- Intake and output (I & O)

3- Furosemide The client is displaying typical signs of acute pulmonary edema secondary to fluid-filled alveoli and pulmonary congestion; a diuretic will promote fluid loss. Although enalapril will promote vasodilation and decrease cardiac workload, the client is demonstrating signs of acute pulmonary edema secondary to intra-alveolar fluid. Heparin will prevent deep vein thrombosis secondary to immobility, but will not reduce fluid excess. Although all clients with congestive heart failure should have daily weights and I & O monitored, this is not a priority; removing fluid volume and treating dyspnea are matters of priority.

The nurse is caring for a patient with cardiomyopathy. Which assessment finding should alert the nurse to worsening of the condition? 1- Signs and symptoms of infection 2- Hypotension 3- Increasing dyspnea 4- An audible heart murmur

3- Increasing dyspnea Increasing dyspnea would indicate the patient's heart is becoming weaker and less able to pump. Additional signs and symptoms of cardiomyopathy include activity intolerance, angina, dizziness, hypertension, and palpitations.

The nurse is administering a calcium channel blocker to a patient for treatment of hypertension. What other effect does this medication have that the nurse should be aware of? 1- It increases the heart rate. 2- It decreases venous return to the lungs. 3- It decreases cardiac contractibility. 4- It increases cardiac workload.

3- It decreases cardiac contractibility. Most calcium channel blockers also lower the heart rate. The nurse should be aware of this effect so that the heart rate can be properly monitored.

The nurse is assessing the patient who has been taking digoxin (Lanoxin) for the past 2 months. Which assessment finding would alert the nurse that the patient may be experiencing digitalis toxicity? 1- The patient's heart rate is 54. 2- The patient reports feeling fatigued. 3- The patient reports frequent nausea and diarrhea. 4- The patient has edema in the feet and ankles.

3- The patient reports frequent nausea and diarrhea. Yellow-green halos around lights, nausea, diarrhea, and confusion are the classic symptoms of digitalis toxicity. The patient's heart rate being below 60 is a concern since digoxin can cause the heart rate to fall below normal, but it is not a sign of toxicity. Fatigue and edema are also not signs of toxicity. All of the assessment findings warrant further investigation, but toxicity is the priority.

A client with hypertension is started on verapamil (Calan). What teaching does the nurse provide for this client? 1- "Consume foods high in potassium." 2- "Monitor for irregular pulse." 3- "Monitor for muscle cramping." 4- "Avoid grapefruit juice."

4- "Avoid grapefruit juice." Grapefruit juice should be avoided with verapamil because it can enhance the action of the drug. Foods high in potassium should be encouraged for clients taking diuretics, not calcium channel blockers such as verapamil. Bradycardia, not irregular pulse, is a typical side effect of verapamil. Muscle cramping may occur with statins, not with calcium channel blockers.

When considering physiological changes common in geriatric patients, the healthcare provider understands that which of these factors may increase the risk of heart failure in older patients? Choose 1 answer: 1- Increased stroke volume 2- Impaired diastolic filling 3- Increased myocardial contractility 4- Decreased sympathetic activity

4- Decreased sympathetic activity As we age, the myocardium becomes less compliant. Decreased myocardial compliance results in impaired filling of the cardiac chambers during diastole.

The nurse is caring for a patient who was diagnosed with aortic valve stenosis. What would indicate that the patient's stenosis is worsening? 1- Angina 2- Syncope 3- Dyspnea 4- Peripheral cyanosis

4- Peripheral cyanosis Dyspnea, angina, and syncope on exertion are classic symptoms of aortic stenosis. As the condition worsens, the patient experiences extreme fatigue, weakness, and peripheral cyanosis.

The nurse provides discharge instructions to a client with congestive heart failure (CHF). Which food does the nurse teach the patient to avoid? 1- Spinach 2- Ice cream 3- Orange juice 4- Steak sauce.

4- Steak sauce. Spinach is not high in sodium, unless sodium is added. Fresh and frozen varieties should be chosen over canned spinach. Ice cream does not worsen heart failure. Orange juice does not worsen heart failure. Patients with CHF should avoid foods high in sodium such as steak sauce. Explanation Monitoring/limiting sodium intake is important to help reduce fluid retention and hypertension. Clients with CHF should weigh themselves daily to help monitor fluid retention, which can exacerbate CHF symptoms

A client with stable angina has a prescription for ranolazine 500 mg twice a day. Which client finding is most important for the nurse to discuss with the health care provider? 1. Heart rate is 52 beats/min. 2. Client is also taking carvedilol for angina. 3. Client reports having chronic constipation. 4. Blood pressure is 106/56 mm Hg

3. Client reports having chronic constipation. Chronic constipation is a common adverse effect of ranolazine. Ranolazine does not impact heart rate or blood pressure and can be taken with beta-blockers or nitrates. The other information may also be reported to the HCP but does not require a change in the client plan of care.

A client has experienced an episode of pulmonary edema. The nurse determines that the client's respiratory status is improving after this episode if which breath sounds are noted? 1. Rhonchi 2. Wheezes 3. Crackles in the bases 4. Crackles throughout the lung fields

3. Crackles in the bases Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of frothy, pink-tinged sputum. As the client's condition improves, the amount of fluid in the alveoli decreases, which may be detected by crackles in the bases. (Clear lung sounds indicate full resolution of the episode.) Rhonchi and wheezes are not associated with pulmonary edema. Auscultation of the lungs reveals crackles throughout the lung fields. Note the subject, breath sounds associated with an improvement in pulmonary edema. Fluid in the lungs from pulmonary edema produces sounds that are called crackles, which eliminates options 1 and 2. From the remaining options, eliminate option 4, noting the words respiratory status is improving in the question. Crackles throughout the lung fields do not indicate an improvement in the client's condition.

Two weeks ago, a client with heart failure received a new prescription for carvedilol 12.5 mg orally. Which finding by the nurse who is evaluating the client in the cardiology clinic is of most concern? 1. Reports of increased fatigue and activity intolerance 2. Weight increase of 0.5 kg over a 1-week period 3. Sinus bradycardia at a rate of 48 beats/min 4. Traces of edema noted over both ankles

3. Sinus bradycardia at a rate of 48 beats/min Research indicates that mortality is decreased when clients with heart failure use beta-blocking medications such as carvedilol. When beta-blocker therapy is started for clients with heart failure, heart failure symptoms may initially become worse for a few weeks, so increased fatigue, activity intolerance, weight gain, and edema are not indicative of a need to discontinue the medication at this time. However, a heart rate of 48 beats/min indicates a need to decrease the carvedilol dose.

A client's total cholesterol level is 344 mg/dL (8.6 mmol/L), low-density lipoprotein cholesterol (LDL-C) level is 164 mg/dL (4.25 mmol/L), and high-density lipoprotein cholesterol (HDL-C) level is 30 mg/dL (1.2 mmol/L). Based on analysis of the data, how should the nurse direct client teaching? 1. The client should maintain the current dietary regimen but increase activity level. 2. Results are inconclusive unless the triglyceride level is also screened, so teaching is not indicated at this time. 3. The client is at high risk for cardiovascular disease, and measures to modify all identified risk factors should be taught. 4. The client is at low risk for cardiovascular disease, so the client should be encouraged to continue to follow the current regimen.

3. The client is at high risk for cardiovascular disease, and measures to modify all identified risk factors should be taught. In the absence of documented cardiovascular disease, the desired goal is to have the total cholesterol level lower than 200 mg/dL (<5 mmol/L). A desired LDL-C level for all individuals is lower than 100 mg/dL (<2.59 mmol/L), and a desirable HDL-C level is higher than 40 mg/dL (>1.55 mmol/L). Because the client's levels are outside the range to a significant degree for all three values, the client is at high risk for developing cardiovascular disease and requires teaching on risk factor reduction.

A client admitted for heart failure has a priority problem of hypervolemia related to compromised regulatory mechanisms. Which assessment result obtained the day after admission is the best indicator that the treatment has been effective? 1- The client has diuresis of 400 mL in 24 hours. 2- The client's blood pressure is 122/84 mm Hg. 3- The client has an apical pulse of 82 beats/min. 4- The client's weight decreases by 2.5 kg.

4- The client's weight decreases by 2.5 kg. The best indicator of fluid volume gain or loss is daily weight; because each kilogram represents approximately 1 liter, this client has lost approximately 2500 mL of fluid. Diuresis of 400 mL in 24 hours represents oliguria. Although a blood pressure of 122/84 mm Hg is a normal finding, alone it is not significant for relief of hypervolemia. Although an apical pulse of 82 beats/min is a normal finding, alone it is not significant to determine whether hypervolemia is relieved.

The nurse is discussing smoking cessation with a client diagnosed with coronary artery disease (CAD). Which statement should the nurse make to try to motivate the client to quit smoking? 1. "None of the cardiovascular effects are reversible, but quitting might prevent lung cancer." 2. "Because most of the damage has already been done, it will be all right to cut down a little at a time." 3. "If you totally quit smoking right now, you can cut your cardiovascular risk to zero within a year." 4. "If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years."

4. "If you quit now, your risk of cardiovascular disease will decrease to that of a nonsmoker in 3 to 4 years." The risks to the cardiovascular system from smoking are noncumulative and are not permanent. Three to 4 years after cessation, a client's cardiovascular risk is similar to that of a person who never smoked. In addition, tobacco use and passive smoking from "secondhand smoke" (also called environmental smoke) substantially reduce blood flow in the coronary arteries. The statements in the remaining options are incorrect.

A client with variant angina is scheduled to receive an oral calcium channel blocker twice daily. Which statement by the client indicates the need for further teaching? 1. "I should notify my doctor if my feet or legs start to swell." 2. "My doctor told me to call his office if my pulse rate decreases below 60." 3. "Avoiding grapefruit juice will definitely be a challenge for me, since I usually drink it every morning with breakfast." 4. "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning."

4. "My spouse told me that since I have developed this problem, we are going to stop walking in the mall every morning." Variant angina, or Prinzmetal's angina, is prolonged and severe and occurs at the same time each day, most often at rest. The pain is a result of coronary artery spasm. The treatment of choice is usually a calcium channel blocker, which relaxes and dilates the vascular smooth muscle, thus relieving the coronary artery spasm in variant angina. Adverse effects can include peripheral edema, hypotension, bradycardia, and heart failure. Grapefruit juice interacts with calcium channel blockers and should be avoided. If bradycardia occurs, the client should contact the health care provider. Clients should also be taught to change positions slowly to prevent orthostatic hypotension. Physical exertion does not cause this type of angina; therefore, the client should be able to continue morning walks with his or her spouse.

The nurse is reviewing the laboratory results for a client with an elevated cholesterol level who is taking atorvastatin. Which result is most important to discuss with the health care provider? 1. Serum potassium is 3.4 mEq/L (3.4 mmol/L). 2. Blood urea nitrogen (BUN) is 9 mg/dL (3.2 mmol/L). 3. Aspartate aminotransferase (AST) is 30 units/L (0.5 μkat/L). 4. Low-density lipoprotein (LDL) cholesterol is 170 mg/dL (4.4 mmol/L).

4. Low-density lipoprotein (LDL) cholesterol is 170 mg/dL (4.4 mmol/L). The client's low-density lipoprotein level continues to be elevated and indicates a need for further assessment (e.g., the client may not be taking the atorvastatin), a change in medication, or both. Although statin medications may cause rhabdomyolysis, which could increase BUN and potassium, the client's BUN and potassium are not elevated. Although ongoing monitoring of liver function is recommended when statins are used, this client's AST is normal.

The nurse has given morphine sulfate 4 mg IV to a client who is having an acute myocardial infarction. When evaluating the client's response 5 minutes after giving the medication, which finding indicates a need for immediate further action? Focus: Prioritization 1. Blood pressure decrease from 114/65 to 106/58 mm Hg 2. A respiratory rate drop from 18 to 12 breaths/min 3. Cardiac monitor indicating sinus rhythm at a rate of 96 beats/min 4. Persisting chest pain at a level of 1 (on a scale of 0 to 10)

4. Persisting chest pain at a level of 1 (on a scale of 0 to 10) The goal in pain management for the client with an acute myocardial infarction is to completely eliminate the pain (because ongoing pain indicates cardiac ischemia). Even pain rated at a level of 1 out of 10 should be treated with additional morphine sulfate (although possibly a lower dose). The other data indicate a need for ongoing assessment for the possible adverse effects of hypotension, respiratory depression, and tachycardia but do not require further action at this time.

A client with pulmonary edema has been receiving diuretic therapy. The client has a prescription for additional furosemide in the amount of 40 mg intravenous push. Knowing that the client will also be started on digoxin, which laboratory result should the nurse review as the priority? 1. Sodium level 2. Digoxin level 3. Creatinine level 4. Potassium level

4. Potassium level Diuretic therapy can cause hypokalemia. The serum potassium level is measured in the client receiving digoxin and furosemide. Heightened digoxin effect leading to digoxin toxicity can occur in the client with hypokalemia. Hypokalemia also predisposes the client to ventricular dysrhythmias.

A client recovering from an exacerbation of left-sided heart failure is experiencing activity intolerance. Which change in vital signs during activity would be the best indicator that the client is tolerating mild exercise? 1. Oxygen saturation decreased from 96% to 91%. 2. Pulse rate increased from 80 to 104 beats per minute. 3. Blood pressure decreased from 140/86 to 112/72 mm Hg. 4. Respiratory rate increased from 16 to 19 breaths per minute.

4. Respiratory rate increased from 16 to 19 breaths per minute. Vital signs that remain near baseline indicate good cardiac reserve with exercise. Only the respiratory rate remains within the normal range. In addition, it reflects a minimal increase. A pulse rate increase to a rate more than 100 beats per minute during mild exercise does not show tolerance, nor does a 5% decrease in oxygen saturation levels. In addition, blood pressure decreasing by more than 10 mm Hg is not a sign indicating tolerance of activity.

While reviewing a hospitalized client's medical record, the nurse obtains this information about cardiovascular risk factors. Which interventions will be important to include in the discharge plan for this client? Select all that apply. Health History ■ Hypertension for 10 years ■ Takes thiazide 25 mg daily ■ BP range 110/60 to 132/72 Family History ■ Client's mother and 2 siblings have had MI Social History ■ 20 pack-year history of cigarette use ■ Walks 2 to 3 miles daily 1. Referral to community programs that assist in smoking cessation 2. Teaching about the impact of family history on cardiovascular risk 3. Education about the need for a change in antihypertensive therapy 4. Assistance in reducing emotional stress 5. Discussion of the risks associated with having a sedentary lifestyle

ANS 1, 2 The client's major modifiable risk factor is ongoing smoking. The family history is significant, and the client should be aware that this increases cardiovascular risk. The blood pressure is well controlled on the current medication, and no change is needed. There is no indication that stress is a risk factor for this client, and the client's activity level meets the American Heart Association recommendation for at least 150 minutes of moderate activity weekly.

The nurse assesses a client with suspected pulmonary edema and notes bilateral crackles, orthopnea, dyspnea, and peripheral edema. After notifying the health care provider (HCP), the nurse takes what initial actions? Select all that apply. 1- Elevate head of bed to high-Fowler's position. 2- Prepare a diuretic medication dose. 3- Assess oxygenation with pulse oximetry. 4- Document strict intake and output. 5- Elevate both legs to improve venous return.

ANS 1, 2, 3, High-Fowler's position would improve the client's ventilation. Diuretics would help reduce pulmonary edema and fluid overload. The nurse assesses oxygenation with pulse oximetry and administers oxygen if needed. Supplemental oxygen helps improve the client's oxygenation. Documenting intake and output correctly is essential with the client experiencing fluid overload. This is not an immediate action but an ongoing nursing function. Intake and output is examined hourly, every 8-12 hours, and as a whole every 24 hours to determine fluid balance issues. Elevating the patient's legs increase venous return. This could overload the heart and worsen the patient's condition. Explanation This patient is showing signs of pulmonary edema caused by left-sided heart failure. Steps taken by the nurse include actions to support ventilation and prevent worsening fluid overload. The nurse can expect the HCP to prescibe a loop diuretic such as furosemide to promote fluid loss through the kidneys.

The nurse questions a client with acute exacerbation of heart failure about recent medical history and medication usage. The nurse recognizes that what medications or conditions may contribute to this client's exacerbation of heart failure? Select all that apply. 1- Anemia 2- Daily ibuprofen use 3- Daily metformin use 4- Hyperthyroidism 5- Irritable bowel syndrome

ANS 1, 2, 3, 4 Anemia, if severe enough, may cause a high output heart failure, where the heart cannot meet the body's oxygen requirements. High output heart failure is less common than other types of heart failure. Ibuprofen, a nonsteroidal anti-inflammatory drug, may contribute to retention of sodium and water. The increased workload on the heart may exacerbating heart failure. Diabetes is a known risk factor for heart failure. The nurse assess the client for taking antidiabetic medications including insulin and metformin, when admitting the client with exacerbation of heart failure. Both hyperthyroidism and hypothyroidism place the client at increased risk of exacerbation of heart failure. Irritable bowel syndrome is not known to contribute to heart failure exacerbations. Explanation Chronic congestive heart failure can easily exacerbate and decompensate. Exacerbations arise from from infections, arrhythmias, hypertension, anemia, hyperthyroidism, hypothyroidism, inadequate diet, and NSAIDs use. Diabetes is a known risk factor for heart failure.

A client with heart failure (HF) due to systolic dysfunction is prescibed lisinopril (Prinivil) at discharge. Which teaching does the nurse include for this medication? 1- This drug may contribute to hyperkalemia. 2- It's safe to take during pregnancy. 3- Report a cough immediately. 4- This drug can make it easier to exercise. 5- It relaxes blood vessels which lowers blood pressure.

ANS 1, 3, 4, 5 ACE inhibitors affect the kidneys and may cause hyperkalemia-especially when the client takes potassium supplements or has renal disease. ACE inhibitors, including lisinopril, carry a black box warning to discontinue when pregnancy is known. It can contribute to fetal injury and death. ACE inhibitors are widely known for a common adverse effect of persistent dry cough. This occurs in up to 20% of clients after starting the drug. The cough resolves after discontinuation. ACE inhibitors are known to inducing life-threatening angioedema. Although the risk for this in any client is low, the wide use of these drugs requires that all clients are aware Actions on muscle tissue are thought to help with exercise tolerance. Though the reasons are not fully understood, numerous trials have found that therapy with ACE inhibitors significantly improves exercise capacity in patients with HF. Explanation • Lisinopril is in a drug class called angiotensin-converting enzyme (ACE) inhibitors which are frequently used to treat heart failure and hypertension. • ACE inhibitors improve lung function by increasing alveolar-capillary membrane diffusing capacity and pulmonary vascular function in patients with HF. • Some side effects associated with ACE inhibitors include hypotension, acute renal failure, and hyperkalemia. • ACE inhibitors are known to occasionally induce life-threatening angioedema. Although the risk for this in any client is low, the wide use of these drugs requires that nurses be alert for reports of asymmetric swelling of non-dependant tissue-especially common in the face. Face, tongue, lips, and upper airway swelling can lead to rapid airway compromise.

A nurse cares for a client with severe acute left-sided heart failure. The nurse includes which nursing intervention in the care plan? Select all that apply. 1- Administer furosemide as prescribed. 2- Administer dobutamine as prescribed. 3- Reduce stress in the environment. 4- Elevate the legs higher than the heart. 5- Limit fluid intake to 1500 mL daily.

ANS 1, 2, 3, 5 First-line therapy generally includes a loop diuretic such as furosemide, which will inhibit sodium chloride reabsorption in the ascending loop of Henle. Diuretics reduce circulating blood volume, diminish preload, and lessen systemic and pulmonary congestion. The most powerful way to increase contractility of the heart is to use inotropic medications. Inotropic agents, including dobutamine or milrinone, may be used when diuretics fail to improve clinical status. The client also needs to reduce physical and emotional stress to improve ventricular pump performance and reduce myocardial workload Even though the legs are edematous, elevating the legs rapidly increases venous return to the heart. This may worsen the client's condition. Fluid restriction may be included for clients with severe heart failure-especially when hyponatremia is present. A limit of 1500-2000 mL/day is typical. Explanation • Both right and left-sided heart failure result in low cardiac output. • Left-sided heart failure (formerly congestive heart failure) falls into 2 categories: systolic (decreased contractility resulting in pulmonary congestion) or diastolic (inadequate ventricular filling). Interventions for both types of left-sided failure are the same. • Right-sided heart failure may be caused by left-sided failure, myocardial infarction, or pulmonary hypertension. • High-output heart failure is less common than the other 2 types. It is caused by excessive metabolic needs (sepsis).

The nurse is conducting a health history of a client with a primary diagnosis of heart failure. Which conditions reported by the client could play a role in exacerbating the heart failure? Select all that apply. 1. Emotional stress 2. Atrial fibrillation 3. Nutritional anemia 4. Peptic ulcer disease 5. Recent upper respiratory infection

ANS 1, 2, 3, 5 Heart failure is precipitated or exacerbated by physical or emotional stress, dysrhythmias, infections, anemia, thyroid disorders, pregnancy, Paget's disease, nutritional deficiencies (thiamine, alcoholism), pulmonary disease, and hypervolemia. Peptic ulcer disease is not an exacerbating factor. Test-Taking Strategy: Focus on the subject, conditions that will exacerbate heart failure. Remembering that heart failure is exacerbated by factors that increase the workload of the heart will direct you to the correct options.

The nurse cares for a client who was diagnosed with acute myocardial infarction. The nurse incorporates what assessments as part of monitoring for common complications of myocardial infarction (MI)? 1- Lung auscultation 2- Apical heart rate 3- Cognitive assessment 4- Daily weight 5- Residual urine volumes

ANS 1, 2, 4 The client may be at risk for left-sided heart failure if enough of the left-ventricle was affected by the MI. Due to the risk for pulmonary edema related to decreased cardiac output and the resulting increase in pulmonary capillary pressures, the nurse should auscultate the lungs. Cardiac arrhythmias are the most common complication associated with a MI due to the interruption of the normal cardiac conduction from tissue ischemia and inflammation. Dysrhythmias are a common cause of post-MI mortality and should be assessed for by the nurse. Cognitive impairment is not an expected or common complication of myocardial infarction. An example of a cognitive assessment is the Mini Mental Status Examination. A cognitive assessment is more specific than assessing the spheres of orientation or level of consciousness. Daily weight helps determine if the client is experiencing fluid retention related to decreased cardiac output and the activation of the renin-angiotensin-aldosterone system and antidiuretic hormone release. A gain of more than 3 pounds in 24-hours is evidence of fluid volume excess. Residual urine volumes are done to determine if a client has urinary retention which is not associated with MI. Explanation Common complications of myocardial infarction include dysrhythmias and decreased cardiac output. The degree of risk will depend on the size and location of the infarct. Assessment for evidence of heart failure focuses on fluid volume status with the most life-threatening complication of left-sided heart failure being acute pulmonary edema. Often the client will be placed on telemetry after the MI and the nurse should also assess apical rate and rhythm in addition to monitoring telemetry due to the high risk for mortality post MI secondary to dysrhythmias.

The healthcare provider is administering an angiotensin converting enzyme (ACE) inhibitor to a patient diagnosed with heart failure. Which of the following describe the ways in which the ACE inhibitor is therapeutic for the patient who has heart failure? Choose all answers that apply: 1- Decreases myocardial remodeling 2- Decreases cardiac preload 3- Decreases cardiac output 4- Increases myocardial contractility 5- Decreases cardiac workload 6- Increases peripheral vascular resistance

ANS 1, 2, 5 Decreased pumping ability of the heart causes decreased renal perfusion. Decreased renal perfusion causes sympathetic nervous system (SNS) activation and initiation of the renin-angiotensin-aldosterone system (RAAS). RAAS and SNS activation cause increased peripheral vascular resistance, increased preload, and increased afterload. Angiotensin II and aldosterone are implicated in remodeling of the myocardium, which results in impaired contractility.

The nurse is caring for a client with heart failure. For which symptoms does the nurse assess? Select all that apply. 1- Chest discomfort or pain 2- Tachycardia 3- Expectorating thick, yellow sputum 4- Sleeping on back without a pillow 5- Fatigue

ANS 1, 2, 5 Decreased tissue perfusion with heart failure may cause chest pain or angina. Tachycardia may occur as compensation for or as a result of decreased cardiac output. Fatigue is a symptom of poor tissue perfusion in clients with heart failure. Presence of a cough or dyspnea results as pulmonary venous congestion ensues. Clients with acute heart failure have dry cough and, when severe, pink, frothy sputum. Thick, yellow sputum is indicative of infection. Position for sleeping isn't a symptom; Clients usually find it difficult to lie flat because of dyspnea symptoms.

The nurse is reviewing the medical record for an adult client diagnosed with mitral valve stenosis. Which documented observations or therapies prompt the nurse to contact the health care provider (HCP)? Select all that apply. 1- pO2 of 70 mm Hg 2- Report of cough 3- WBC 5,000 mm3 4- IV fluid rate 80 mL/ hour 5- Crackles upon auscultation

ANS 1, 2, 5 The arterial blood gas values indicates hypoxia (low blood oxygen) and hypercapnia (high carbon dioxide) despite oxygen therapy. Normal pO2 is 80-100 mmHg. Mitral valve stenosis can lead to heart failure as evidenced by an increase in pCO2 levels (and a decrease in pO2) due to increased preload and decreased cardiac output. The report of a new cough is concerning for congestive heart failure from worsening stenosis or an evolving infection. The HCP may prescribe a chest x-ray to evaluate the new symptom. A total white blood cell count of 5,000 is within the expected range of 5000 to 10,000 for adults and is not a concern for notifying the provider. This fluid rate is appropriate for fluid maintenance. The nurse should question rapid fluid rates or fluid boluses that would worsen fluid overload and lead to pump failure. Rales (crackles) is an indication of pulmonary edema that has developed secondary to the congestive heart failure. Explanation • The arterial blood gas values indicates hypoxia (low blood oxygen) and hypercapnia (high carbon dioxide) despite oxygen therapy. Normal pO2 is 80-100 mmHg and normal pCO2 is 35-45 mmHg. Mitral valve stenosis can lead to heart failure as evidenced by an increase in pCO2 levels and a decrease in pO2 due to increased preload and decreased cardiac output. • Heart failure is a common complication of patients with mitral valve stenosis. This is evident by jugular vein distention, cold clammy skin, tachycardia, orthopnea, increased arterial pCO2, and a decrease in pO2. • Preload should be closely monitored for clients with signs of mitral stenosis. The right ventricle can easily become overloaded increasing pulmonary pressures and further decreasing cardiac output. The nurse should closely monitor fluid status and avoid rapid fluid replacement.

Which topics will the nurse plan to include in discharge teaching for a client who has been admitted with heart failure? Select all that apply. 1. How to monitor and record daily weight 2. Importance of stopping exercise if heart rate increases 3. Symptoms of worsening heart failure 4. Purpose of chronic antibiotic therapy 5. How to read food labels for sodium content 6. Date and time for follow-up appointments

ANS 1, 3, 5, 6 To avoid rehospitalization, topics that should be included when discharging a client with heart failure include low-sodium diet, purpose and common side effects of medications such as angiotensin-converting enzyme inhibitors and beta-blockers, what to do if symptoms of worsening heart failure occur, and follow-up appointments. The nurse will teach the client that a moderate increase in heart rate and respiratory effort is normal with exercise. Antibiotics are not included in the treatment regimen for heart failure, which is not an infectious process.

A nurse assesses a client with chronic hypertension. What signs does the nurse identify as a chronic complication of hypertension? SATA 1- Protein in urine 2- Weakness 3- Vomiting 4- Dyspnea at rest 5- Leg pain when climbing stairs

ANS 1, 4, 5 Proteinuria and albuminuria are early indicators of renal injury, a serious complication that can be caused by chronic hypertension. High pressures damage the kidneys' ability to filter toxins, and evidence of this damage is seen as proteins leak out into the urine. Weakness may be an adverse effect of certain medications used to treat hypertension, however it is not commonly associated with chronic hypertension. Nausea or vomiting may indicate acutely increased intracranial pressure. Although this life-threatening condition may result from severe hypertension, it is not a sign of chronically elevated blood pressure. Dyspnea at rest is associated with congestive heart failure (CHF). High blood pressure contributes directly to the development of CHF by increasing the workload of the heart and leading to thickening of the ventricle walls. Peripheral artery disease is a complication of hypertension in which plaques in leg arteries and hardened vessel walls compromise blood flow to the legs, causing pain, aching, or heaviness in the legs, feet, and buttocks after activity. Explanation Chronic hypertension typically does not produce symptoms for many years. Over time, damage to small vessels in the kidneys, heart, brain, and eyes produce changes in normal function of end-organs, producing clinical signs that indicate tissue damage.

While the nurse is caring for clients on the cardiac unit. Which conditions affect cardiac output by reducing preload? 1- Sinus bradycardia 2- Urinary sepsis 3- Postpartum hemorrhage 4- Upper thoracic spinal cord injury 5- Chronic renal failure

ANS 2, 3, 4 A slower heart rate increases filling time which increases the amount of blood that fills the ventricles and increases preload. Tachycardia and hypotension result in reduced preload is sepsis and is treated with IV fluid resuscitation. Uncontrolled bleeding leads to hypovolemia which reduces venous return to the heart-reducing preload. Injuries above T-6 lead to spinal shock, decreased vasomotor tone, and decreased preload due to decreased venous return. This condition also decreases afterload due to decreased peripheral vascular resistance. Renal failure results in sodium and fluid retention and increases the risk for fluid overload which increases preload. During and immediately after hemodialysis, the client is at risk for decreased preload, though. Explanation Preload is determined by how much the muscles of the heart stretch due to the blood volume that has filled the ventricles at the end of diastole. Preload is decreased by conditions that reduce circulating volume, venous return, or right ventricular volume.

The client taking spironolactone daily is prescribed digoxin for the treatment of heart failure (HF). Which response by the client indicates an understanding of the medication regimen? Select all that apply. 1- Digoxin toxicity is a rare issue. 2- My radial pulse rate should decrease. 3- I should report seeing halos or rings of light. 4- I should seek medical care if I experience palpitations. 5- Spironolactone may affect my digoxin blood level.

ANS 2, 3, 4, 5 Digoxin preparations have a narrow window of therapeutic efficacy, and toxicity from digitalis is common. Clients are taught to assess heart rate daily before taking a dose of this drug. A decrease in heart rate is expected. Clients are often advised to contact the health care provider before taking their dose if the pulse is less than 60. Visual changes are some of the clinical manifestations of digoxin toxicity, and the health care provider should be notified. Palpitations indicate irregular heartbeat or rapid rate which can indicate digoxin toxicity. The cardiac manifestations of digitalis toxicity can include virtually any type of arrhythmia with the exception of rapidly conducted atrial arrhythmias. In clients taking spironolactone, a potassium-sparing diuretic, hyperkalemia and digitalis toxicity may result even at low serum digoxin levels. This drug may also interfere with tests to measure digoxin levels in the blood. Explanation • Digoxin is used as a long-term treatment for certain types of heart failure and affects the transport of sodium to and from cells in the myocardium. This results in stronger contractions (positive inotrope). Digoxin also delays the electrical impulse from the SA node and slows conduction through the AV node, resulting in a slower rate (it is also used to treat atrial fibrillation). There is evidence that digoxin affects baroreceptors in the heart as well, decreasing vagal tone. These actions can benefit clients with HF symptoms. • Electrolyte abnormalities greatly increase the risk for toxicity so diuretics that can cause imbalances or renal insufficiency can increase risk. Renal functions and possible drug interactions should be reviewed.

The nurse caring for a client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider? Select all that apply. 1- Hypokalemia 2- Sinus bradycardia 3- Fatigue 4- Serum digoxin level of 1.5 5- Anorexia

ANS 2, 3, 5 Digoxin toxicity may cause bradycardia. Fatigue and anorexia are symptoms of digoxin toxicity. Hypokalemia causes increased sensitivity to the drug and toxicity, but it is not a symptom of toxicity. A serum digoxin level between 0.8 and 2.0 is considered normal and is not a symptom.

An 84-year-old client with heart failure presents to the emergency department with confusion, blurry vision, and an upset stomach. Which assessment data is most concerning to the nurse? a. Digoxin (Lanoxin) therapy daily. b. Daily metoprolol (Lopressor). c. Furosemide (Lasix) twice daily. d. Currently taking an antacid for upset stomach.

ANS: A Confusion, blurry vision, and upset stomach are symptoms of Digoxin toxicity, which is common in older adults and requires immediate treatment. The other answers are important assessment data but do not indicate immediate connection to the client's presentation.

A client is prescribed lisinopril (Zestril) for control of hypertension. What health teaching will the nurse provide to this patient? (Select all that apply.) a. "This medication can cause increased potassium levels." b. "It is important to change positions slowly when you start this medication." c. "This medication may cause you to develop a persistent, non-productive cough." d. "To achieve maximum benefit of Zestril, your diet should include foods high in sodium." e. "Be sure to monitor your BP regularly while taking this medication."

ANS: A, B, C, E Lisinopril (Zestril) is an ACE inhibitor which is known to cause orthostatic hypotension associated with vasodilation; thus changing positions slowly is important. Persistent, nagging cough is also common in this drug category. Because this medication is being used to modify BP, regular monitoring is important to assess effectiveness. Hyperkalemia is also associated with ACE Inhibitors especially for clients with diabetes mellitus and renal dysfunction. A high sodium diet is inappropriate for a client with hypertension and would adversely affect BP.

A client is diagnosed with right-sided heart failure. Which assessment findings will the nurse expect the client to have? (Select all that apply.) a. Peripheral edema b. Crackles in both lungs c. Increased abdominal girth d. Ascites e. Tachypnea

ANS: A, C, D, E Peripheral edema, increased abdominal girth, ascites, and tachypnea are all symptoms associated with right-sided heart failure due to the back up into the peripheral system. Crackles in the lungs are associated with left-sided heart failure. Cognitive Level: Application

A client with chronic heart failure presents to the ED with a new onset of atrial fibrillation. Which of the following medications would the nurse question? a. Lasix (furosemide) b. Toprol XL (metoprolol succinate) c. Cardizem (diltiazem) d. Corlanor (ivabradine)

ANS: D Ivabradine is contraindicated in the presence of atrial fibrillation and should be stopped.

The healthcare provider is reviewing health data collected on a group of patients at risk for high-output heart failure. Which of the following problems increase a patient's risk for this disorder? Choose all answers that apply: 1- Chronic anemia 2- Aortic valve stenosis 3- Cirrhosis 4- Hyperthyroidism 5- Pericarditis

Ans 1, 3, 4 High-output heart failure occurs when the heart is unable to supply the body with adequate oxygen and nutrients, despite adequate ventricular function. Hyperthyroidism is associated with sympathetic nervous system and adrenal activation, resulting in an increased metabolic rate. Decreased oxygen-carrying capacity of the blood causes the heart to work harder to deliver oxygen to the tissues. Cirrhosis can cause fluid shifts, leading to decreased circulating volume, causing the heart to work harder to circulate blood around the body.

A client is prescribed enalapril (Vasotec) for control of hypertension. What health teaching will the nurse provide before the client begins therapy? A. "You may develop a higher pulse rate." B. "You may notice some swelling in your feet." C. "You may develop a nagging cough." D. "Your diet should include foods high in sodium."

C. "You may develop a nagging cough." Rationale: The most common side effect of angiotensin-converting enzyme inhibitors such as enalapril (Vasotec) is a nagging, dry cough. Teach clients to report this problem to their health care provider as soon as possible. If a cough develops, the drug is usually discontinued.