ch 25- heart disease

The nurse is assigned to care for a patient with heart failure. What classification of medication does the nurse anticipate administering that will improve symptoms as well as increase survival?

ACE inhibitor Explanation: Several medications are routinely prescribed for heart failure (HF), including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and diuretics (Table 29-3). Many of these medications, particularly ACE inhibitors and beta-blockers, improve symptoms and extend survival. Others, such as diuretics, improve symptoms but may not affect survival (Fonarow et al., 2010). Calcium channel blockers are no longer recommended for patients with HF because they are associated with worsening failure (ICSI, 2011).

A client in the emergency room is in cardiac arrest and exhibiting pulseless electrical activity (PEA) on the cardiac monitor. What will be the nurse's next action? Stop all emergency measures. Change oxygen delivery to a mask. Analyze the arterial blood gas. Administer epinephrine.

Administer epinephrine.

The nurse is administering sublingual nitroglycerin to a client with chest pain. What action will the nurse take after administering two sublingual tablets if the client continues with chest pain and has a blood pressure of 120/82 mm Hg?

Administer the third sublingual nitroglycerin tablet.

The nurse understands that a client with which cardiac arrhythmia is most at risk for developing heart failure?

Atrial fibrillation

A patient is seen in the emergency department (ED) with heart failure secondary to dilated cardiomyopathy. What key diagnostic test does the nurse assess to determine the severity of the patient's heart failure? Blood urea nitrogen (BUN) Serum electrolytes Complete blood count (CBC) B-type natriuretic peptide (BNP)

B-type natriuretic peptide (BNP)

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

A patient in severe pulmonary edema is being intubated by the respiratory therapist. What priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea?

Call for a chest x-ray.

A client is exhibiting digitalis toxicity. Which of the following medications would the nurse expect to be ordered for this client? Warfarin Digoxin immune FAB Ibuprofen Amlodipine

Digoxin immune FAB Explanation: Digibind binds with digoxin and makes it unavailable for use. The digibind dosage is based on the digoxin level and the patient's weight. Ibuprofen, warfarin, and amlodipine are not used to reverse the effects of digoxin.

Which is a cerebrovascular manifestation of heart failure?

Dizziness

A client with congestive heart failure is admitted to the hospital after reporting shortness of breath. How should the nurse position the client in order to decrease preload? Head of the bed elevated 45 degrees and lower arms supported by pillows Prone with legs elevated on pillows Supine with arms elevated on pillows above the level of the heart Head of the bed elevated 30 degrees and legs elevated on pillows

Head of the bed elevated 45 degrees and lower arms supported by pillows

Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure?

Increased pulmonary artery diastolic pressure

Which feature is the hallmark of systolic heart failure?

Low ejection fraction (EF)m

Which describes difficulty breathing when a client is lying flat?

Orthopnea Explanation: Orthopnea occurs when the client is having difficulty breathing when lying flat. Sudden attacks of dyspnea at night are known as paroxysmal nocturnal dyspnea. Tachypnea is a rapid breathing rate and bradypnea is a slow breathing rate.

The nurse is administering furosemide to a client with heart failure. What best describes the therapeutic action of the medication?

The medication blocks sodium reabsorption in the ascending loop and dilate renal vessels.

The nurse is discussing basic cardiac hemodynamics and explains preload to the client. What nursing intervention will decrease preload? application of antiembolic stockings administration of a vasodilating drug (as ordered by a health care provider) increasing activity sustained elevation of the client's legs

administration of a vasodilating drug (as ordered by a health care provider) Explanation: Preload is the amount of blood presented to the ventricles just before systole. Anything that decreases the amount of blood returning to the heart will decrease preload, such as vasodilation or blood pooling in the extremities. Anything that assists in returning blood to the heart (antiembolic stockings) or preventing blood from pooling in the extremities will increase preload.

The nurse is providing care to a client with cardiogenic shock requiring a intra-aortic balloon pump (IABP). What is the therapeutic effect of the IABP therapy? decreased peripheral perfusion to the extremities decreased renal perfusion decreased left ventricular workload decreased right ventricular workload

decreased left ventricular workload

The nurse is assigned to care for a client with heart failure. What medication does the nurse anticipate administering that will improve client symptoms as well as increase survival?

lisinopril

A nurse reviews the client's medical record and reads in the progress notes that the client has decreased left ventricular function. What assessment will validate the diagnosis? increased appetite bibasilar rales cleared with coughing orthopnea resting bradycardia

orthopnea Explanation: Decreased left ventricular function would be characterized by orthopnea, dyspnea, anorexia, bibasilar rales not cleared with coughing, and resting tachycardia.

A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." What additional assessment information would be important for the CSU nurse to obtain?

pulmonary crackles

A client has been diagnosed with systolic heart failure. What percentage will the nurse expect the patient's ejection fraction to be? 30% 55% 65% 5%

30% Explanation: The ejection fraction is normal in diastolic heart failure, but severely reduced in systolic heart failure. The normal EF is 55%-65%. An EF of 5% is not life sustaining and an EF of 30% is about half the normal percentage. Reference:

The pathophysiology of pericardial effusion is associated with all of the following except: Atrial compression. Inability of the ventricles to fill adequately. Increased right and left ventricular end-diastolic pressures. Increased venous return.

Increased venous return. Explanation: Venous return is decreased (not increased) with Pericardial effusion because there is an increase in the pericardial fluid, which raises the pressure within the pericardial sac and compresses the heart. Increased right and left ventricular end-diastolic pressures, inability of the ventricles to fill adequately, and atrial compression are all effects of pericardial effusion

Which is a manifestation of right-sided heart failure? Increase in forward flow Systemic venous congestion Paroxysmal nocturnal dyspnea Accumulation of blood in the lungs

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. Some clients with left-sided heart failure get episodes of dyspnea at night, known as paroxysmal nocturnal dyspnea.

The triage nurse in the Emergency Department (ED) is admitting a client with a history of Class III heart failure. What symptoms would the nurse expect the client to exhibit? Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea. The client does not experience any limitation of activity. Ordinary physical activity results in fatigue, heart palpitation, or dyspnea. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitation, or dyspnea. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.

The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitation, or dyspnea.Class III (Moderate): There is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitation, or dyspnea. This makes options A, B, and D incorrect.

Assessment of a client on a medical surgical unit finds a regular heart rate of 120 beats per minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 mL over the past hour. What is the reason the nurse anticipates transferring the client to the intensive care unit? The client is in the early stage of right-sided heart failure. The client is going into cardiogenic shock. The client is experiencing heart failure. The client shows signs of aneurysm rupture.

The client is going into cardiogenic shock. Explanation: This client's findings indicate cardiogenic shock, which occurs when the heart fails to pump properly, impeding blood supply and oxygen flow to vital organs. Cardiogenic shock also may cause cold, clammy skin and generalized weakness, fatigue, and muscle pain as poor blood flow causes lactic acid to accumulate and prevents waste removal. Left-sided and right-sided heart failure eventually cause venous congestion with jugular vein distention and edema as the heart fails to pump blood forward. A ruptured aneurysm causes severe hypotension and a quickly deteriorating clinical status from blood loss and circulatory collapse; this client has low but not severely decreased blood pressure. Also, in ruptured aneurysm, deterioration is more rapid and full cardiac arrest is common.

A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client? The development of cor pulmonale The development of left-sided heart failure The development of chronic obstructive pulmonary disease (COPD) The development of right-sided heart failure

The development of left-sided heart failure

A client with a history of heart failure is returning from the operating room after inguinal hernia repair and the nurse assesses a low pulse oximetry reading. What is the most important nursing intervention? Titrate oxygen therapy. Administer pain medication. Assess the surgical incisional area. Assess for jugular vein distention.

Titrate oxygen therapy. Explanation: The nurse needs to titrate oxygen therapy to increase the client's oxygen levels. Assessing for jugular vein distention and examining the surgical incision area will not meet the oxygen demands. Administering pain medication will not increase oxygenation levels.

A client is awaiting the availability of a heart for transplant. What option may be available to the client as a bridge to transplant? Ventricular assist device (VAD) Intra-aortic balloon pump (IABP) Pacemaker Implanted cardioverter-defibrillator (ICD)

Ventricular assist device (VAD) Explanation: VADs may be used for one of three purposes:(1) a bridge to recovery, (2) a bridge to transplant, or (2) destination therapy (mechanical circulatory support when there is no option for a heart transplant). An implanted cardioverter-defibrillator or pacemaker is not a bridge to transplant and will only correct the conduction disturbance and not the pumping efficiency. An IABP is a temporary, secondary mechanical circulatory pump to supplement the ineffectual contraction of the left ventricle. The IABP is intended for only a few days

The critical care nurse is caring for a client with cardiogenic shock. What is the premise for inserting an intra-aortic balloon pump? inadequate tissue perfusion myocardial ischemia right atrial flutter coronary artery stenosis

inadequate tissue perfusion Explanation: The classic signs of cardiogenic shock are related to tissue hypoperfusion and an overall state of shock that is proportional to the extent of left ventricular damage. Reduced cardiac output and stroke volume reduces arterial blood pressure and tissue perfusion. A myocardial infarction may lead to cardiogenic shock, but is not the premise for the intra-aortic balloon pump. Coronary artery stenosis is not related to shock. Right arterial flutter is not indicative of shock.

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

peripheral edema Explanation: Peripheral edema is a sign of fluid volume excess and worsening heart failure. A skin rash and postural hypotension are adverse reactions to captopril, but they don't indicate that therapy is ineffective. The individual will also most like experience trachycardia instead of bradycardia if the heart failure is worsening ang not responding to captopril.

A client who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly reports chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the client for other signs and symptoms of pulmonary edema. pulmonary embolism. myocardial infarction. pneumonia.

pulmonary embolism. Explanation: Pulmonary embolism is a potentially life-threatening disorder typically caused by blood clots in the lungs. This disorder poses a particular threat to people with cardiovascular disease. Blood clots that form in the deep veins of the legs and embolize to the lungs can cause a pulmonary infarction, whereby emboli mechanically obstruct the pulmonary vessels, cutting off the blood supply to sections of the lung. Clinical indicators of pulmonary embolism can vary but typically include dyspnea, pleuritic chest pain, and tachypnea.