Heart Failure: Chapter 34

A patient with a recent diagnosis of heart failure (HF) has been prescribed furosemide. Which physiological effect would the nurse expect this medication to have? 1. Reduces preload 2. Decreases afterload 3. Increases contractility 4. Promotes vasodilation

1. Reduces preload Pg 743

The nurse is assessing the client diagnosed with congestive heart failure. Which laboratory data would indicate that the client is in severe congestive heart failure? 1. An elevated B-type natriuretic peptide (BNP). 2. An elevated creatine kinase (CK-MB). 3. A positive D-dimer. 4. A positive ventilation/perfusion (V/Q) scan.

1. An elevated B-type natriuretic peptide (BNP). BNP is a specific diagnostic test. Levels higher than normal indicate congestive heart failure, with the higher the num- ber, the more severe the CHF.

Which cause of fatigue is associated with heart failure? 1. Anemia 2. Increased cardiac output 3. Increased oxygen to tissues 4. Optimal perfusion to organs

1. Anemia Pg 740

The nurse is developing a nursing care plan for a client diagnosed with congestive heart failure. A nursing diagnosis of "decreased cardiac output related to inability of the heart to pump effectively" is written. Which short-term goal would be best for the client? The client will: 1. Be able to ambulate in the hall by date of discharge. 2. Have an audible S1 and S2 with no S3 heard by end of shift. 3. Turn, cough, and deep breathe every two (2) hours. 4. Have a pulse oximeter reading of 98% by day two (2) of care.

2. Have an audible S1 and S2 with no S3 heard by end of shift. Audible S1 and S2 sounds are normal for a heart with adequate output. An audible S3 sound might indicate left ventricular failure which could be life threatening.

A patient newly diagnosed with heart failure is being discharged from the hospital. Which health care team member frequently works with protocols set up with the patient's health care provider to identify problems and start interventions? 1. Physical therapist 2. Home health nurse 3. Occupational therapist 4. Social services provider

2. Home health nurse Pg 748

The nurse recalls that which type of drug therapy is used to treat volume overload in patients with acute decompensated heart failure (ADHF)? a. Diuretics b. Narcotics c. Vasodilators d. Positive inotropes

a. Diuretics Pg 744

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse? a. Oxygen saturation of 88% b. Weight gain of 1 kg (2.2 lb) c. Heart rate of 106 beats/minute d. Urine output of 50 mL over 2 hours

a. Oxygen saturation of 88% A decrease in oxygen saturation to less than 92% indicates hypoxemia. The nurse should administer supplemental oxygen immediately to the patient. An increase in apical pulse rate, 1-kg weight gain, and decreases in urine output also indicate worsening heart failure and require nursing actions, but the low oxygen saturation rate requires the most immediate nursing action.

The nurse reviews the laboratory results of a patient with heart failure (HF) who receives a prescription for digoxin. The nurse decides to withhold the medication based on abnormal findings of what blood study? a. Potassium b. Thyroid function tests c. White blood cells (WBCs) d. Blood urea nitrogen (BUN.)

a. Potassium Pg 745

During a visit to a 78-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain over the past 2 days, and complains of feeling too tired to get out of bed. Based on these data, the best nursing diagnosis for the patient is a. activity intolerance related to fatigue. b. disturbed body image related to weight gain. c. impaired skin integrity related to ankle edema. d. impaired gas exchange related to dyspnea on exertion.

a. activity intolerance related to fatigue. The patients statement supports the diagnosis of activity intolerance. There are no data to support the other diagnoses, although the nurse will need to assess for other patient problems.

During history-taking, the nurse notes that a patient consumes foods high in sodium, which contributes to the patient's hypertension. The nurse develops a dietary plan and should educate the patient to avoid which food item? a. Shrimp b. Spinach salad c. Canned soups d. Skinless chicken breasts

c. Canned soups Pg 747

A male patient with a diagnosis of heart failure receives a prescription for a nitrate. Which item would the nurse teach the patient to avoid? a. High-potassium foods b. Over-the-counter H2 receptor blockers c. Drugs used to treat erectile dysfunction d. Nonsteroidal antiinflammatory drugs (NSAIDs)

c. Drugs used to treat erectile dysfunction Pg 745

A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)? a. Assess the IV insertion site for signs of extravasation. b. Teach the patient the reasons for remaining on bed rest. c. Monitor the patients blood pressure and heart rate every hour. d. Titrate the rate to keep the systolic blood pressure >90 mm Hg.

c. Monitor the patients blood pressure and heart rate every hour. An experienced LPN/LVN would be able to monitor BP and heart rate and would know to report significant changes to the RN. Teaching patients, making adjustments to the drip rate for vasoactive medications, and monitoring for serious complications such as extravasation require RN level education and scope of practice.

IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to titrate the nitroprusside rate if the patient develops a. ventricular ectopy. b. a dry, hacking cough. c. a systolic BP <90 mm Hg. d. a heart rate <50 beats/minute.

c. a systolic BP <90 mm Hg. Sodium nitroprusside is a potent vasodilator, and the major adverse effect is severe hypotension. Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause increased ventricular ectopy.

A patient is admitted with acute decompensated heart failure. Which part of the treatment plan will increase fatigue in this patient? 1. A 2-g sodium diet 2. Cardiac monitoring 3. Oxygen at 2 L by nasal cannula 4. IV furosemide 40 mg every six hours

4. IV furosemide 40 mg every six hours Pg 748

While assessing a 68-year-old with ascites, the nurse also notes jugular venous distention (JVD) with the head of the patients bed elevated 45 degrees. The nurse knows this finding indicates a. decreased fluid volume. b. jugular vein atherosclerosis. c. increased right atrial pressure. d. incompetent jugular vein valves.

c. increased right atrial pressure. The jugular veins empty into the superior vena cava and then into the right atrium, so JVD with the patient sitting at a 45-degree angle reflects increased right atrial pressure. JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume. JVD is not caused by incompetent jugular vein valves or atherosclerosis.

A nurse provides discharge instructions to a patient with chronic heart failure related to dietary restrictions. Which statement made by the patient indicates an understanding of the teaching? a. "I should not add salt at the table." b. "I can increase my intake of whole milk." c. "I should avoid the use of lemon juice and spices." d. "I can eat bread, processed meat, and cheese."

a. "I should not add salt at the table." Pg 747

Which patient conditions increase the risk of developing heart failure? SATA a. Anemia b. Rib fractures c. Thyrotoxicosis d. Paget's disease e. Bacterial endocarditis

a. Anemia c. Thyrotoxicosis d. Paget's disease e. Bacterial endocarditis Pg 735

The nurse provides education about a 2-g sodium diet to a patient with heart failure. Which statement made by the patient indicates the need for further teaching? 1. "I can eat fresh fruits, such as bananas and peaches." 2. "I will limit my intake of milk products to 2 cups a day." 3. "Bread is a good food choice because it has very a low salt content." 4. "When I eat canned soups, I will need to choose soups low in sodium."

3. "Bread is a good food choice because it has very a low salt content." Pg 747

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

a. infection Pg 751

The client is admitted to the telemetry unit diagnosed with acute exacerbation of congestive heart failure (CHF). Which signs/symptoms would the nurse expect to find when assessing this client? 1. Apical pulse rate of 110 and 4+ pitting edema of feet. 2. Thick white sputum and crackles that clear with cough. 3. The client sleeping with no pillow and eupnea. 4. Radial pulse rate of 90 and capillary refill time <3 seconds.

1. Apical pulse rate of 110 and 4+ pitting edema of feet. The client with CHF would exhibit tachycardia (apical pulse rate of 110), dependent edema, fatigue, third heart sounds, lung congestion, and change in mental status.

The nurse on the telemetry unit has just received the a.m. shift report. Which client should the nurse assess first? 1. The client diagnosed with myocardial infarction who has an audible S3 heart sound. 2. The client diagnosed with congestive heart failure who has 4+ sacral pitting edema. 3. The client diagnosed with pneumonia who has a pulse oximeter reading of 94%. 4. The client with chronic renal failure who has an elevated creatinine level.

1. The client diagnosed with myocardial infarction who has an audible S3 heart sound. An S3 heart sound indicates left ventric- ular failure, and the nurse must assess this client first because it is an emergency situation.

A patient who underwent cardiac transplantation exhibits signs of acute rejection. The nurse recognizes that which medication is often used as posttransplantation therapy to prevent this type of response? 1. Ibuprofen 2. Metoprolol 3. Tacrolimus 4. Acetaminophen

3. Tacrolimus Pg 751

The client diagnosed with congestive heart failure is complaining of leg cramps at night. Which nursing interventions should be implemented? 1. Check the client for peripheral edema and make sure the client takes a diuretic early in the day. 2. Monitor the client's potassium level and assess the client's intake of bananas and orange juice. 3. Determine if the client has gained weight and instruct the client to keep the legs elevated. 4. Instruct the client to ambulate frequently and perform calf-muscle stretching exercises daily.

2. Monitor the client's potassium level and assess the client's intake of bananas and orange juice. The most probable cause of the leg cramping is potassium excretion as a result of diuretic medication. Bananas and orange juice are foods that are high in potassium.

The nurse is developing a discharge-teaching plan for the client diagnosed with congestive heart failure. Which interventions should be included in the plan? Select all that apply. 1. Notify health-care provider of a weight gain of more than one (1) pound in a week. 2. Teach client how to count the radial pulse when taking digoxin, a cardiac glycoside. 3. Instruct client to remove the saltshaker from the dinner table. 4. Encourage client to monitor urine output for change in color to become dark. 5. Discuss the importance of taking the loop diuretic furosemide at bedtime.

2. Teach client how to count the radial pulse when taking digoxin, a cardiac glycoside. The client should not take digoxin if the radial pulse is less than 60. 3. Instruct client to remove the saltshaker from the dinner table. The client should be on a low-sodium diet to prevent water retention.

The health-care provider has ordered an angiotensin-converting enzyme (ACE) inhibitor for the client diagnosed with congestive heart failure. Which discharge instructions should the nurse include? 1. Instruct the client to take a cough suppressant if a cough develops. 2. Teach the client how to prevent orthostatic hypotension. 3. Encourage the client to eat bananas to increase potassium level. 4. Explain the importance of taking the medication with food.

2. Teach the client how to prevent orthostatic hypotension. Orthostatic hypotension may occur with ACE inhibitors as a result of vasodila- tion. Therefore, the nurse should in- struct the client to rise slowly and sit on the side of the bed until equilibrium is restored.

Which is considered decisional capacity for informed consent related to treatment decisions? 1. The patient must be able to read the treatment consent 2. The patient must be able to communicate his or her decisions 3. The health care provider encourages the patient to choose a specific option for treatment 4. The patient has an advanced directive listing the patient's decisions for life-sustaining treatment

2. The patient must be able to communicate his or her decisions Pg 751

Which treatment would the nurse expect to be prescribed for a patient after heart transplantation? 1. Antibiotic therapy 2. Antifungal therapy 3. Immunosuppressive therapy 4. IV immunoglobulin (IVIG) therapy

3. Immunosuppressive therapy Pg 751

The nurse is assessing the client diagnosed with congestive heart failure. Which signs/symptoms would indicate that the medical treatment has been effective? 1. The client's peripheral pitting edema has gone from 3+ to 4+. 2. The client is able to take the radial pulse accurately. 3. The client is able to perform ADLs without dyspnea. 4. The client has minimal jugular vein distention.

3. The client is able to perform ADLs without dyspnea. Being able to perform activities of daily living (ADLs) without shortness of breath (dyspnea) would indicate the client's condition is improving. The client's heart is a more effective pump and can oxygenate the body better with- out increasing fluid in the lungs.

The charge nurse is making shift assignments for the medical floor. Which client should be assigned to the most experienced registered nurse? 1. The client diagnosed with congestive heart failure who is being discharged in the morning. 2. The client who is having frequent incontinent liquid bowel movements and vomiting. 3. The client with an apical pulse rate of 116, a respiratory rate of 26, and a blood pressure of 94/62. 4. The client who is complaining of chest pain with inspiration and a nonproductive cough.

3. The client with an apical pulse rate of 116, a respiratory rate of 26, and a blood This client is exhibiting signs/symptoms of shock, which makes this client the most unstable. An experienced nurse should care for this client.

The nurse enters the room of the client diagnosed with congestive heart failure. The client is lying in bed gasping for breath, is cool and clammy, and has buccal cyanosis. Which intervention would the nurse implement first? 1. Sponge the client's forehead. 2. Obtain a pulse oximetry reading. 3. Take the client's vital signs. 4. Assist the client to a sitting position.

4. Assist the client to a sitting position. The nurse must first put the client in a sitting position to decrease the workload of the heart by decreasing venous return and maximizing lung expansion. Then, the nurse could take vital signs and

The nurse and an unlicensed assistive personnel (UAP) are caring for four clients on a telemetry unit. Which nursing task would be best for the nurse to delegate to the UAP? 1. Assist the client to go down to the smoking area for a cigarette. 2. Transport the client to the intensive care unit via a stretcher. 3. Provide the client going home discharge-teaching instructions. 4. Help position the client who is having a portable x-ray done.

4. Help position the client who is having a portable x-ray done. The UAP can assist the x-ray techni- cian in positioning the client for the portable x-ray. This does not require judgment.

The nurse has written an outcome goal "demonstrates tolerance for increased activity" for a client diagnosed with congestive heart failure. Which intervention should the nurse implement to assist the client to achieve this outcome? 1. Measure intake and output. 2. Provide two (2)-g sodium diet. 3. Weigh client daily. 4. Plan for frequent rest periods.

4. Plan for frequent rest periods. Scheduling activities and rest periods allows the client to participate in his or her own care and addresses the desired outcome.

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? a. A patient who is cool and clammy, with new-onset confusion and restlessness b. A patient who has crackles bilaterally in the lung bases and is receiving oxygen. c. A patient who had dizziness after receiving the first dose of captopril (Capoten) d. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure of 100/62

a. A patient who is cool and clammy, with new-onset confusion and restlessness The patient who has wet-cold clinical manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management. The other patients also should be assessed as quickly as possible but do not have indications of severe decreases in tissue perfusion.

A patient with chronic heart failure receives a prescription for an angiotensin-converting enzyme (ACE) inhibitor. The nurse should monitor the patient for what major side effect? a. Angioedema b. Hypokalemia c. Inability to swallow d. Symptomatic hypertension

a. Angioedema Pg 745

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. What actions should the nurse take related to post-discharge care? SATA a. Arranging for home health care b. Providing printed medication instructions c. Arranging for transportation for follow-up appointments. d. Discussing the importance of eating three large meals per day. e. Coordinating equipment for at-home monitoring, including an electronic scale, a blood pressure cuff, and a pulse oximeter

a. Arranging for home health care b. Providing printed medication instructions c. Arranging for transportation for follow-up appointments. e. Coordinating equipment for at-home monitoring, including an electronic scale, a blood pressure cuff, and a pulse oximeter Pg 748

Based on the Joint Commission Core Measures for patients with heart failure, which topics should the nurse include in the discharge teaching plan for a patient who has been hospitalized with chronic heart failure (select all that apply)? a. How to take and record daily weight b. Importance of limiting aerobic exercise c. Date and time of follow-up appointment d. Symptoms indicating worsening heart failure e. Actions and side effects of prescribed medications

a. How to take and record daily weight c. Date and time of follow-up appointment d. Symptoms indicating worsening heart failure e. Actions and side effects of prescribed medications

Which condition increases a patient's risk for digoxin toxicity? a. Hypokalemia b. Hypocalcemia c. Hyperuricemia d. Hypermagnesemia

a. Hypokalemia Pg 744-755

Which action should the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)? a. Monitor blood pressure frequently. b. Encourage patient to ambulate in room. c. Titrate nesiritide slowly before stopping. d. Teach patient about home use of the drug.

a. Monitor blood pressure frequently. Nesiritide is a potent arterial and venous dilator, and the major adverse effect is hypotension. Because the patient is likely to have orthostatic hypotension, the patient should not be encouraged to ambulate. Nesiritide does not require titration and is used for ADHF but not in a home setting.

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? SATA 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. Monitor serum potassium levels. b. Teach the patient how to take a pulse rate.

The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies? a. Observe for distended neck veins. b. Auscultate for crackles in the lungs. c. Palpate for heaves or thrills over the heart. d. Review hemoglobin and hematocrit values.

a. Observe for distended neck veins. Cor pulmonale is right ventricular failure caused by pulmonary hypertension, so clinical manifestations of right ventricular failure such as peripheral edema, jugular venous distention, and right upper-quadrant abdominal tenderness would be expected.

3. Potassium chloride intravenously is prescribed for a client with heart failure experiencing hypokalemia. Which actions would the nurse take to plan for preparation and administration of the potassium? Select all that apply. a. Obtain an intravenous (IV) infusion pump. b. Monitor urinary output during administration. c. Prepare the medication for bolus administration. d. Monitor the IV site for signs of infiltration or phlebitis. e. Ensure that the medication is diluted in the appropriate volume of fluid.

a. Obtain an intravenous (IV) infusion pump. b. Monitor urinary output during administration. d. Monitor the IV site for signs of infiltration or phlebitis. e. Ensure that the medication is diluted in the appropriate volume of fluid.

Which statements accurately describe heart failure with preserved ejection fraction (HFpEF)? SATA 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. Uncontrolled hypertension is the primary cause. b. Left ventricular ejection fraction may be within normal limits. c. The pathophysiology involves ventricular relaxation and filling. e. Therapies focus on symptom control and treatment of underlying conditions.

A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All of the following medications have been ordered for the patient. The nurses priority action will be to a. give IV morphine sulfate 4 mg. b. give IV diazepam (Valium) 2.5 mg. c. increase nitroglycerin (Tridil) infusion by 5 mcg/min. d. increase dopamine (Intropin) infusion by 2 mcg/kg/min.

a. give IV morphine sulfate 4 mg. Morphine improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output, but it will also increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will not act as quickly as morphine to decrease dyspnea.

The nurse is performing an assessment on a client with a diagnosis of left-side-heart failure. Which assessment component would elicit specific information regarding client's left-sided heart failure? a. listening to lung sounds. b. palpating for organomegaly c. assessing for jugular vein distention d. assessing for peripheral and sacral edema

a. listening to lung sounds.

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

b. Age over 70 years e. Advanced cerebral or vascular disease not amenable to correction Pg 750

The nurse is monitoring for adverse effects in a client who is taking digoxin. Which findings are characteristic of digoxin toxicity? Select all that apply a. Tremors b. Diarrhea c. Irritability d. blurred vision. e. Nausea and vomiting

b. Diarrhea d. blurred vision. e. Nausea and vomiting

A patient who takes digitalis receives a prescription for another new medication. Which medication would cause the nurse to monitor electrolytes more frequently? a. Nitrate b. Diuretic c. B-Adrenergic receptor blocker (B-blocker) d. Angiotensin-converting enzyme (ACE) inhibitor

b. Diuretic Pg 745

The nurse develops dietary education for a patient with heart failure (HF) and should include what information? a. A list of foods high in thiamine b. Guidelines for a low-sodium diet c. Guidelines for a high-protein diet d. Instructions for fluid restriction of less than 500 mL per day

b. Guidelines for a low-sodium diet Pg 742

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

b. Infection c. Rejection e. Sudden cardiac death

After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first? a. Patient who is taking carvedilol (Coreg) and has a heart rate of 58 b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L c. Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache d. Patient who is taking captopril (Capoten) and has a frequent nonproductive cough

b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L The patients low potassium level increases the risk for digoxin toxicity and potentially fatal dysrhythmias. The nurse should assess the patient for other signs of digoxin toxicity and then notify the health care provider about the potassium level. The other patients also have side effects of their medications, but their symptoms do not indicate potentially life-threatening complications.

A 53-year-old patient with Stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy. Which response by the nurse is most appropriate? a. Because you have diabetes, you would not be a candidate for a heart transplant. b. The choice of a patient for a heart transplant depends on many different factors. c. Your heart failure has not reached the stage in which heart transplants are needed. d. People who have heart transplants are at risk for multiple complications after surgery.

b. The choice of a patient for a heart transplant depends on many different factors. Indications for a heart transplant include end-stage heart failure (Stage D), but other factors such as coping skills, family support, and patient motivation to follow the rigorous posttransplant regimen are also considered. Diabetic patients who have well-controlled blood glucose levels may be candidates for heart transplant. Although heart transplants can be associated with many complications, this response does not address the patients question.

2. The nurse is monitoring a client who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication? Select all that apply a. The development of complaints of insomnia b. The development of audible expiratory wheezes c. A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication. d. A baseline resting heart rate of 88 beats/minute followed by a resting heart rate of 72 beats/minute after two doses of the medication. e. Heart rate of 45 beats per/minute after two doses of medication

b. The development of audible expiratory wheezes e. Heart rate of 45 beats per/minute after two doses of medication

What instructions what the nurse provide to a patient who is scheduled for an exercise stress test? Select all that apply a. Stop smoking 1 hour before the test b. do not take B-blockers 24 hours before the test c. avoid strenuous exercise three hours before the test d. wear comfortable clothes and shoes that can be worn for walking or running e. drink a cup of coffee on the way to the stress test

b. do not take B-blockers 24 hours before the test c. avoid strenuous exercise three hours before the test d. wear comfortable clothes and shoes that can be worn for walking or running

A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry, hacking cough. Which action should the nurse do first? a. Auscultate the abdomen. b. Check the capillary refill. c. Auscultate the breath sounds. d. Assess the level of orientation.

c. Auscultate the breath sounds. This patients severe dyspnea and cough indicate that acute decompensated heart failure (ADHF) is occurring. ADHF usually manifests as pulmonary edema, which should be detected and treated immediately to prevent ongoing hypoxemia and cardiac/respiratory arrest. The other assessments will provide useful data about the patients volume status and also should be accomplished rapidly, but detection (and treatment) of pulmonary complications is the priority.

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? a. Serum troponin b. Arterial blood gases c. B-type natriuretic peptide d. 12-lead electrocardiogram

c. B-type natriuretic peptide B-type natriuretic peptide (BNP) is secreted when ventricular pressures increase, as they do with heart failure. Elevated BNP indicates a probable or very probable diagnosis of heart failure. A twelve-lead electrocardiogram, arterial blood gases, and troponin may also be used in determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as BNP.

Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 33%? a. Need to begin an aerobic exercise program several times weekly b. Use of salt substitutes to replace table salt when cooking and at the table c. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors d. Importance of making an annual appointment with the primary care provider

c. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors The core measures for the treatment of heart failure established by The Joint Commission indicate that patients with an ejection fraction (EF) <40% receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise may not be appropriate for a patient with this level of heart failure, salt substitutes are not usually recommended because of the risk of hyperkalemia, and the patient will need to see the primary care provider more frequently than annually.

An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider? a. 2+ pedal edema b. Heart rate of 56 beats/minute c. Blood pressure (BP) of 88/42 mm Hg d. Complaints of fatigue

c. Blood pressure (BP) of 88/42 mm Hg The patients BP indicates that the dose of metoprolol may need to be decreased because of hypotension. Bradycardia is a frequent adverse effect of b-adrenergic blockade, but the rate of 56 is not unusual with adrenergic blocker therapy. b-Adrenergic blockade initially will worsen symptoms of heart failure in many patients, and patients should be taught that some increase in symptoms, such as fatigue and edema, is expected during the initiation of therapy with this class of drugs.

An acutely ill patient develops unexplained, new-onset heart failure (HF) that is unresponsive to usual care. Which diagnostic procedure is likely to take place during heart catheterization? a. Chest x-ray b. Orthostatic BP c. Endomyocardial biopsy (EMB) d. Multigated acquisition (MUGA) scan

c. Endomyocardial biopsy (EMB) Pg 741

The nurse is caring for a patient with acute decompensated heart failure who is receiving IV dobutamine. Why would this drug be prescribed? SATA 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. Heart contractility will improve. d. Dobutamine is a selective β-agonist.

A patient with heart failure has a new order for captopril (Capoten) 12.5 mg PO. After administering the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective? a. I will be sure to take the medication with food. b. I will need to eat more potassium-rich foods in my diet. c. I will call for help when I need to get up to use the bathroom. d. I will expect to feel more short of breath for the next few days.

c. I will call for help when I need to get up to use the bathroom. Captopril can cause hypotension, especially after the initial dose, so it is important that the patient not get up out of bed without assistance until the nurse has had a chance to evaluate the effect of the first dose. The angiotensin-converting enzyme (ACE) inhibitors are potassium sparing, and the nurse should not teach the patient to purposely increase sources of dietary potassium. Increased shortness of breath is expected with the initiation of b-adrenergic blocker therapy for heart failure, not for ACE inhibitor therapy. ACE inhibitors are best absorbed when taken an hour before eating.

A patient has recently started on digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for the management of heart failure. Which assessment finding by the home health nurse is a priority to communicate to the health care provider? a. Presence of 1 to 2+ edema in the feet and ankles b. Palpable liver edge 2 cm below the ribs on the right side c. Serum potassium level 3.0 mEq/L after 1 week of therapy d. Weight increase from 120 pounds to 122 pounds over 3 days

c. Serum potassium level 3.0 mEq/L after 1 week of therapy Hypokalemia can predispose the patient to life-threatening dysrhythmias (e.g., premature ventricular contractions), and potentiate the actions of digoxin and increase the risk for digoxin toxicity, which can also cause life-threatening dysrhythmias. The other data indicate that the patients heart failure requires more effective therapies, but they do not require nursing action as rapidly as the low serum potassium level.

Following an acute myocardial infarction, a previously healthy 63-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about a. digitalis preparations. a. b-adrenergic blockers. b. calcium channel blockers. c. angiotensin-converting enzyme (ACE) inhibitors.

c. angiotensin-converting enzyme (ACE) inhibitors. ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure. Digoxin therapy for heart failure is no longer considered a first-line measure, and digoxin is added to the treatment protocol when therapy with other medications such as ACE-inhibitors, diuretics, and b-adrenergic blockers is insufficient. Calcium channel blockers are not generally used in the treatment of heart failure. The badrenergic blockers are not used as initial therapy for new onset heart failure.

A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days. The nurses priority action will be to a. have the patient recall the dietary intake for the last 3 days. b. ask the patient about the use of the prescribed medications. c. assess the patient for clinical manifestations of acute heart failure. d. teach the patient about the importance of restricting dietary sodium.

c. assess the patient for clinical manifestations of acute heart failure. The 5-pound weight gain over 3 days indicates that the patients chronic heart failure may be worsening. It is important that the patient be assessed immediately for other clinical manifestations of decompensation, such as lung crackles. A dietary recall to detect hidden sodium in the diet, reinforcement of sodium restrictions, and assessment of medication compliance may be appropriate interventions but are not the first nursing actions indicated.

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL). Appropriate instructions for the patient include a. limit dietary sources of potassium. b. take the hydrochlorothiazide before bedtime. c. notify the health care provider if nausea develops. d. skip the digoxin if the pulse is below 60 beats/minute.

c. notify the health care provider if nausea develops. Nausea is an indication of digoxin toxicity and should be reported so that the provider can assess the patient for toxicity and adjust the digoxin dose, if necessary. The patient will need to include potassium-containing foods in the diet to avoid hypokalemia. Patients should be taught to check their pulse daily before taking the digoxin and if the pulse is less than 60, to call their provider before taking the digoxin. Diuretics should be taken early in the day to avoid sleep disruption.

A patient who has chronic heart failure tells the nurse, I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating! The nurse will document this assessment finding as a. orthopnea. b. pulsus alternans. c. paroxysmal nocturnal dyspnea. d. acute bilateral pleural effusion.

c. paroxysmal nocturnal dyspnea. Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus alternans is the alternation of strong and weak peripheral pulses during palpation. Orthopnea indicates that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time period.

While admitting an 82-year-old with acute decompensated heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the water pill with the heart pill. When planning for the patients discharge the nurse will facilitate a a. consult with a psychologist. b. transfer to a long-term care facility. c. referral to a home health care agency. d. arrangements for around-the-clock care.

c. referral to a home health care agency. The data about the patient suggest that assistance in developing a system for taking medications correctly at home is needed. A home health nurse will assess the patients home situation and help the patient develop a method for taking the two medications as directed. There is no evidence that the patient requires services such as a psychologist consult, long-term care, or around-the-clock home care.

The nurse working on the heart failure unit knows that teaching an older female patient with newly diagnosed heart failure is effective when the patient states that a. she will take furosemide (Lasix) every day at bedtime. b. the nitroglycerin patch is applied when any chest pain develops. c. she will call the clinic if her weight goes from 124 to 128 pounds in a week. d. an additional pillow can help her sleep if she is feeling short of breath at night.

c. she will call the clinic if her weight goes from 124 to 128 pounds in a week. Teaching for a patient with heart failure includes information about the need to weigh daily and notify the health care provider about an increase of 3 pounds in 2 days or 3 to 5 pounds in a week. Nitroglycerin patches are used primarily to reduce preload (not to prevent chest pain) in patients with heart failure and should be used daily, not on an as needed basis. Diuretics should be taken earlier in the day to avoid nocturia and sleep disturbance. The patient should call the clinic if increased orthopnea develops, rather than just compensating by further elevating the head of the bed.

Atorvastatin has been prescribed for a client, and the nurse provides instructions to the client about the medication. Which statement by the client indicates the need for further teaching? a."This medication will lower my cholesterol level." b."I will need to have blood tests drawn while I am taking this medication." c."I won't need to adhere to a low-fat diet as long as I take this medication faithfully." d."I need to talk to the primary health care provider before taking any over-the-counter medications."

c."I won't need to adhere to a low-fat diet as long as I take this medication faithfully."

A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving? a. Furosemide (Lasix) 60 mg b. Captopril (Capoten) 25 mg c. Digoxin (Lanoxin) 0.125 mg d. Carvedilol (Coreg) 3.125 mg

d. Carvedilol (Coreg) 3.125 mg Although carvedilol is appropriate for the treatment of chronic heart failure, it is not used for patients with acute decompensated heart failure (ADHF) because of the risk of worsening the heart failure. The other medications are appropriate for the patient with ADHF.

Which symptom is present in right-sided heart failure but not in left-sided heart failure? a. Fatigue b. Anxiety c. Depression d. Pedal edema

d. Pedal edema Pg 740

The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective? a. Weight loss of 2 pounds in 24 hours b. Hourly urine output greater than 60 mL c. Reduction in patient complaints of chest pain d. Reduced dyspnea with the head of bed at 30 degrees

d. Reduced dyspnea with the head of bed at 30 degrees Because the patients major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees. The other assessment data also may indicate that diuresis or improvement in cardiac output has occurred, but are not as specific to evaluating this patients response.

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. Renin-angiotensin-aldosterone activation

The nurse reviews the teaching plan for a patient with chronic heart failure who is being discharged from the hospital. Which item listed on the plan would the nurse question? a. Eat small, frequent meals b. Obtain the annual flu vaccine c. Avoid extremes of heat and cold d. Report a weight gain of 5 pounds in two days

d. Report a weight gain of 5 pounds in two days Pg 746

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. difficulty in estimating prognosis.

When teaching the patient with newly diagnosed heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include a. canned and frozen fruits. b. fresh or frozen vegetables. c. eggs and other high-protein foods. d. milk, yogurt, and other milk products.

d. milk, yogurt, and other milk products. Milk and yogurt naturally contain a significant amount of sodium, and intake of these should be limited for patients on a diet that limits sodium to 2000 mg daily. Other milk products, such as processed cheeses, have very high levels of sodium and are not appropriate for a 2000-mg sodium diet. The other foods listed have minimal levels of sodium and can be eaten without restriction.