NUR 212 EAQ - Chapter 34 Heart Failure

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?

Intraaortic balloon pump (IABP.)

Which intervention would most improve the hemodynamic stability of a patient with worsening acute decompensated heart failure (ADHF)?

Intraaortic balloon pump (IABP.)

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?

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

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?

"I should not add salt at the table."

Which patient conditions increase the risk of developing heart failure? Select all that apply.

-Anemia -Thyrotoxicosis -Paget's disease -Bacterial endocarditis

Which is the order of events that occur when the sympathetic nervous system is activated to compensate for a low cardiac output (CO)?

1. Inadequate CO. 2. Release of catecholamines. 3. Increase in peripheral vasoconstriction. 4. Increase in CO.

Which respiratory rate would the nurse anticipate when assessing a patient who is developing pulmonary edema?

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. p. 739

Which condition is an absolute contraindication for cardiac transplantation?

Advanced cerebral vascular disease not amenable to correction.

Which cause of fatigue is associated with heart failure?

Anemia.

A patient being treated for acute decompensated heart failure (ADHF) presents with intractable cough. The nurse reviews the patient's medication profile and suspects that which drug is related to the assessment finding?

Angiotensin-converting enzyme (ACE) inhibitor.

An echocardiogram for a patient indicates enlarged ventricles of the heart. Which condition could be the cause of the cardiac dilation?

Elevated pressure in the ventricles.

Which complication is the major risk of death for a patient six months after receiving a heart transplant?

Infection.

Which is the action that must occur before requesting the family to make health care decisions for the patient?

Assessing the patient's decisional capacity.

A patient is diagnosed with paroxysmal nocturnal dyspnea. Which clinical manifestation would the nurse expect the patient to report?

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. p. 740

Which assessment is the priority of the nurse caring for a patient receiving IV nesiritide?

BP.

Which intervention may be included in the collaborative plan of care for a patient with chronic heart failure?

Cardiac resynchronization therapy (CRT.)

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?

Comfortable at rest but fatigue with ordinary physical activity.

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.

A patient is diagnosed with pulmonary edema. Which type of medication would the nurse anticipate being prescribed?

Diuretic.

A patient who takes digitalis receives a prescription for another new medication. Which medication would cause the nurse to monitor electrolytes more frequently?

Diuretic.

Which type of drug therapy is used to treat volume overload in patients with acute decompensated heart failure (ADHF)?

Diuretics.

Which information would the nurse include in the dietary education for a patient with heart failure (HF)?

Guidelines for a low-sodium diet.

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?

Home health nurse.

Which condition increases a patient's risk for digoxin toxicity?

Hypokalemia.

A patient diagnosed with heart failure experiences fatigue. Which factor causes the fatigue?

Impaired perfusion to vital organs.

Which effect would be expected from a medication that acts to increase chronotropy?

Increased heart rate. Increased heart rate is a positive chronotropic effect. Increases in myocardial contractility, stroke volume, and cardiac output are positive inotropic effects. p. 737

Which assessment finding is consistent with right-sided heart failure (HF)? Jugular venous distention (JVD) 2 Presence of S3 and S4 heart sounds 3 Paroxysmal nocturnal dyspnea (PND) 4 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. p. 740

The nurse is caring for a patient with manifestations of acute decompensated heart failure (ADHF). Which assessment is the nursing priority?

Lung sounds.

A patient with a recent diagnosis of heart failure (HF) has been prescribed furosemide. Which physiologic effect would the nurse expect this medication to have?

Reduce preload.

The assessment findings of a patient with myocardial infarction (MI) include jugular venous distention, weight gain, peripheral edema, and a heart rate of 108 beats/min. Which complication would the nurse suspect?

Right-sided HF.

Which term is used to describe difficulty breathing when lying down?

Orthopnea.

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. p. 740

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 C.

Which symptom is present in right-sided heart failure but not in left-sided heart failure?

Pedal edema.

Which clinical manifestation occurs with left-sided heart failure (HF) but not with right-sided HF?

Pink sputum.

A patient with acute decompensated heart failure (ADHF) experiences severe pulmonary edema. Which intervention will increase oxygenation and decrease preload for this patient?

Providing bilevel positive airway pressure (BiPAP.)

What is the most likely reason for the development of orthopnea in a patient with pulmonary edema?

Pulmonary congestion.

Which assessment finding would the nurse expect from patient with left-sided heart failure?

Pulmonary congestion.

Which finding would the nurse monitor in the patient who has left-sided heart failure?

Pulmonary congestion.

Which condition causes cor pulmonale?

Pulmonary disease.

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. p. 740

A male patient with chronic heart failure develops enlarged breasts. Which medication from the patient's medication profile is the likely cause of the patient's condition?

Spironolactone.

A patient who underwent cardiac transplantation exhibits signs of acute rejection. Which medication is often used to prevent this type of response?

Tacrolimus.

The nurse is providing discharge education for a patient with moderate heart failure. Which activity instruction would the nurse recommend to be included in the plan of care?

Taking frequent rest breaks during activities.

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)? 1

Dobutamine.

A patient receives immunosuppressive therapy after cardiac transplantation. For which conditions is the patient at risk? Select all that apply.

-Cancer -Cytomegalovirus (CMV) infection -Epstein-Barr virus (EBV) infection

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 -Anasarca

Which items in a patient's medical history are risk factors for heart failure (HF)? Select all that apply.

-Hypertension -Metabolic syndrome

Which events occur as a result of ventricular remodeling? Select all that apply.

-Increased wall tension. -Increased ventricular mass. -Increased O2 consumption.

The nurse is caring for a patient admitted to the intensive care unit with heart failure. The patient is prescribed IV sodium nitroprusside. Which actions would the nurse take when administering the medication? Select all that apply.

-Monitor arterial BP. -Ensure a slow rate of administration. -Record baseline BP and continuously throughout the administration.

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. -Mixed systolic and diastolic failure.

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

Which compensatory mechanisms are initially effective in maintaining adequate cardiac output (CO) in heart failure? Select all that apply.

-Ventricular dilation. -Ventricular hypertrophy. -Activation of the sympathetic nervous system (SNS.)

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. Fluid leaking into interstitial spaces. 4. Inadequate alveolar gas exchange.

The nurse is caring for a patient with acute decompensated heart failure (ADHF) who is experiencing volume overload. The nurse would anticipate a prescription for which type of drug?

Diuretic.

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?

Ejection fraction (EF) of 55%.

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?

Endomyocardial biopsy (EMB.)

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 decrease the need for additional oxygen.

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?

Ultrafiltration (UF.)

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

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. p. 739