Chapter 34 Heart Failure - Complex Fall 2021

The nurse educates a patient with heart failure (HF) about lifestyle changes to avoid complications. Which statement made by the patient indicates that further teaching is needed? "I can add salt to my food and eat what I want." "I can eat hard candy or ice pops to avoid thirst." "I shouldn't exercise or do anything to strain my heart." "I will take all of my medications at the prescribed times."

"I can add salt to my food and eat what I want." Not following a low-sodium diet may lead to complications such as hypertension, edema, and other conditions. Fluid restriction is not usually prescribed for the patient with mild to moderate HF. However, in chronic HF, fluids are limited to 2 L/day. The use of ice pops and hard candy helps avoid thirst, which is a side effect of HF medications. Lack of exercise does not increase a patient's sodium level. Taking medication at the prescribed times is correct and does not need further teaching.

At a clinic visit, the nurse provides dietary teaching for a patient recently hospitalized with an exacerbation of chronic heart failure. The nurse determines that teaching is successful if the patient makes which statement? "I will limit the amount of milk and cheese in my diet." "I can add salt when cooking foods but not at the table." "I will take an extra diuretic pill when I eat a lot of salt." "I can have unlimited amounts of foods labeled as reduced sodium."

"I will limit the amount of milk and cheese in my diet." Rationale: Milk products should be limited to 2 cups per day for a 2500-mg sodium-restricted diet. Salt should not be added during food preparation or at the table. Diuretics should be taken as prescribed (usually daily) and not based on sodium intake. Foods labeled as reduced sodium contain at least 25% less sodium than regular.

An older adult patient with chronic heart failure (HF) and atrial fibrillation asks the nurse why warfarin (Coumadin) has been prescribed to continue at home. What is the best response by the nurse? "The medication prevents blood clots from forming in your heart." "The medication dissolves clots that develop in your coronary arteries." "The medication reduces clotting by decreasing serum potassium levels." "The medication increases your heart rate so that clots do not form in your heart."

"The medication prevents blood clots from forming in your heart." Rationale: Chronic HF causes enlargement of the chambers of the heart and an altered electrical pathway, especially in the atria. When numerous sites in the atria fire spontaneously and rapidly, atrial fibrillation occurs. Atrial fibrillation promotes thrombus formation within the atria with an increased risk of stroke and requires treatment with cardioversion, antidysrhythmics, and/or anticoagulants. Warfarin is an anticoagulant that interferes with hepatic synthesis of vitamin K-dependent clotting factors.

In response to heart failure, in which order does the sequence of events in the renin-angiotensin-aldosterone system (RAAS) occur? Renin is released. Cardiac output falls. Vasoconstriction occurs. Angiotensinogen is activated. Angiotensin I is converted to angiotensin II.

1. Cardiac output falls. 2. Renin is released. 3. Angiotensinogen is activated. 4. Angiotensin I is converted to angiotensin II. 5. Vasoconstriction occurs In the RAAS, decreased cardiac output leads to the release of renin from the kidneys. Renin causes activation of angiotensinogen, which is the enzyme that changes angiotensin I into angiotensin II, which is a potent vasoconstrictor.

Which is the order of events that occur when the sympathetic nervous system is activated to compensate for a low cardiac output (CO)? 1.Release of catecholamines 2.Increase in peripheral vasoconstriction 3.Inadequate CO 4.Increase in CO

1. Inadequate CO 2. Release of catecholamines 3. Increase in peripheral vasoconstriction 4. Increase of CO The compensatory mechanism is activated when the CO is inadequate, which results in the increased release of catecholamines. Increased catecholamines cause constriction of the blood vessels, which causes the preload of the heart to increase. Eventually, the CO is increased.

In which order do the changes involved in the development of dyspnea associated with left-sided heart failure (HF) occur? 1. Ineffective ventricular contractility 2.Elevated pressure in the left atrium 3.Inadequate alveolar gas exchange 4. Fluid leaking into interstitial spaces

1. Ineffective ventricular contractility 2. Elevated pressure in the left atrium 3. Fluid leaking into interstitial spaces 4. Inadequate alveolar gas exchange In left ventricular HF, ineffective ventricular contractions impair the normal forward flow of blood to the body. As a result, fluid returning to the heart from the lungs backs up in the heart and increases the pressure in the left atrium. If contractility continues to falter, the blood continues to back up into the pulmonary vasculature and eventually can result in fluid leaking into the interstitial spaces and alveoli of the lungs. This abnormal fluid in the parenchyma and alveoli impairs gas exchange, which causes dyspnea.

In which order of events can severe anemia lead to heart failure? Increase in cardiac workload Increase in the size of the left ventricle Decrease in the oxygen-carrying capacity of the blood Increase in cardiac output When a patient has severe, chronic anemia, a decrease in the oxygen-carrying capacity of the blood stimulates an increase in cardiac output. This increase in cardiac output causes an increase in cardiac workload, resulting in hypertrophy of the left ventricle.

1.Decrease in the oxygen-carrying capacity of the blood 2.Increase in cardiac output 3.Increase in cardiac workload 4.Increase in the size of the left ventricle When a patient has severe, chronic anemia, a decrease in the oxygen-carrying capacity of the blood stimulates an increase in cardiac output. This increase in cardiac output causes an increase in cardiac workload, resulting in hypertrophy of the left ventricle.

Which respiratory rate would the nurse anticipate when assessing a patient who is developing pulmonary edema? 10 to 14 breaths/min 16 to 20 breaths/min 22 to 24 breaths/min 32 to 36 breaths/min

32 to 36 breaths/min A respiratory rate higher than 30 breaths/min is often found in patients with pulmonary edema. A patient experiences dyspnea and orthopnea as a result of the accumulation of edematous fluid in the lung tissues, which affects the patient's respiratory rate. Respiratory rates in the ranges of 10 to 24 breaths/min indicate normal respiration.

A patient who has irreversible brain injury had previously requested to be an organ donor. Which assessments must be performed to determine the suitability of harvesting the heart for cardiac transplantation? Select all that apply. Gram stain Bronchoscopy ABO blood type Body size and heart size Human leukocyte antigen typing Panel of reactive antibody (PRA) level

ABO blood type Body size and heart size Human leukocyte antigen typing Panel of reactive antibody (PRA) level In order to avoid complications after cardiac transplantation, a careful selection of the donor's heart must be performed. The donor's organ must fulfill certain matching criteria with the recipient. These assessments include ABO blood type, body size, heart size, human leukocyte antigen, and PRA level. Gram stain and bronchoscopy findings are the matching criteria to be fulfilled for lung transplantation.

Which condition is the most probable cause of death in a patient during the first year after heart transplantation? Lymphoma Acute rejection Cardiac vasculopathy Sudden cardiac death

Acute rejection. Acute rejection of the graft would be the most probable cause of death within a year of cardiac transplantation. Other long-term causes after the first year include lymphoma, sudden cardiac death, and cardiac vasculopathy.

A patient admitted with heart failure is anxious and reports shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety? (Select all that apply.) Administer ordered morphine sulfate. Position patient in a semi-Fowler's position. 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.

Administer ordered morphine sulfate. Position patient in a semi-Fowler's position. Instruct patient on the use of relaxation techniques. Use a calm, reassuring approach while talking to patient. Rationale: Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety.

A patient with chronic heart failure asks the nurse about heart transplantation. Which findings in the patient history would absolutely contraindicate transplant surgery? Select all that apply. Severe obesity Age over 70 years Recurrent life-threatening dysrhythmias Cardiac abnormalities that severely limit normal function Advanced cerebral or vascular disease not amenable to correction

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

Which patient conditions increase the risk of developing heart failure? Select all that apply. Anemia Rib fractures Thyrotoxicosis Paget's disease Bacterial endocarditis

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

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

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

A patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first? Review urinary output for the previous 24 hours. Restrict the patient's oral fluid intake to 500 mL/day. Assist the patient to a sitting position with arms on the overbed table. Teach the patient to use pursed-lip breathing until the dyspnea subsides.

Assist the patient to a sitting position with arms on the overbed table. Rationale: The nurse should place the patient with ADHF in a high Fowler's position with the feet horizontal in the bed or dangling at the bedside. This position helps decrease venous return because of the pooling of blood in the extremities. This position also increases the thoracic capacity, allowing for improved ventilation. Pursed-lip breathing helps with obstructive air trapping but not with acute pulmonary edema. Restricting fluids takes considerable time to have an effect.

The nurse is preparing to administer a nitroglycerin patch to a patient. When providing teaching about the use of the patch, what should the nurse include? Avoid drugs to treat erectile dysfunction. Increase diet intake of high-potassium foods. Take an over-the-counter H2-receptor blocker. Avoid nonsteroidal antiinflammatory drugs (NSAIDS).

Avoid drugs to treat erectile dysfunction. Rationale: The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. NSAIDs do not pose a risk in combination with nitrates. There is no need to take an H2-receptor blocker or increase the dietary intake of high-potassium foods.

A patient is diagnosed with paroxysmal nocturnal dyspnea. Which clinical manifestation would the nurse expect the patient to report? Decreased attention span Breathlessness on exertion Shortness of breath when lying down Awakening with a feeling of suffocation

Awakening with a feeling of suffocation Paroxysmal nocturnal dyspnea occurs when the patient is asleep. The patient awakes in a state of panic with a feeling of suffocation and has a strong desire to sit or stand up. Breathlessness on exertion is called dyspnea. Shortness of breath when lying down, that is, orthopnea, often accompanies dyspnea. A decreased attention span is a behavioral change that may be a result of poor gas exchange or worsening heart failure.

A patient is diagnosed with paroxysmal nocturnal dyspnea. Which clinical manifestation would the nurse expect the patient to report? Decreased attention span Breathlessness on exertion Shortness of breath when lying down Awakening with a feeling of suffocation

Awakening with a feeling of suffocation Paroxysmal nocturnal dyspnea occurs when the patient is asleep. The patient awakes in a state of panic with a feeling of suffocation and has a strong desire to sit or stand up. Breathlessness on exertion is called dyspnea. Shortness of breath when lying down, that is, orthopnea, often accompanies dyspnea. A decreased attention span is a behavioral change that may be a result of poor gas exchange or worsening heart failure.

What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure? Urine output Lung sounds Blood pressure Respiratory rate

Blood pressure Rationale: 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.

An asymptomatic patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before dangling the patient on the bedside, what should the nurse assess first? Urine output Heart rhythm Breath sounds Blood pressure

Blood pressure Rationale: The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the semi-Fowler's position and use other measures to improve gas exchange.

Which finding in the medical record of a patient with heart failure (HF) is not consistent with the patient's diagnosis? Fatigue Bradycardia Clammy and cold skin Paroxysmal nocturnal dyspnea

Bradycardia Bradycardia is not related to acute decompensated heart failure (ADHF) or chronic heart failure. Fatigue is an indication associated with chronic heart failure. Clammy and cold skin is a result of vasoconstriction during ADHF. Paroxysmal nocturnal dyspnea is also associated with chronic heart failure.

Which food item would the nurse suggest that a patient who has hypertension should avoid? Shrimp Spinach Canned soups Skinless chicken breasts

Canned soups Canned soups are high in sodium and should be avoided by patients with hypertension. Skinless chicken breasts, spinach, fish, and shellfish are low in sodium and may be consumed on a low-sodium diet.

Which intervention may be included in the collaborative plan of care for a patient with chronic heart failure? Ultrafiltration (UF) Hemodynamic monitoring Intraaortic balloon pump (IABP) Cardiac resynchronization therapy (CRT)

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

Which is a major cause of death several years after a heart transplant? Infection Acute rejection Immunosuppression Cardiac vasculopathy

Cardiac vasculopathy Beyond the first year after a heart transplant, cardiac vasculopathy (accelerated coronary artery disease [CAD]) and malignancy (especially lymphoma) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection.

A patient is scheduled for a heart transplant. What is a major cause of death beyond the first year after a heart transplant? Infection Acute rejection Immunosuppression Cardiac vasculopathy

Cardiac vasculopathy Rationale: Beyond the first year after a heart transplant, cancer (especially lymphoma) and cardiac vasculopathy (accelerated coronary artery disease) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection.

A patient is suspected of having heart failure. Which diagnostic tests are commonly used to make this diagnosis? Select all that apply. Chest x-ray Echocardiogram Pulmonary function tests Electrocardiogram (ECG) Electroencephalogram (EEG)

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

A patient with a long-standing history of heart failure recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? Taper the patient off his current medications. Continue education for the patient and his family. Pursue experimental therapies or surgical options. Choose interventions to promote comfort and prevent suffering.

Choose interventions to promote comfort and prevent suffering. Rationale: 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. Experimental therapies and surgeries are not used in the care of hospice patients.

A patient is admitted to the hospital with heart failure. Following an assessment, the health care provider classifies the patient as New York Heart Association (NYHA) II. Which patient profile matches this classification? Unable to perform daily chores, such as dressing oneself Dyspnea even at rest and discomfort that increases with activities Comfortable at rest but fatigue with ordinary physical activity No dyspnea when resting or when performing daily routine activities

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

A patient is prescribed an angiotensin-converting enzyme (ACE) inhibitor for the treatment of heart failure (HF). Which mechanism will this medication block? Secretion of aldosterone Conversion of pro-renin to renin Conversion of angiotensin I to angiotensin II Conversion of angiotensinogen to angiotensin I

Conversion of angiotensin I to angiotensin II Angiotensin I is subsequently converted to angiotensin II by the ACE found in the lungs. When renal blood flow is reduced, the juxtaglomerular cells secrete renin into the circulation. Renin carries out the conversion of angiotensinogen released by the liver to angiotensin I. Angiotensin II also stimulates the secretion of the hormone aldosterone; it causes the reabsorption of sodium and water into the blood, which increases the BP.

A patient is diagnosed with left ventricular hypertrophy from untreated hypertension. For which condition would the nurse plan to monitor? Decreased contractility Decreased O2 requirements Decreased ventricular irritability Increased coronary arterial circulation

Decreased contractility Poor contractility is a complication seen in patients who have hypertrophy of the cardiac walls. The heart muscle, which undergoes hypertrophy, increases in muscle mass and cardiac wall thickness as a result of overwork and strain. As a result, the hypertrophic heart muscle exhibits poor contractility over time. A hypertrophic heart requires more O2 to perform work. Hypertrophic heart muscle is more irritable and, thus, prone to dysrhythmias. The tissue in a hypertrophic heart has poor coronary artery circulation.

Which condition related to heart failure causes fatigue? Impaired renal perfusion Increased pulmonary pressure Decreased oxygenation of the tissues Reabsorption of fluid from dependent body areas

Decreased oxygenation of the tissues Fatigue is caused by decreased oxygenation of the tissues. Dyspnea, not fatigue, is caused by increased pulmonary pressure. Impaired renal perfusion resulting in decreased urine output during the day is a cause of nocturia, not fatigue. Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluids from the dependent body areas when the patient is lying flat.

Which primary manifestation results from the decreased filling of the cardiac ventricles associated with diastolic failure? Decreased afterload Decreased left ventricular ejection fraction Decreased left ventricular end-diastolic pressure Decreased stroke volume and cardiac output (CO)

Decreased stroke volume and cardiac output (CO) Decreased filling of the ventricles results in decreased stroke volume and CO. Diastolic failure is characterized by high filling pressures because of stiff ventricles, increasing afterload and left ventricular end-diastolic pressure. Venous engorgement in both the pulmonary and systemic vascular systems causes a decreased left ventricular ejection fraction.

The nurse reviews the laboratory results of a patient with heart failure (HF) and notes an increased calcium level and decreased magnesium level. Which scheduled medication would the nurse withhold while notifying the health care provider of the findings? Digoxin Metoprolol Spironolactone Morphine sulfate

Digoxin Hypomagnesemia can trigger digitalis toxicity. The digoxin should be withheld, and the health care provider should be notified. The laboratory findings are not indications to withhold metoprolol, spironolactone, or morphine sulfate.

Which findings will the nurse likely observe when a patient has right-sided heart failure (HF)? Select all that apply. Distended neck veins Enlarged cardiac muscle Engorged or enlarged liver Decreased afterload in the ventricle Decreased resistance to blood ejection

Distended neck veins Enlarged cardiac muscle Engorged or enlarged liver Right-sided HF occurs when the right ventricle (RV) does not pump effectively. When the RV fails, fluid backs up into the venous system. This causes movement of fluid into the tissues and organs (e.g., distended neck veins, enlarged cardiac muscle, engorged or enlarged liver, peripheral edema, abdominal ascites). Right-sided HF increases resistance to blood flow and increases afterload.

A patient is diagnosed with pulmonary edema. Which type of medication would the nurse anticipate being prescribed? Diuretic Vasodilator β-Adrenergic receptor blocker (β-blocker) Angiotensin-converting enzyme (ACE) inhibitor

Diuretic Diuretics are used to treat pulmonary edema because they act on the ascending loop of Henle to promote sodium, chloride, and water excretion. Vasodilators cause dilation of the blood vessel wall. β-Blockers help counteract the negative effect of the sympathetic nervous system. ACE inhibitors block the enzyme that can cause angiotensin I to form angiotensin II, which is a potent vasoconstrictor.

Which medication is a selective β-agonist that does not increase systemic vascular resistance (SVR) and is preferred for the short-term treatment of acute decompensated heart failure (ADHF)? Milrinone Dopamine Dobutamine Procainamide

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

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

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

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

Edema Ascites Anasarca Edema, ascites, and anasarca are manifestations of right-sided heart failure caused by fluid retention. Crackles and wheezes are manifestations of left-sided heart failure because fluid moves from the pulmonary capillary bed into the pulmonary interstitium and alveoli.

A patient admitted to the emergency department with pain, dyspnea, and lower extremity edema is diagnosed with diastolic heart failure. Which finding supports the diagnosis of diastolic heart failure? Low filling pressures Ejection fraction (EF) of 55% Impaired contractile function EF of 40%

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

Which term is used to describe difficulty breathing when lying down? Dyspnea Orthopnea Bradypnea Paroxysmal nocturnal dyspnea (PND

Orthopnea Orthopnea refers to dyspnea when recumbent (lying down). Dyspnea refers to difficulty breathing. Bradypnea is the term for abnormally slow breathing. PND is episodic sudden dyspnea that wakes a patient at night.

An echocardiogram for a patient indicates enlarged ventricles of the heart. Which condition could be the cause of the cardiac dilation? Increased heart rate Increased muscle thickness Elevated pressure in the ventricles Increased release of catecholamine

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

Which situation is indicated by the presence of bilateral fine crackles in a patient with acute decompensated heart failure (ADHF)? Fluid in the alveoli Mucus in the alveoli Bronchoconstriction Upper airway obstruction

Fluid in the alveoli Fluid in the alveoli is the correct answer because crackles are made by the sound of air moving through fluid-filled alveoli. Mucus in the airways sounds like rhonchi or would cause diminished lung sounds if there were consolidation. Bronchoconstriction results in wheezing. Upper airway obstruction results in stridor or, in complete obstruction, an absence of breath sounds.

Paroxysmal nocturnal dyspnea is indicative of which more serious problem? Chronic obstructive pulmonary disease (COPD) Asthma Bronchitis Heart failure

Heart failure A classic symptom of left-sided heart failure is paroxysmal nocturnal dyspnea, which awakens the patient after several hours of sleep. Although a patient with COPD, asthma, or bronchitis may experience shortness of breath, these symptoms do not usually manifest while the patient is sleeping.

Which primary causes of heart failure are linked to specific genes and gene mutations? Select all that apply. Hypertension Hyperthyroidism Cardiomyopathy Rheumatic heart disease Coronary artery disease (CAD)

Hypertension Cardiomyopathy Coronary artery disease (CAD) Primary causes of heart failure linked to specific genes and gene mutations include hypertension, cardiomyopathy, and CAD. Hyperthyroidism and rheumatic heart disease are primary causes of heart failure that are not linked to specific genes and gene mutations.

Which items in a patient's medical history are risk factors for heart failure (HF)? Select all that apply. Cirrhosis Hypertension Multiple sclerosis Marfan's syndrome Metabolic syndrome

Hypertension Metabolic syndrome Hypertension and coronary artery disease (CAD) are the primary risk factors for HF. Other co-morbidities, such as diabetes, metabolic syndrome, advanced age, tobacco use, and vascular disease, contribute to the risk of the development of HF. Cirrhosis, multiple sclerosis, and Marfan's syndrome are not precipitating causes of HF.

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

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

Which treatment would the nurse expect to be prescribed for a patient after heart transplantation? Antibiotic therapy Antifungal therapy Immunosuppressive therapy IV immunoglobulin (IVIG) therapy

Immunosuppressive therapy Immunosuppressive therapy is used to suppress the immune system and prevent rejection of the transplanted heart. IVIG is a blood product that is administered IV. It contains the pooled, polyvalent, and immunoglobulin G (IgG) antibodies extracted from the plasma of over 1000 blood donors and is used to boost the immune system. Antibiotic therapy is used to prevent infection. Antifungal therapy is used to treat fungal infections.

A patient diagnosed with heart failure experiences fatigue. Which factor causes the fatigue? Increased cardiac output Increased hemoglobin level Impaired perfusion to vital organs Increased oxygenation of the tissues

Impaired perfusion to vital organs Fatigue is one of the early signs of heart failure. As a result of heart failure, there is inadequate blood circulation, leading to decreased perfusion to the vital organs. Impaired functioning of the vital organs may lead to fatigue. Cardiac output decreases in heart failure, depriving the body tissues of oxygen and nutrients, leading to fatigue. Inadequate blood supply results in inadequate oxygenation of the tissue and causes fatigue when the oxygen demands are not met. Hemoglobin levels are low in heart failure, leading to anemia. A decreased oxygen-carrying capacity of the blood also results in fatigue.

Which characteristic feature of diastolic failure would the nurse explain to a patient? High pulmonary pressures Decrease in the ejection fraction (EF) Inability of the ventricles to relax and fill Inability of the ventricles to pump blood effectively

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

Which effect would be expected from a medication that acts to increase chronotropy? Increased heart rate Increased stroke volume Increased cardiac output Increased myocardial contractility

Increased heart rate Increased heart rate is a positive chronotropic effect. Increases in myocardial contractility, stroke volume, and cardiac output are positive inotropic effects.

Which physiologic change is caused when epinephrine and norepinephrine are released in response to decreased cardiac output? Vasodilation Decreased heart rate Decreased BP Increased oxygen demand

Increased oxygen demand Catecholamines increase the heart rate and contractility, which increase myocardial workload and oxygen demand. Catecholamines cause vasoconstriction (not vasodilation), an increased heart rate (not decreased), and an increase in BP (not decrease).

Which events occur as a result of ventricular remodeling? Select all that apply. Increased contractility Increased wall tension More effective pumping Increased ventricular mass Increased O2 consumption

Increased wall tension Increased ventricular mass Increased O2 consumption Remodeling involves hypertrophy of the ventricular myocytes. This results in large, abnormally shaped contractile cells. This altered shape of the ventricles eventually leads to increased wall tension, increased ventricular mass, increased O2 consumption, and impaired contractility. Although the ventricles become larger, they become less effective pumps.

The nurse is caring for a patient with worsening heart failure (HF) who is hemodynamically unstable. Which intervention is likely to be included in the patient's treatment plan to increase coronary blood flow to the heart muscle? Ultrafiltration Vasoconstrictors Intraaortic balloon pump (IABP) Ventricular assist device (VAD)

Intraaortic balloon pump (IABP) The IABP is a device that increases coronary blood flow to the heart muscle and decreases the heart's workload through a process called counterpulsation. Vasoconstrictors will increase afterload and worsen heart failure. Ultrafiltration is the process of removing excess salt and water from the patient's blood. VADs are used to maintain cardiac output.

Which intervention would most improve the hemodynamic stability of a patient with worsening acute decompensated heart failure (ADHF)? Ultrafiltration (UF) Endotracheal intubation Intraaortic balloon pump (IABP) Bilevel positive airway pressure (BiPAP)

Intraaortic balloon pump (IABP) The IABP uses a process called counterpulsation to increase coronary blood flow and decrease the heart's workload. UF is a process to remove excess salt and water from the blood. Endotracheal intubation and BiPAP help maintain an open airway.

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

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

Which assessment finding is consistent with right-sided heart failure (HF)? Jugular venous distention (JVD) Presence of S3 and S4 heart sounds Paroxysmal nocturnal dyspnea (PND) Displacement of the point of maximal impulse (PMI)

Jugular venous distention (JVD) JVD is a sign of right-sided HF. Presence of S3 and S4 heart sounds, PND, and displacement of the PMI are all signs/symptoms of left-sided HF.

The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient? (Select all that apply.) Left ventricular function is documented Controlling dysrhythmias will eliminate HF Prescription for digoxin (Lanoxin) at discharge Prescription for angiotensin-converting enzyme inhibitor at discharge Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen

Left ventricular function is documented Prescription for angiotensin-converting enzyme inhibitor at discharge Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen Rationale: The Joint Commission has identified these 3 core measures for heart failure patients. Although controlling dysrhythmias will improve CO and workload, it will not eliminate HF. Prescribing digoxin for all HF patients is no longer done because there are newer effective drugs and digoxin toxicity occurs easily related to electrolyte levels and the therapeutic range must be maintained.

A nurse is caring for a patient with pleural effusion who has S3 and S4 heart sounds, crackles, and an increased heart rate. Which condition is likely affecting the patient? Cor pulmonale Pulmonary embolism Left-sided heart failure Right-sided heart failure

Left-sided heart failure Manifestations of left-sided heart failure include pleural effusion, S3 and S4 heart sounds, crackles, and an increased heart rate. These symptoms indicate a low cardiac output. Cor pulmonale is the dilation of the right ventricle caused by pulmonary diseases. It manifests as right heart failure. Right-sided heart failure causes edema, murmurs, and jugular vein distention. Pulmonary embolism manifests as chest pain, tachycardia, anxiety, and dizziness.

The nurse is administering a dose of Digitalis (digoxin) to a patient with heart failure (HF). The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom? Muscle aches Constipation Loss of appetite Pounding headache

Loss of appetite Rationale: Anorexia, nausea, vomiting, blurred or yellow vision, and dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms.

A patient's apical heart rate is 45 beats/minute. Which scheduled medication would the nurse withhold? Morphine Metoprolol Furosemide Rosuvastatin

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

A patient is admitted to the hospital with a diagnosis of acute decompensated heart failure (ADHF). The health care provider prescribes a continuous IV infusion of sodium nitroprusside. Which is the priority nursing intervention? Monitor urinary output. Monitor BP. Check serum potassium level. Assess the IV site.

Monitor BP. The priority nursing intervention is to monitor BP because symptomatic hypotension is the main adverse effect of sodium nitroprusside. Monitoring urinary output is a general intervention but not a priority during a continuous IV infusion of sodium nitroprusside. Hyperkalemia may occur with renin-angiotensin-aldosterone inhibitors, angiotensin II receptor blockers, and aldosterone antagonists. Assessment is needed for the skin around an IV infusion of dopamine (Intropin) because it can cause tissue necrosis with sloughing.

A patient hospitalized with heart failure (HF) often experiences dyspnea and reports feeling very anxious during the dyspneic episodes. Which medication may be prescribed short term for anxiety reduction and preload reduction? Digoxin Morphine Dopamine Metolazone

Morphine Morphine is an opioid analgesic used to both reduce anxiety and treat heart failure. Digoxin is a cardiac glycoside and is used to increase cardiac contractility. Dopamine is a positive inotrope that is used to treat heart failure. Metolazone is a thiazide-like diuretic that is used to treat heart failure.

Which conditions are primary causes of heart failure? Select all that apply. Anemia Myocarditis Paget's disease Pulmonary embolism Coronary artery disease

Myocarditis Coronary artery disease Myocarditis and coronary artery disease are primary causes of heart failure. Anemia, Paget's disease, and pulmonary embolism are precipitating causes of heart failure.

A patient is diagnosed with left-sided heart failure. Which assessment finding would the nurse expect? Orthopnea Low BP Pulsating neck veins Edema in the lower extremities

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

A patient is diagnosed with left-sided heart failure. Which assessment finding would the nurse expect? Orthopnea Low BP Pulsating neck veins Edema in the lower extremities

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

The nurse reviews assessment data for patients with heart failure (HF) who are being monitored regularly. The nurse identifies that which patient's data requires further evaluation and intervention? Patient A Patient B Patient C Patient D

Patient C The nurse would be concerned about Patient C's use of NSAIDs. NSAIDs should not be taken by patients with HF since they can contribute to sodium retention and exacerbate HF. Nitroglycerin is often used PRN by HF patients, it is appropriate to decrease use of added salt to foods, and a weight gain of 2 pounds in the past week would not be a concern. A cough is a common side effect of ACE inhibitors. It is recommended that salt intake be under 2 g total daily. A heart rate above 60 beats per minute and low-sodium snacks are both acceptable.

Which clinical manifestation occurs with left-sided heart failure (HF) but not with right-sided HF? Fatigue Anxiety Pink sputum Loss of appetite

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

The nurse assesses that a patient with acute decompensated heart failure (ADHF) experiences dyspnea. Which is the priority nursing action? Perform ultrafiltration. Provide supplemental oxygen. Provide mechanical ventilation. Obtain arterial blood gases (ABGs)

Provide supplemental oxygen. Supplemental oxygen helps increase the percentage of oxygen in inspired air. Ultrafiltration is a process used to remove excess salt and water from the blood in the case of volume overload. Mechanical ventilation is used to help decrease the preload in cases of pulmonary edema. An ABG test will provide information about the amount of oxygen and carbon dioxide in the blood, but it is not a priority.

A patient with acute decompensated heart failure (ADHF) experiences severe pulmonary edema. Which intervention will increase oxygenation and decrease preload for this patient? Placing the patient in the Trendelenburg position Administering O2 at 2 to 4 L by nasal cannula Providing bilevel positive airway pressure (BiPAP) Advising the patient to take physical and emotional rest

Providing bilevel positive airway pressure (BiPAP) In severe pulmonary edema, the patient may need noninvasive positive pressure ventilation (e.g., BiPAP) or intubation and mechanical ventilation. BiPAP is also effective in decreasing preload. When a patient has dyspnea, the patient should be placed in the high Fowler's position. Oxygen therapy delivered at 2 to 4 L/min via nasal cannula will not be adequate for a patient experiencing severe pulmonary edema. Taking physical and emotional rest helps in conserving energy; it does not increase the percentage of inspired O2, and it does not decrease preload.

What is the most likely reason for the development of orthopnea in a patient with pulmonary edema? Dysrhythmia Hypertension Pulmonary failure Pulmonary congestion

Pulmonary congestion In pulmonary edema, there is congestion in the lungs, which causes inadequate oxygenation. In a recumbent position, the congestion is further increased, causing further hypoxemia, which causes orthopnea, or shortness of breath while lying down. Dysrhythmias do not directly cause orthopnea, although they may worsen heart failure. Hypertension and pulmonary failure are found in later stages of heart failure.

Which finding would the nurse monitor in the patient who has left-sided heart failure? Pedal edema Hepatomegaly Splenomegaly Pulmonary congestion

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

Which condition causes cor pulmonale? Liver disease Renal disease Pulmonary disease Preexisting heart disease

Pulmonary disease Cor pulmonale is a cardiac condition in which a disease of the pulmonary system causes an increase in right ventricular pressure. This increased right ventricular pressure causes right ventricular failure, which may eventually lead to heart failure. This term is not used for heart disease caused by liver, kidney, or preexisting heart disease.

A patient with a history of acute decompensated heart failure (ADHF) reports blood-tinged sputum, a productive frothy cough, and a rapid heart rate. Which condition is consistent with these clinical manifestations? Cerebral edema Peripheral edema Lymphatic edema Pulmonary edema

Pulmonary edema ADHF can manifest as pulmonary edema, which is an acute, life-threatening condition. In this condition, the alveoli become filled with serosanguinous fluid, and the clinical manifestations include cough, blood-stained sputum, and a rapid heart rate. Cerebral edema presents in the form of seizures, headache, and other neurologic symptoms. Peripheral edema presents as a swelling in the lower extremities. Lymphatic edema presents as hyperplasia and hyperkeratosis.

A patient with a history of left-sided heart failure arrives in the emergency department reporting extreme shortness of breath and a persistent cough with pink, frothy sputum. On auscultation of the heart, the nurse notes an S3 gallop. Which condition is a likely cause of these symptoms? Pneumonia Asthma attack Pulmonary edema Myocardial infarction

Pulmonary edema Extreme shortness of breath and a persistent cough with pink, frothy sputum are symptoms of pulmonary edema. Pink, frothy sputum and an S3 gallop are not symptoms of pneumonia, an asthma attack, or myocardial infarction.

Which effects of nitroglycerin benefit a patient with acute decompensated heart failure (ADHF)? Select all that apply. Reduces preload Prevents dysrhythmias Prevents thromboembolism Dilates the coronary arteries Increases myocardial oxygen supply

Reduces preload Dilates the coronary arteries Increases myocardial oxygen supply Nitroglycerin is a medication that decreases preload, dilates the coronary arteries, and improves blood flow with oxygenation to the myocardium. Nitroglycerin has no dysrhythmic properties and does not prevent thromboembolism.

A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix). What outcome would demonstrate medication effectiveness? Promote vasodilation. Reduction of preload. Decrease in afterload. Increase in contractility.

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

A patient with chronic heart failure is being discharged from the hospital. Which instructions would the nurse include in the patient's teaching plan? Limit activity, including daily exercise. Restrict fluid intake to less than 2 L per day. Report a weight gain of 3 lb (1.4 kg) in two days. Take one extra dose of diuretic medication for swelling.

Report a weight gain of 3 lb (1.4 kg) in two days. Daily weight is the best indicator of changes in fluid status. An activity such as daily exercise is encouraged because exercise improves the patient's sense of well-being. Fluid restriction may be recommended for advanced heart failure. The patient should never adjust medications without consulting with the health care provider.

Which response in heart failure is triggered by the renin-angiotensin-aldosterone system (RAAS)? Vasodilation Decreased cardiac output Retention of sodium and water Decreased release of antidiuretic hormone (ADH)

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

After having a myocardial infarction (MI), the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108 beats/min. What should the nurse suspect is happening? Chronic HF Left-sided HF Right-sided HF Acute decompensated HF

Right-sided HF Rationale: An MI is a primary cause of heart failure. The jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure.

Which area of the body would best show accumulation of edema in a patient with heart failure (HF) who spends most of the time in bed? Feet Lungs Sacrum Abdomen

Sacrum In patients with HF who spend a great deal of time in bed, it would be important to assess the sacral area for edema. Edema related to HF may also be found in the feet, lungs, and abdomen. But in this patient, given the history of bed rest, the sacrum will be the most accurate area to assess.

The nurse prepares to administer digoxin 0.125 mg to a patient admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication? Prothrombin time Urine specific gravity Serum potassium level Hemoglobin and hematocrit

Serum potassium level Rationale: Serum potassium should be monitored because hypokalemia increases the risk for digoxin toxicity. Changes in prothrombin time, urine specific gravity, and hemoglobin or hematocrit would not require holding the digoxin dose.

The home care nurse visits a patient with chronic heart failure. Which assessment findings would indicate acute decompensated heart failure (pulmonary edema)? Fatigue, orthopnea, and dependent edema Severe dyspnea and blood-streaked, frothy sputum Temperature is 100.4° F and pulse is 102 beats/min Respirations 26 breaths/min despite oxygen by nasal cannula

Severe dyspnea and blood-streaked, frothy sputum Rationale: Manifestations of pulmonary edema include anxiety, pallor, cyanosis, clammy and cold skin, severe dyspnea, use of accessory muscles of respiration, a respiratory rate greater than 30 breaths/min, orthopnea, wheezing, and coughing with the production of frothy, blood-tinged sputum. Auscultation of the lungs may reveal crackles, wheezes, and rhonchi throughout the lungs. The heart rate is rapid, and blood pressure may be elevated or decreased.

A patient with valvular heart disease has not experienced any symptoms of heart failure (HF). How would the nurse classify this patient according to the American College of Cardiology/American Heart Association (ACC/AHA) stages of HF? Stage A Stage B Stage C Stage D

Stage B According to ACC/AHA the nurse should classify this patient as stage B. Stage B patients have structural heart disease without any signs or symptoms. Stage A patients are at high risk for HF but do not have structural heart disease or symptoms of HF. Stage C patients have prior or current symptoms of HF associated with known structural heart disease. Stage D patients have refractory HF requiring specialized interventions.

A patient is diagnosed with heart failure. Which factors may influence the patient's cardiac output (CO)? Select all that apply. Stroke volume Portal pressure Respiratory rate Ventricular filling Myocardial contractility

Stroke volume Ventricular filling Myocardial contractility CO depends on various factors, such as stroke volume, filling of the ventricles, and myocardial contractility. Stroke volume × heart rate = CO. Decreased filling of the ventricles decreases CO. Impaired myocardial contractility decreases CO. Respiratory rate and portal pressure do not alter CO

Which condition causes the symptoms of right-sided heart failure? Decreased preload Increased cardiac output Fluid congestion in the lungs Systemic venous congestion

Systemic venous congestion The symptoms of right-sided heart failure are caused by the backup of blood into the venous system. Preload in right-sided heart failure is increased. Cardiac output is decreased in right-sided heart failure. Fluid congestion in the lungs is a symptom of left-sided heart failure

A patient's diagnostic results reveal an ejection fraction (EF) of 32%. Which conditions may be indicated by this finding? Select all that apply. Systolic failure Diastolic failure Myocardial infarction Coronary heart disease Mixed systolic and diastolic failure

Systolic failure Mixed systolic and diastolic failure The EF is defined as the amount of blood ejected from the left ventricle after each contraction. A normal EF is 55% to 60%. The hallmark of systolic failure is a decrease in the EF (less than 45%). Patients with mixed systolic and diastolic failure have an extremely low EF (less than 35%). The EF in diastolic failure is normal. Myocardial infarction is damage to the heart muscle as a result of decreased blood flow and oxygen supply, which may or may not result in a low EF. Coronary heart disease, if not severe, may not affect the EF.

A patient presents to the emergency department with acute decompensated heart failure (ADHF) and indications of alveolar edema. Which assessment findings would the nurse expect? Select all that apply. Tachypnea Decreased PaO2 Increased PaCO2 Increased glucose levels Changes in metabolic status

Tachypnea Decreased PaO2 Increased PaCO2 When the pulmonary venous pressure increases, the alveoli lining cells are disrupted, and fluid containing red blood cells moves into the alveoli (alveolar edema). As the disruption becomes worse from further increases in the pulmonary venous pressure, the alveoli and airways are flooded with fluid. This is accompanied by tachypnea and a worsening of the arterial blood gases (i.e., lower PaO2 and increased partial pressure of CO2 in arterial blood and progressive respiratory acidosis). Abnormalities in the glucose levels and metabolic status of the patient would not be expected with alveolar edema.

The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to acute decompensated heart failure (ADHF)? Take medications as prescribed. Use oxygen when feeling short of breath. Direct questions only to the health care provider. Encourage most activity in the morning when rested.

Take medications as prescribed. Rationale: The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies such as alternating activity with rest will help the patient meet this goal. If the patient needs to use oxygen at home, it will probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient. This nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening HF.

Which interventions are aimed at preventing the primary causes of heart failure (HF)? Select all that apply. Blood transfusions for anemia Taking BP medication as prescribed Decreasing dysrhythmias by reducing caffeine intake Initiating lifestyle changes to avoid coronary artery disease (CAD) Taking aspirin every day to reduce the incidence of pulmonary embolism

Taking BP medication as prescribed Initiating lifestyle changes to avoid coronary artery disease (CAD) Hypertension and CAD are considered primary causes of HF. Anemia, dysrhythmias, and pulmonary embolism are precipitating causes of heart failure.

The nurse encourages the patient diagnosed with chronic heart failure to obtain physical and emotional rest. Which rationale would the nurse give for this recommendation? To relieve dyspnea and fatigue To increase the oxygen saturation of the blood To decrease the need for additional oxygen To involve the patient in cardiac rehabilitation

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

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

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

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

Ventricular dilation Ventricular hypertrophy Activation of the sympathetic nervous system (SNS) Increased contraction as a result of dilation initially leads to increased CO and maintenance of BP and perfusion. The increased contractile power of the heart's muscle fibers as a result of hypertrophy initially leads to an increase in CO and maintenance of tissue perfusion. The SNS responds by releasing catecholamines (epinephrine and norepinephrine), which enhance peripheral vasoconstriction and cause an increase in the heart rate and myocardial contractility. Initially, this compensatory mechanism is beneficial, with a result of increased CO. Endothelin is a potent vasoconstrictor; it contributes to the development of heart failure. The release of renin by the kidneys starts a cascade of events, which results in further water and sodium retention in an already-overloaded state.

Which classification of acute decompensated heart failure includes a normal cardiac output (CO), increased pulmonary artery wedge pressure (PAWP), dyspnea, edema, and orthopnea? Dry-cold Wet-cold Dry-warm Wet-warm

Wet-warm Normal CO, increased PAWP, and symptoms of congestion (dyspnea, edema, orthopnea) would be classified as wet-warm. A dry-cold profile would include a decreased or normal PAWP, decreased CO, edema, hypotension, and cool extremities. A wet-cold profile would have increased PAWP, decreased CO, altered mental status, decreased O2 saturation, reduced urine output, and shock. A dry-warm profile would be reflected by normal PAWP and CO and no signs or symptoms.

The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What is the priority action by the nurse? Withhold the daily dose until the following day. Withhold the dose and report the potassium level. Give the digoxin with a salty snack, such as crackers. Give the digoxin with extra fluids to dilute the sodium level.

Withhold the dose and report the potassium level. Rationale: The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and wait for the potassium level to normalize. The provider may order the digoxin to be given once the potassium level has been treated and decreases to within normal range.

A patient with chronic heart failure and atrial fibrillation is treated with low-dose digitalis and a loop diuretic. What does the nurse need to do to prevent complications of this drug combination? (select all that apply) a. Monitor serum potassium levels. b. Teach the patient how to take a pulse rate. c. Withhold digitalis if pulse rhythm is irregular. d. Keep an accurate measure of intake and output. e. Teach the patient about dietary potassium restrictions.

a, b Rationale: Hypokalemia, which can be caused by using potassium-depleting diuretics (e.g., thiazides, loop diuretics), is a common cause of digitalis toxicity. Low serum levels of potassium enhance the action of digitalis, causing a therapeutic dose to achieve toxic levels. Hypokalemia can precipitate dysrhythmias. Monitoring the serum potassium levels of patients receiving digitalis preparations and potassium-depleting diuretics is essential. Teach patients taking digitalis preparations how to measure their pulse rate because bradycardia and atrioventricular blocks are late signs of digitalis toxicity. Patients should know what pulse rate would require a call to the HCP. Patients should not independently decide to skip a dose of digitalis.

Which statements accurately describe heart failure with preserved ejection fraction (HFpEF)? (select all that apply) a. Uncontrolled hypertension is the primary cause. b. Left ventricular ejection fraction may be within normal limits. c. The pathophysiology involves ventricular relaxation and filling. d. Multiple evidence-based therapies have been shown to decrease mortality. e. Therapies focus on symptom control and treatment of underlying conditions.

a, b, c, e Rationale: Uncontrolled HTN is the main cause. HFpEF results from impaired ventricular relaxation and filling and LVEF may be normal. Therapies concentrate on symptom management and treatment of underlying conditions. To date, there are no therapies shown to decrease mortality or morbidity in patients with HFpEF.

Patients are at risk for which complications in the first year after heart transplantation? (select all that apply) a. Cancer b. Infection c. Rejection d. Vasculopathy e. Sudden cardiac death

b, c, e Rationale: A variety of complications can occur after heart transplantation. In the first year after transplantation, the major causes of death are acute rejection and infection. Heart transplant recipients are at risk for sudden cardiac death. Later, cancers, especially lymphoma, and cardiac vasculopathy (accelerated CAD) are major causes of death

The nurse is caring for a patient with acute decompensated heart failure who is receiving IV dobutamine. Why would this drug be prescribed? (select all that apply) a. It dilates renal blood vessels. b. It will increase the heart rate. c. Heart contractility will improve. d. Dobutamine is a selective β-agonist. e. It increases systemic vascular resistance.

c, d Rationale: Dobutamine has a positive inotropic effect (improves contractility). It is used for patients who, despite conventional therapies, have a very low CO. It is a selective β-adrenergic agonist and works primarily on the β1-adrenergic receptors in the heart. It does not increase heart rate or systemic vascular resistance. Dopamine, not dobutamine, dilates renal blood vessels.

A barrier to hospice referrals for patients with stage D heart failure is a. family member refusal. b. scarcity of hospice facilities. c. history of pacemaker placement. d. difficulty in estimating prognosis.

d Rationale: A hospice referral must include a physician's attestation of a life expectancy of 6 months or less. Barriers to HCP hospice referrals for patients with end-stage HF are partially due to the particularly challenging nature of accurately prognosticating life expectancy.

What compensatory mechanism involved in both chronic heart failure and acute decompensated heart failure leads to fluid retention and edema? a. Ventricular dilation b. Ventricular hypertrophy c. Increased systemic blood pressure d. Renin-angiotensin-aldosterone activation

d Rationale: Compensatory mechanisms in both chronic and acute HF include fluid and sodium retention and edema resulting from activation of the renin angiotensin aldosterone system (RAAS). Ventricular dilation, hypertrophy, and high BP do not cause fluid retention and edema.