Perfusion, Heart Problems
The nurse is providing discharge teaching to the client with heart failure, focusing on when to seek medical attention. Which statement by the client indicates understanding of the teaching? 1. "I will call the provider if I have a cough lasting 3 or more days." 2. "I will report to the provider weight loss of 2 to 3 pounds in a day." 3. "I will try walking for 1 hour each day." 4. "I should expect occasional chest pain."
1. Cough, a symptom of heart failure, is indicative of intra-alveolar edema; the provider should be notified. The client should call the provider for weight gain of 3 pounds in a week. The client should begin by walking 200 to 400 feet per day. Chest pain is indicative of myocardial ischemia and worsening of heart failure; the provider should be notified.
The nurse caring for a client discusses the importance of restricting sodium in the diet. Which statement made by the client indicates that he needs further teaching? 1. "I should avoid grilling hamburgers." 2. "I must cut out bacon and canned foods." 3. "I shouldn't put the salt shaker on the table anymore." 4. "I should avoid lunch meats but may cook my own turkey."
1. Cutting out beef or hamburgers made at home is not necessary; however, fast food hamburgers are to be avoided owing to higher sodium content.
The nurse is caring for an 82-year-old client admitted for exacerbation of heart failure. The nurse questions the client about the use of which medication because it raises an index of suspicion as to the cause of heart failure? 1. Ibuprofen (Motrin) 2. Hydrochlorothiazide (HydroDIURIL) 3. NPH Insulin 4. Levothyroxine (Synthroid)
1. Long-term use of NSAIDs, such as ibuprofen (Motrin), causes fluid and sodium retention.
After receiving change-of-shift report about these four clients, which client should the nurse assess first? 1. The 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset, frequent premature ventricular complexes 2. The 55-year-old admitted with pulmonary edema who received furosemide (Lasix) and whose current O2 saturation is 94% 3. The 68-year-old with pericarditis who is reporting sharp, stabbing chest pain when taking deep breaths 4. The 79-year-old admitted for possible rejection of a heart transplant who has sinus tachycardia, rate 104
1. This client's premature ventricular complexes may be indicative of digoxin toxicity. Further assessment for clinical manifestations of digoxin toxicity should be done and the physician notified about the dysrhythmia.
The client begins therapy with lisinopril (Prinivil, Zestril). What should 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 (LFTs)
2. Angiotensin-converting enzyme (ACE) inhibitors are associated with first-dose hypotension and orthostatic hypotension, which are more likely in those older than 75 years.
The home health nurse visits a client with heart failure who has gained 5 pounds in the past 3 days. The client states, "I feel so tired and short of breath." Which action should the nurse take first? 1. Assess the client for peripheral edema. 2. Listen to the client's posterior breath sounds. 3. Notify the physician about the client's weight gain. 4. Remind the client about dietary sodium restrictions.
2. Because the client is at risk for pulmonary edema and hypoxemia, the first action should be to assess breath sounds.
The nurse recognizes that which medication when given in heart failure may improve morbidity and mortality? 1. Dobutamine (Dobutrex) 2. Carvedilol (Coreg) 3. Digoxin (Lanoxin) 4. Bumetamide (Bumex)
2. Beta-adrenergic blockers reverse consequences of sympathetic stimulation and catecholamine release that worsen heart failure; they improve morbidity, mortality, and quality of life. Dobutamine and Digoxin are inotropic agents used in acute heart failure; it does not improve mortality. Bumetamide is a high-ceiling diuretic that promotes fluid excretion; it does not improve morbidity and mortality.
A client with heart failure has furosemide (Lasix). Which finding would concern the nurse with this new prescription? 1. Serum sodium level of 135 mEq/L 2. Serum potassium level of 2.8 mEq/L 3. Serum creatinine of 1.0 mg/dL 4. Serum magnesium level of 1.9 mEq/L
2. Clients taking loop diuretics should be monitored for potassium deficiency from diuretic therapy.
How does the nurse in the cardiac clinic recognize that the client with heart failure has demonstrated a positive outcome related to the addition of metoprolol (Lopressor) to the medication regimen? 1. Ejection fraction is 25%. 2. Client states that she is able to sleep on one pillow. 3. Client was hospitalized five times last year with pulmonary edema. 4. Client reports that she experiences palpitations.
2. Improvement in activity tolerance, less orthopnea, and improved symptoms represent a positive response to beta blockers.
The client who has been admitted for the third time this year for cardiac failure says, "This isn't worth it anymore. I just want it all to end." What is the nurse's best response? 1. Calls the family to lift the client's spirits 2. Considers further assessment for depression 3. Sedates the client to decrease myocardial oxygen demand 4. Tells the client that things will get better
2. This client is at risk for depression because of the diagnosis of heart failure, and further assessment should be done.
Which of these clients is best to assign to an LPN/LVN working on the telemetry unit? 1. A client with heart failure who is receiving dobutamine (Dobutrex) 2. A client with restrictive cardiomyopathy who uses oxygen for exertional dyspnea 3. A client with pericarditis who has a paradoxical pulse and distended jugular veins 4. A client with rheumatic fever who has a new systolic murmur
2. This client, who needs oxygen only with exertion, is the most stable; administration of oxygen to a stable client is within the scope of LPN/LVN practice. the client with the first option, is receiving an intravenous inotropic agent, which requires monitoring by the professional nurse. option 2 needs oxygen only with exertion, is the most stable; administration of oxygen to a stable client is within the scope of LPN/LVN practice. option 3 is displaying signs of cardiac tamponade and requires immediate life-saving intervention. option 4 has a new-onset murmur requires assessment and notification of the provider, which is within the scope of practice of the professional nurse.
In monitoring the diagnostic test of a client admitted with heart failure (HF), which finding is consistent with this diagnosis? 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. 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 heart failure but may also occur with other conditions; it is not specific to heart failure. Consolidation on chest x-ray may indicate pneumonia.
Which of these nursing actions should the nurse delegate to a nursing assistant working on the medical unit? 1. Determine the usual alcohol intake for a client with cardiomyopathy. 2. Monitor the pain level for a client with acute pericarditis. 3. Obtain daily weights for several clients with class IV heart failure. 4. Check for peripheral edema in a client with endocarditis.
3. Daily weight assessment is included in the role of the nursing assistant, who will report the weights to the RN.
Which intervention will best assist the client with acute pulmonary edema in reducing anxiety and dyspnea? 1. Monitor pulse oximetry and cardiac rate and rhythm. 2. Reassure the client that his distress can be relieved with proper intervention. 3. Place the client in high Fowler's position with the legs down. 4. Ask a family member to remain with the client.
3. High Fowler's position and placing the legs in a dependent position will decrease venous return to the heart, thus decreasing pulmonary venous congestion.
The client, a college athlete who has collapsed during soccer practice, has been diagnosed with hypertrophic cardiomyopathy. The client says, "This can't be. I am in great shape. I eat right and exercise." What is the nurse's best response? 1. "How does this make you feel?" 2. "This can be caused by taking performance-enhancing drugs." 3. "This may be caused by a genetic trait." 4. "Just imagine how bad it would be if you weren't in good shape."
3. Hypertrophic cardiomyopathy is often transmitted as a single-gene autosomal dominant trait. Hypertrophic cardiomyopathy is not caused by performance-enhancing drugs.
Which nursing intervention for a client admitted today with heart failure will assist the client to conserve energy? 1. Client ambulates around the nursing unit with a walker. 2. The nurse monitors the client's pulse and blood pressure frequently. 3. The nurse obtains a bedside commode before administering furosemide. 4. The nurse returns the client to bed when he becomes tachycardic.
3. Limiting the need for ambulation on the first day of admission to sitting in a chair or performing basic leg exercises promotes physical rest and reduced oxygen demand.
When caring for a client who has undergone a partial left ventriculectomy, which of these new-onset clinical manifestations indicates the need for immediate action by the nurse? 1. Chest pain with movement 2. Fatigue after ambulation 3. Muffled heart sounds 4. Bi-basilar fine crackles
3. Muffled heart sounds may be a clinical manifestation of bleeding into the pericardial space; the nurse should assess the client for possible decreased cardiac output and should notify the surgeon.
The nurse is assessing the client with a cardiac infection. Which symptoms support the diagnosis of infective endocarditis instead of pericarditis or rheumatic carditis? 1. Friction rub auscultated at the left lower sternal border 2. Pain aggravated by breathing, coughing, and swallowing 3. Splinter hemorrhages 4. Thickening of the endocardium
3. Splinter hemorrhages are indicative of infective endocarditis. Friction rub in the left lower sternal border is a sign of chronic constrictive pericarditis. Pain aggravated by breathing, coughing, and swallowing is indicative of signs and symptoms of chronic constrictive pericarditis.Thickening of the endocardium is indicative of rheumatic carditis.
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. Oliguria, S3 present, EF 30%, BNP 560, Na 130mEq/L .Which prescription should the nurse carry out first? 1. Enalapril 2. Heparin 3. Furosemide 4. I & O
3. The client is displaying typical signs of acute pulmonary edema, secondary to fluid-filled alveoli and pulmonary congestion; a diuretic will promote fluid loss.
When following up in the clinic with a client with heart failure, how does the nurse recognize that the client has been compliant with fluid restrictions? 1. Auscultation of crackles 2. Pedal edema 3. Weight loss of 6 pounds since the last visit 4. Reports sucking on ice chips all day for dry mouth
3. Weight loss in this client indicates effective fluid restriction and diuretic drug therapy. Lung crackles indicate intra-alveolar edema and fluid excess. Pedal edema indicates fluid excess. Sucking on ice chips indicates noncompliance with fluid restrictions; alternative methods of treating dry mouth should be explored.
Although the client with cardiac failure is asymptomatic, the nurse suspects noncompliance with prescribed home therapy. Which laboratory test confirms the nurse's suspicions? 1. B-type natriuretic peptide (BNP) 90 pg/mL 2. Serum electrolytes 3. Hemoglobin and hematocrit 4. Digoxin level of 0.2 ng/dL
4. A therapeutic digoxin level is 0.8 to 2.0 ng/dL. A level of 0.2 ng/dL indicates that the client has not been taking his digoxin as prescribed.
The nurse prepares to administer digoxin to a client with heart failure and notes the following information: Temperature: 99.8 Pulse: 48 and irregular Respirations: 20 Potassium level: 3.2 mEq/L What action does the nurse take? 1. Give digoxin; reassess the heart rate in 30 minutes. 2. Give the digoxin; document assessment findings in the medical record. 3. Hold the digoxin, and obtain a prescription for an additional dose of furosemide. 4. Hold the digoxin, and obtain a prescription for a potassium supplement.
4. Digoxin causes bradycardia; hypokalemia potentiates digitalis. The nurse seeks to correct this situation through collaboration with the provider.
The nurse is caring for the client with congestive heart failure (CHF) in the coronary care unit (CCU). The client is now exhibiting signs of air hunger and anxiety. Which nursing intervention does the nurse perform first for this client? 1. Determines the client's physical limitations 2. Encourages alternate rest and activity periods 3. Monitors and documents heart rate, rhythm, and pulses 4. Positions the client to alleviate dyspnea
4. Positioning the client to alleviate dyspnea will help ease air hunger and anxiety.
A client admitted for heart failure has a priority problem of Excess Fluid Volume related to compromised regulatory mechanisms. Which of these assessment data obtained the day after admission is the best indicator that the treatment has been effective? 1. The client has a 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 best indicator of fluid volume loss is daily weight; because each kilogram represents approximately 1 L, this client has lost approximately 2500 mL of fluid.
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. Breathlessness D. Ascites E. Lung congestion
A, B, E Rationale: Clients diagnosed with right-sided heart failure generally retain fluid. Assessment findings are often related to the fluid gain and include increased weight gain, peripheral edema, crackles in the lungs (indicative of fluid in the lung tissues), and shortness of breath from the fluid accumulation. Ascites is the accumulation of fluid in the peritoneal cavity and is most often related to liver disease or failure. Lung congestion is generally related to lung disease and is often diagnosed through auscultation of course breath sounds or the production of sputum. Fluid accumulation related to heart failure is often manifested as crackles instead of lung congestion.
The nurse is caring for a patient newly diagnosed with heart failure. The patient is to receive a first dose of digoxin (Lanoxin) 0.125 mg IV push. An ampule containing 0.25 mg/ml is available. How many milliliters should the nurse draw up to administer the dose? A. 0.5mL B. 0.6mL C. 1.2mL D. 1.4mL
A. 0.125 mg (dose desired) ÷ 0.25 mg/ml (dose available) = 0.5 ml
A patient with a recent diagnosis of HF has been prescribed furosemide (Lasix) in an effort to A. Reduce preload. B. Decrease afterload. C. Increase contractility. D. Promote vasodilation.
A. Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence contractility, afterload, or vessel tone.
An older adult taking digoxin and furosemide (Lasix) for chronic heart failure is admitted to the emergency department (ED) with an apical pulse of 52. A family member states that the client has fallen four times this week. What is the nurse's first action? A. Call the ED physician immediately. B. Draw a serum digoxin level. C. Assess for signs of hypokalemia. D. Establish the client's airway.
B Rationale: The client has signs and symptoms of digoxin toxicity and needs to be placed on a monitor immediately to determine the extent of effects on the heart and conduction system. Symptoms of digoxin toxicity include blurred vision or yellow or green halos around visual images, confusion, muscle weakness, and vertigo. Toxicity may be increased from furosemide-induced hypokalemia. This can lead to premature ventricular contractions (PVCs) that may lead to other life-threatening dysrhythmias and death. Clients need to be cautioned not to store both digoxin and furosemide in the same container. The most common dose of each medication is available in a small white pill (similar in appearance), increasing the chances of error. Serum digoxin levels and electrolytes need to be drawn. Symptoms of hypokalemia are mostly neuromuscular with generalized weakness. There is no indication that the client is having difficulty with breathing. Respiratory rate may be increased.
A client has been taking furosemide (Lasix) for the past 3 years. This morning, the hospital laboratory notifies the nurse that the client's serum potassium level is 2.9 mEq/L. What is the nurse's best action at this time? A. Notify the health care provider. B. Ask the lab to retest the potassium level. C. Give potassium as an IV infusion. D. Withhold this morning's Lasix dose.
B Rationale: This potassium value is at a critical level. The nurse should request that the lab confirm that this value is accurate since the client has been taking furosemide for 3 years. The lab value should be confirmed prior to contacting the health care provider for orders.
The nurse would recognize that indications for the use of dopamine (Intropin) in the care of a patient with heart failure include A. Acute anxiety. B. Hypotension and tachycardia. C. Peripheral edema and weight gain. D. Paroxysmal nocturnal dyspnea (PND).
B. Dopamine is a β-adrenergic agonist whose inotropic action is reserved for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not warrant the use of dopamine.
The nurse is preparing to administer digoxin to a patient with HF. In preparation, lab results are reviewed with the following findings: sodium 139 mEq/L, potassium 3.0 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dl. The nurse should do which of the following at this time? A. Withhold the daily dose until the following day. B. Withhold the dose and report the potassium level. C. Give the digoxin with a salty snack, such as crackers. D. Give the digoxin with extra fluids to dilute the sodium level.
B. The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hypokalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the potassium level. The physician may order the digoxin to be given once the potassium level has been treated and rises to within normal range.
A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. This patient should be advised to avoid: A. High-potassium foods. B. Drugs to treat erectile dysfunction. C. Over-the-counter H2-receptor blockers. D. Nonsteroidal antiinflammatory drugs.
B. The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension. NSAIDs, H2-receptor blockers, and high-potassium foods do not pose a risk in combination with nitrates.
The priority nursing assessment of a patient receiving IV nesiritide (Natrecor) to treat HF would be A. Urine output. B. Lung sounds. C. Blood pressure. D. Respiratory rate.
C. Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.
The nurse is caring for a client with heart failure. For which symptoms should the nurse assess? Select all that apply. Chest discomfort or pain Tachycardia Expectorates thick, yellow sputum Sleeps on back without a pillow Shortness of breath with exertion
Chest discomfort or pain: Decreased tissue perfusion may cause chest pain or discomfort. Tachycardia may occur as compensation for or as a result of decreased cardiac output. Shortness of breath with exertion: Dyspnea results as pulmonary venous congestion ensues.
A client who recently had a heart valve replacement is taking warfarin (Coumadin) as prescribed. What health teaching will the nurse include before the client is discharged? A. "Take your pulse every day and call your doctor if it is below 60." B. "Weigh yourself every day in the morning using the same scale." C. "Purchase a home kit to monitor your blood pressure every day." D. "Avoid foods that are high in vitamin K, such as kale and spinach."
D Rationale: To help warfarin work effectively, it is important to instruct the client to keep his or her vitamin K intake as consistent as possible. Sudden increases in vitamin K intake may decrease the effect of warfarin. On the other hand, greatly lowering vitamin K intake could increase the effect of warfarin. Warfarin is an anticoagulant and does not increase or decrease the heart rate, so checking the pulse daily is not necessary with warfarin therapy. Warfarin does not cause fluid loss or retention, so daily weights are not necessary. Warfarin does not increase or decrease blood pressure.
The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which of the following symptoms? A. muscle aches B. constipation C. pounding headache D. anorexia and nausea
D. Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the prescriber if the patient exhibited any of these symptoms.
A male patient with a long-standing history of HF has recently qualified for hospice care. Which of the following measures should the nurse now prioritize when providing care for this patient? A. Tapering the patient off his current medications B. Continuing education for the patient and his family C. Pursuing experimental therapies or surgical options D. Choosing interventions to promote comfort and prevent suffering
D. The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue but providing comfort is paramount. Medications should be continued unless they are not tolerated and experimental therapies and surgeries are not commonly used in the care of hospice patients.
Which priority problems may be considered for the client with heart failure? Select all that apply. Decreased fluid volume related to compromised regulatory mechanism Impaired Physical Mobility related to limited cardiovascular endurance Impaired Gas Exchange related to ventilation-perfusion imbalance Potential for pulmonary edema Risk for Ineffective renal Perfusion related to hypervolemia
Impaired Physical Mobility related to limited cardiovascular endurance: Owing to intra-alveolar edema and poor cardiac output, the client is fatigued and has limited endurance. Impaired Gas Exchange related to ventilation-perfusion imbalance: Owing to intra-alveolar edema and poor cardiac output, the client may develop hypoxemia. Potential for pulmonary edema owing to limited cardiac reserve Risk for Ineffective renal Perfusion related to hypervolemia: The client with heart failure has poor cardiac output, reduced blood flow to the kidney, and accumulation of pulmonary and peripheral fluid.
A patient admitted with HF appears very anxious and complains of shortness of breath. Which of the following nursing actions would be appropriate to alleviate this patients anxiety (select all that apply)? Position patient in a semi-Fowlers position. Administrate ordered morphine sulfate. Position patient on left side with head of bed flat. Instruct patient on the use of relaxation techniques. Use a calm, reassuring approach while talking to patient.
Position patient in a semi-Fowlers position. Administrate ordered morphine sulfate. Instruct patient on the use of relaxation techniques. Use a calm, reassuring approach while talking to patient. Morphine sulfate reduces anxiety and may assist in reducing dyspnea. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety. The patient should be positioned in semi-Fowlers position to improve ventilation.
The nurse caring for the 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. Hypokalemia Sinus bradycardia Fatigue Serum digoxin level of 1.5 Anorexia
Sinus bradycardia Fatigue Anorexia
