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A nurse is checking laboratory values on a client who has crackles in the lower lobes, 2+ pitting edema, and dyspnea with minimal exertion. Which laboratory value does the nurse expect to be abnormal? a. Potassium b. B-type natriuretic peptide (BNP) c. C-reactive protein (CRP) d. Platelet count

B. bnp

Which sign is an early indicator of heart failure in an infant with a congenital heart defect? a. tachypnea b. tachycardia c. poor weight gain d. pulmonary edema

B. tachycardia The earliest sign of heart failure in infants is tachycardia (sleeping heart rate greater than 160 beats/minute) as a direct result of sympathetic stimulation. Tachypnea (respiratory rate greater than 60 breaths/minute in infants) occurs later in response to decreased lung compliance. Poor weight gain is a result of the increased energy demands to the heart and breathing efforts, not an early sign of heart failure itself. Pulmonary edema occurs as the left ventricle fails and blood volume and pressure increase in the left atrium, pulmonary veins, and lungs; it isn't an early sign of heart failure.

A client with heart failure has been receiving an I.V. infusion at 125 ml/hour. Now the client is short of breath and the nurse notes bilateral crackles, jugular vein distention, and tachycardia. What should the nurse do first? a. Notify the physician. b. Discontinue the I.V. catheter. c. Administer a ordered diuretic. d. Slow the I.V. infusion.

D. slow infusion Because this client has fluid overload, the nurse should first slow the infusion to prevent additional fluid overload, then notify the physician and obtain further orders. Notifying the physician without slowing the infusion would put the client at risk for pulmonary complications or respiratory failure. Discontinuing the catheter is inappropriate because the nurse may still need vascular access to administer I.V. fluids (at a decreased rate) or additional I.V. medications. Administering a diuretic without changing the I.V. infusion rate wouldn't prevent fluid overload from recurring.

A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement? a. "I sleep on three pillows each night." b. "My feet are bigger than normal." c. "My pants don't fit around my waist." d. "I don't have the same appetite I used to."

a. "I sleep on three pillows each night"

A client with restrictive cardiomyopathy (RCM) is taking digoxin. Because of the risk of increased sensitivity, the nurse should carefully assess the client for which manifestations? a. Anorexia and confusion b. Edema and orthopnea c. Abdominal pain and diarrhea d. Tachypnea and dyspnea

a. Anorexia and confusion

Which client with cardiomyopathy does the nurse identify as having the greatest risk for a complication? a. Client with orthopnea and activity intolerance b. Client with an ejection fraction of 25% and atrial fibrillation c. Client with peripheral edema and 2-kg weight gain d. Client with hepatomegaly and ascites

b. Client with an ejection fraction of 25% and atrial fibrillation

A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect? a. Pulmonary embolism b. Heart failure c. Cardiac tamponade d. Tension pneumothorax

b. Heart failure

A nurse in the emergency department is caring for a client with acute heart failure. Which laboratory value is most important for the nurse to check before administering medications to treat heart failure? a. Platelet count b. Potassium c. Calcium d. White blood cell (WBC) count

b. Potassium

A nurse is assessing a client with heart failure. When assessing hepatojugular reflux, what is the appropriate action for the nurse to take? a. elevate the client's head to 90 degrees. b. press the right upper abdomen. c. press the left upper abdomen. d. lay the client flat in bed.

b. press on right upper abdomen

Tetralogy of Fallot is a congenital condition of the heart that manifests in four distinct anomalies of the infant heart. It is considered a cyanotic heart defect because of the right-to-left shunting of the blood through the ventricular septal defect. A hallmark of this condition is the "tet spells" that occur in these children. What is a tet spell? a. A stressful period right after birth that occurs without evidence of cyanosis b. A hyperoxygenated period when the infant is at rest c. A hypercyanotic attack brought on by periods of stress d. A hyperpneic attack in which the infant loses consciousness

c. A hypercyanotic attack brought on by periods of stress The degree of obstruction may be dynamic and can increase during periods of stress causing hypercyanotic attacks ("tet spells"). None of the other answers occur in association with tetralogy of Fallot or tet spells.

The client is admitted to the hospital with cardiomyopathy, pulmonary edema, and dyspnea. The client is started on dobutamine. What should the nurse include in the client's teaching about dobutamine? Select all that apply. a. "Dobutamine increases activity tolerance." b. "Dobutamine produces arrhythmias." c. "Dobutamine increases blood pressure." d. "Dobutamine increases cardiac output." e. "Dobutamine increases urinary output."

d. "Dobutamine increases cardiac output." e. "Dobutamine increases urinary output." The nurse should explain that Dobutamine helps increase the strength of the heart muscle and urinary output. Dobutamine does not increase blood pressure or activity tolerance, and it does not produce arrhythmias.

A toddler with a ventricular septal defect is receiving digoxin to treat heart failure. Which assessment finding should be the nurse's priority concern? a. bradycardia b. tachycardia c. hypertension d. hyperactivity

a. bradycardia

Which action should a nurse include in the care plan for a 2-month-old infant with heart failure? a. Allow the infant to rest before feeding. b. Bathe the infant and administer medications before feeding. c. Weigh and bathe the infant before feeding. d. Feed the infant when the infant cries.

A. allow the infant to rest before feeding

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

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

A client is diagnosed with dilated cardiomyopathy. What is the most likely cause of the client's condition? a. chronic alcohol abuse b. heredity c. scleroderma d. previous myocardial infarction

a. alcohol abuse

A physician orders digoxin elixir for a client with heart failure. Immediately before administering this drug, the nurse must check the client's a. serum sodium level. b. urine output. c. weight. d. apical pulse.

d. apical pulse

Which type of cardiomyopathy is associated with syncope? a. Restrictive b. Dilated c. Arrhythmic d. Hypertrophic

d. hypertrophic

The nurse prepared a concept map in preparation for providing care to an assigned client. The nurse identified the client as being at risk for potential problems such as heart failure and thromboembolic event. According to the map pictured above, which nursing diagnoses are linked to decreased cardiac output? Select all that apply. a. Anxiety b. Deficient Knowledge c. Risk for Bleeding d. Risk for Falls e. Heart Failure f. Thromboembolic Events

a. Anxiety b. Deficient Knowledge d. Risk for Falls

Regarding the various forms of heart failure, the nurse knows that which statements are correct? Select all that apply. a. Aortic stenosis can cause left-sided failure. b. Cardiomyopathy is a common cause of heart failure. c. Compensated heart failure may be clinically asymptomatic. d. The most common cause of left-sided failure is blood volume loss. e. Right-sided heart failure produces pulmonary congestion and edema.

a. Aortic stenosis can cause left-sided failure. b. Cardiomyopathy is a common cause of heart failure. c. Compensated heart failure may be clinically asymptomatic. In heart failure, many compensatory mechanisms are activated to support cardiac output, and the client may remain symptom-free for a time. However, these same mechanisms gradually exacerbate the failure, and the client will show signs of deteriorating function. Aortic stenosis impedes outflow of blood from the left ventricle and can lead to left-sided failure. Cardiomyopathy can decrease contractility and contribute to systolic dysfunction, and can decrease the size of the ventricular chamber and lead to diastolic dysfunction. Left-sided failure produces pulmonary congestion and edema. Blood volume loss leads to hypovolemic shock.

Which of the following describes surgical correction of tetralogy of Fallot? a. Closure of the ventricular-septal defect and relief of the right ventricular outflow obstruction b. An arterial switch procedure c. Redirection of systemic venous return to the pulmonary arteries d. Resection of the narrowed segment of the aorta and end-to-end anastomoses of healthy tissue

a. Closure of the ventricular-septal defect and relief of the right ventricular outflow obstruction

A client is admitted with dilated cardiomyopathy with left ventricular dysfunction. The nurse should assess for which clinical manifestations? Select all that apply. a. Dyspnea b. Orthopnea c. Extreme fatigue with activity d. Excess abdominal fluid e. Fainting

a. Dyspnea b. Orthopnea c. Extreme fatigue with activity The most common clinical manifestations of DCM are those related to heart failure, such as dyspnea, orthopnea, and reduced exercise capacity. Hypertrophic cardiomyopathy (HCM) is characterized by myocardial thickening and abnormal diastolic filling. The person experiences fainting/syncope. Restrictive cardiomyopathy, in which there is excessive rigidity of the ventricular wall, increases the work of ventricular emptying and causes cardiac hypertrophy. These clients experience excess abdominal fluid (ascites).

The nurse is aware that heart failure may result from what problems? (Select all that apply.) a. Impaired myocardial contraction during systole b. Impaired relaxation and filling of ventricles during diastole c. A combination of systolic and diastolic dysfunction d. Impaired conduction from the SA node e. Cardiomyopathy

a. Impaired myocardial contraction during systole b. Impaired relaxation and filling of ventricles during diastole c. A combination of systolic and diastolic dysfunction e. Cardiomyopathy Heart failure may result from impaired myocardial contraction during systole (systolic dysfunction), impaired relaxation and filling of ventricles during diastole (diastolic dysfunction), or a combination of systolic and diastolic dysfunction. Cardiomyopathy (weakened and enlarged heart muscle) also increases the risk for the development of heart failure.

Which assessment finding is an early sign of heart failure in a client? a. increased respiratory rate b. increased urine output c. decreased weight d. decreased heart rate

a. Increased respiratory rate increase respiratory and heart rates are the earliest signs of heart failure. Decreased urine output and increased weight are later signs.

The nurse is caring for a client with manifestations of dilated cardiomyopathy. When planning care, which consideration would the nurse make? a. Place bed in a high or semi-high Fowler's position as needed. b. Assist client to bathroom every 2 hours. c. Instruct client to avoid strenuous activity. d. Assess abdominal girth daily.

a. Place bed in a high or semi-high Fowler's position as needed. Dilated cardiomyopathy has clinical manifestations of dyspnea on exertion and when lying down. Depending on level of dyspnea, placing the client in an upright Fowler's position is helpful. Clients with hypertrophic cardiomyopathy have syncopal episodes and can collapse following strenuous activity. Assistance with ambulation to avoid falls is helpful. Restrictive cardiomyopathy includes manifestations of ascites and assessment of abdominal girth.

What disease processes contribute to chronic heart failure? Select all that apply. a. Tachydysrhythmias b. Valvular disease c. Pancreatic disease d. Renal failure e. Pulmonary insufficiency

a. Tachydysrhythmias b. Valvular disease d. Renal failure Hypertension, tachydysrhythmias, valvular disease, cardiomyopathy, and renal failure can contribute to chronic heart failure. Pancreatic disease and pulmonary insufficiency do not contribute to chronic heart failure.

The nurse caring for a client with cardiomyopathy plans to have an education session with the client and the client's spouse about ways to improve cardiac output and reduce the workload of the heart. Which of the following instructions would help reduce preload? a. When resting, sit up with the legs down to pool blood in the legs. b. Lay flat in bed when resting so the heart does not have to pump against gravity. c. Adhere to a regular diet without restrictions. d. Avoid all physical and emotional stress.

a. When resting, sit up with the legs down to pool blood in the legs. Many clients find that sitting up with their legs down is more comfortable than lying in bed. This position is helpful in pooling venous blood in the periphery and reducing preload. Laying flat in bed impairs respiratory efforts due to abdominal contents pushing against the lungs. This client must be on a low sodium cardiac diet to avoid fluid retention. It is impossible to avoid all physical and emotional stress.

A client seeks medical attention for dyspnea, chest pain, syncope, fatigue, and palpitations. A thorough physical examination reveals an apical systolic thrill and heave, along with a fourth heart sound (S4) and a systolic murmur. Diagnostic tests reveal that the client has a new onset of hypertrophic cardiomyopathy (HCM). What will be included on the plan of care? a. an insertion of an implantable cardiac defibrillator b. teaching about heart transplantation surgery c. establishing a daily exercise program d. beginning a weight reduction diet

a. an insertion of an implantable cardiac defibrillator

A client with systemic lupus erythematosus reports palpitations, dyspnea on exertion, and leg swelling. The client's symptoms may indicate: a. cardiomyopathy b. pericarditis. c. thrombophlebitis. d. Buerger's disease.

a. cardiomyopathy Dilated cardiomyopathy is accompanied by dyspnea on exertion and when lying down. The client experiences fatigue and leg swelling and may also have palpitations and chest pain. When a client's medical history includes disorders that are bacterial or viral in origin, a family history of early cardiac deaths, or any of several other conditions that correlate with heart involvement, the possibility of cardiomyopathy is considered. Pericarditis usually is secondary to endocarditis, myocarditis, chest trauma, or MI (heart attack), or develops after cardiac surgery. Clients with thrombophlebitis often complain of discomfort in the affected extremity. With Buerger's disease, the client notes that one or both feet are always cold and may report numbness, burning, and tingling in some areas of the feet.

The nurse is caring for an infant with a large ventricular septal defect, also called a hole in the heart, which is a congenital heart defect causing a right to left shunt. The nurse illustrates for the parents how this compromises their child's ability to deliver oxygenated blood to the tissues, causing: a. cyanosis secondary to an anatomic shunt. b. jaundice related to an anatomic shunt. c. a physiologic shunt and chest pain. d. a physiologic shunt and pallor.

a. cyanosis secondary to an anatomic shunt. An anatomic shunt is also called a right to left shunt because a hole in the septum allows blood to go from the right side of the heart to the left without traveling through the lungs. If the septal defect is large, cyanosis is often present due to the lack of oxygen-rich blood. Physiologic shunt involves a mismatching of ventilation and perfusion in the lungs.

A client with hypertrophic cardiomyopathy (HCM) is experiencing dyspnea, chest pain, syncope, fatigue, and palpitations and has an apical systolic thrill and heave, fourth heart sound (S4), and systolic murmur. Which nursing diagnosis should the nurse use to guide this client's care? a. decreased cardiac output b. risk for deficient fluid volume c. ineffective peripheral tissue perfusion d. risk for activity intolerance

a. decreased cardiac output

A client with a history of cardiomyopathy experiences dyspnea on exertion, fatigue, leg swelling, and chest pain. This client has which type of cardiomyopathy? a. dilated cardiomyopathy b. peripartum cardiomyopathy c. hypertrophic cardiomyopathy d. restrictive cardiomyopathy

a. dilated cardiomyopathy

The nurse in a pediatric cardiovascular clinic is talking with the father of a 5-year-old child who underwent cardiac surgery for a heart defect at the age of 3. The father reports that the child has been having increased shortness of breath, tires easily after playing, and has been gaining weight. The nurse is aware that the child is most likely demonstrating symptoms of which acquired cardiovascular disorder? a. heart failure b. infective endocarditis c. cardiomyopathy d. Kawasaki Disease

a. heart failure

A client has been living with dilated cardiomyopathy for several years but has experienced worsening symptoms despite aggressive medical management. The nurse should anticipate what potential treatment? a. Heart transplantation b. Balloon valvuloplasty c. Cardiac catheterization d. Stent placement

a. heart transplantation

A client is admitted to the critical care unit (CCU) with a diagnosis of cardiomyopathy. When reviewing the client's most recent laboratory results, the nurse should prioritize assessment of which of the following? a. Sodium b. AST, ALT, and bilirubin c. White blood cell differential d. BUN

a. sodium Sodium is the major electrolyte involved with cardiomyopathy. Cardiomyopathy often leads to heart failure which develops, in part, from fluid overload. Fluid overload is often associated with elevated sodium levels. Consequently, sodium levels are followed more closely than other important laboratory values, including BUN, leukocytes, and liver function tests.

A client with chronic heart failure is receiving digoxin 0.25 mg by mouth daily and furosemide 20 mg by mouth twice daily. The nurse should assess the client for what sign of digoxin toxicity? a. visual disturbances. b. taste and smell alterations. c. dry mouth and urine retention. d. nocturia and sleep disturbances.

a. visual distrubances

Which type of cardiomyopathy are characterized by diastolic dysfunction caused by rigid ventricular walls that impair diastolic filling and ventricular stretch. a. Hypertrophic cardiomyopathy (HCM) b. Restrictive cardiomyopathy (RCM) c. Dilated cardiomyopathy (DCM) d. Arrhythmogenic right ventricular cardiomyopathy (ARVC)

b. Restrictive cardiomyopathy (RCM) RCM may be associated with amyloidosis (amyloid, a protein substance, is deposited within cells) and other such infiltrative diseases. However, the cause is idiopathic in most cases. Hypertrophic cardiomyopathy occurs when the heart muscle asymmetrically increases in size and mass, especially along the septum. Dilated cardiomyopathy is distinguished by significant dilation of the ventricles without simultaneous hypertrophy. Arrhythmogenic right ventricular cardiomyopathy occurs when the myocardium of the right ventricle is progressively infiltrated and replaced by fibrous scar and adipose tissue.

An 8-month-old infant has a ventricular septal defect. Which nursing diagnosis would best apply? a. Ineffective airway clearance related to altered pulmonary status b. Ineffective tissue perfusion related to inefficiency of the heart as a pump c. Impaired gas exchange related to a right-to-left shunt d. Impaired skin integrity related to poor peripheral circulation

b. Ineffective tissue perfusion related to inefficiency of the heart as a pump A ventricular septal defect permits blood to flow across an opening between the right and left ventricles. It results in increased pulmonary blood flow, but it does not cause cyanosis. The blood in the left ventricle, which flows back into the right ventricle, is already oxygenated. Anytime there is an opening between the heart's ventricles, the heart is not as effective as a pump because the pressure gradients are changed. A ventricular septal defect will not cause respiratory problems or problems with peripheral circulation.

A brain (B-type) natriuretic peptide (BNP) sample has been drawn from an older adult client who has been experiencing vital fatigue and shortness of breath. This test will allow the care team to investigate the possibility of what diagnosis? a. Pleurisy b. Heart failure c. Valve dysfunction d. Cardiomyopathy

b. heart failure The level of BNP in the blood increases as the ventricular walls expand from increased pressure, making it a helpful diagnostic, monitoring, and prognostic tool in the setting of HF. It is not specific to cardiomyopathy, pleurisy, or valve dysfunction.

Dilated cardiomyopathy with left ventricular dysfunction is characterized by which change in the ventricular wall? a. Rigidity b. Thinning c. Thickness d. Contractility

b. thinning

A 17-year-old boy is being treated in the ICU after going into cardiac arrest during a football practice. Diagnostic testing reveals cardiomyopathy as the cause of the arrest. What type of cardiomyopathy is particularly common among young people who appear otherwise healthy? a. Dilated cardiomyopathy (DCM). b. Arrhythmogenic right ventricular cardiomyopathy (ARVC) c. Hypertrophic cardiomyopathy (HCM) d. Restrictive or constrictive cardiomyopathy (RCM)

c. Hypertrophic cardiomyopathy (HCM)

A client with hypertrophic cardiomyopathy (HCM) has been admitted to the medical unit. During the nurse's admission interview, the client states that she takes over-the-counter (OTC) "water pills" on a regular basis. How should the nurse best respond to the fact that the client has been taking diuretics? a. Encourage the client to drink at least 2 liters of fluid daily. b. Increase the client's oral sodium intake. c. Inform the care provider because diuretics are contraindicated. d. Ensure that the client's fluid balance is monitored vigilantly.

c. Inform the care provider because diuretics are contraindicated. Diuretics are contraindicated in clients with HCM, so the health care provider should be made aware. Adjusting the client's sodium or fluid intake or fluid monitoring does not address this important contraindication.

For a client in the oliguric phase of acute renal failure (ARF), which nursing intervention is the most important? a. Encouraging coughing and deep breathing b. Promoting carbohydrate intake c. Limiting fluid intake d. Providing pain-relief measures

c. Limiting fluid intake

A nurse administers furosemide to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully? a. Increase in blood pressure b. Increase in blood volume c. Low serum potassium level d. High serum sodium level

c. Low serum potassium level

The initial medical management for a symptomatic client with obstructive hypertrophic cardiomyopathy (HCM) would be administering a medication to block the effects of catecholamines. The nurse will anticipate administering which medication? a. Lisinopril, an ACE-inhibitor b. Furosemide, a diuretic c. Propranolol, a beta-adrenergic blocker d. Digoxin, an inotropic.

c. Propranolol, a beta-adrenergic blocker

The nurse is obtaining a history from a client diagnosed with hypertrophic cardiomyopathy. What information obtained from the client is indicative of hypertrophic cardiomyopathy? a. a history of alcoholism b. a history of amyloidosis c. a parent has the same disorder d. a long-standing history of hypertension

c. a parent has the same disorder

A client is diagnosed with peripartum cardiomyopathy (PPCM). Which therapy would the nurse expect to administer to the client? a. monoamine oxidase inhibitors (MAOIs) b. methadone therapy c. restricted sodium intake d. ginger therapy

c. restricted sodium intake The client with peripartum cardiomyopathy should be prescribed a restricted sodium intake to control the blood pressure. Monoamine oxidase inhibitors are given to treat depression in pregnancy, not peripartum cardiomyopathy. Methadone is a drug given for the treatment of a substance use disorder during pregnancy. Complementary therapies like ginger therapy help in the alleviation of hyperemesis gravidarum, not peripartum cardiomyopathy.

A nurse is caring for a client with end-stage heart failure who is awaiting a heart transplant. The client tells the nurse that they think they are going to die before a donor heart is found. The client also tells the nurse that they have not been attending a church but wants to talk with a priest. What action should the nurse take? A. Contact the nurse's priest to see if they will see the client. b. Reassure the client that they have nothing to worry about because donors are usually found in time. c. Tell the client that it doesn't matter if they attend a church or not. d. Contact the clergy member who is assigned to the transplant team.

d. Contact the clergy member who is assigned to the transplant team.

A nurse is admitting a client with hypertrophic cardiomyopathy (HCM). What medication order will the nurse question? a. enalapril b. spironolactone c. metoprolol d. isosorbide dinitrate

d. isosorbide dinitrate

The nurse is administering digoxin to a client with heart failure. What laboratory value may predispose the client to digoxin toxicity? a. magnesium level of 2.5 mg/dL b. calcium level of 7.5 mg/dL c. sodium level of 152 mEq/L d. potassium level of 2.8 mEq/L

d. potassium level of 2.8 mEq/L

A client with heart failure must be monitored closely after starting diuretic therapy. What is the best indicator for the nurse to monitor? a. fluid intake and output. b. urine specific gravity. c. vital signs. d. weight.

d. weight