Cardiac chapter 37 review

An older adult taking digoxin and furosemide (Lasix) for chronic heart failure is admitted to the emergency department (ED) with an apical pulse of 52. A family member states that the client has fallen four times this week. What is the nurse's first action? A. Call the ED physician immediately. B. Draw a serum digoxin level. C. Assess for signs of hypokalemia. D. Establish the client's airway.

B - Draw a serum digoxin Level. - The client has signs and symptoms of digoxin toxicity and needs to be placed on a monitor immediately to determine the extent of effects on the heart and conduction system. Symptoms of digoxin toxicity include blurred vision or yellow or green halos around visual images, confusion, muscle weakness, and vertigo. Toxicity may be increased from furosemide-induced hypokalemia. This can lead to premature ventricular contractions (PVCs) that may lead to other life-threatening dysrhythmias and death. Clients need to be cautioned not to store both digoxin and furosemide in the same container. The most common dose of each medication is available in a small white pill (similar in appearance), increasing the chances of error. Serum digoxin levels and electrolytes need to be drawn. Symptoms of hypokalemia are mostly neuromuscular with generalized weakness. There is no indication that the client is having difficulty with breathing. Respiratory rate may be increased.

The client begins therapy with lisinopril (Prinivil, Zestril). What should the nurse consider at the start of therapy with this medication? A The client's ability to understand medication teaching B The risk for hypotension C The potential for bradycardia D Liver function tests (LFTs) Incorrect

B The risk for hypotension - Angiotensin-converting enzyme (ACE) inhibitors are associated with first-dose hypotension and orthostatic hypotension, which are more likely in those older than 75 years. Although medication teaching is desirable, understanding of teaching is not essential. ACE inhibitors are vasodilators; they do not affect heart rate. Renal function, not liver function, may be altered by ACE inhibitors.

When following up in the clinic with a client with heart failure, how does the nurse recognize that the client has been compliant with fluid restrictions? A Auscultation of crackles B Pedal edema C Weight loss of 6 pounds since the last visit D Reports sucking on ice chips all day for dry mouth

C Weight loss of 6 pounds since the last visit - Weight loss in this client indicates effective fluid restriction and diuretic drug therapy. Lung crackles indicate intra-alveolar edema and fluid excess. Pedal edema indicates fluid excess. sucking on ice chips all day indicates noncompliance with fluid restrictions; alternative methods of treating dry mouth should be explored.

Which of these nursing actions should the nurse delegate to a nursing assistant working on the medical unit? A Determine the usual alcohol intake for a client with cardiomyopathy. B Monitor the pain level for a client with acute pericarditis. C Obtain daily weights for several clients with class IV heart failure. D Check for peripheral edema in a client with endocarditis.

C Obtain daily weights for several clients with class IV heart failure. - Daily weight assessment is included in the role of the nursing assistant, who will report the weights to the RN. The role of the professional nurse is to perform assessments it is not be delegated.

Which of these clients is best to assign to an LPN/LVN working on the telemetry unit? A A client with heart failure who is receiving dobutamine (Dobutrex) B A client with restrictive cardiomyopathy who uses oxygen for exertional dyspnea C A client with pericarditis who has a paradoxical pulse and distended jugular veins D A client with rheumatic fever who has a new systolic murmur

B A client with restrictive cardiomyopathy who uses oxygen for exertional dyspnea - This client, who needs oxygen only with exertion, is the most stable; administration of oxygen to a stable client is within the scope of LPN/LVN practice. Heart Failure patient receiving an intravenous inotropic agent (Dubutrex), requires monitoring by the professional nurse. A client with pericarditis who has a paradoxical pulse and distended jugular veins are signs of cardiac tamponade and requires immediate life-saving intervention. A new-onset murmur requires assessment and notification of the provider, which is within the scope of practice of the professional nurse.

A client has been taking furosemide (Lasix) for the past 3 years. This morning, the hospital laboratory notifies the nurse that the client's serum potassium level is 2.9 mEq/L. What is the nurse's best action at this time? A. Notify the health care provider. B. Ask the lab to retest the potassium level. C. Give potassium as an IV infusion. D. Withhold this morning's Lasix dose.

B. Ask the lab to retest the potassium level - This potassium value is at a critical level. The nurse should request that the lab confirm that this value is accurate since the client has been taking furosemide for 3 years. The lab value should be confirmed prior to contacting the health care provider for orders.

A client with heart failure has furosemide (Lasix). Which finding would concern the nurse with this new prescription? A. Serum sodium level of 135 mEq/L B. Serum potassium level of 2.8 mEq/L C. Serum creatinine of 1.0 mg/dL D. Serum magnesium level of 1.9 mEq/L

B. Serum potassium level of 2.8 mEq/L - Clients taking loop diuretics should be monitored for potassium deficiency from diuretic therapy.

The nurse is assessing the client with a cardiac infection. Which symptoms support the diagnosis of infective endocarditis instead of pericarditis or rheumatic carditis? A Friction rub auscultated at the left lower sternal border B Pain aggravated by breathing, coughing, and swallowing C Splinter hemorrhages D Thickening of the endocardium

C Splinter hemorrhages - Splinter hemorrhages are indicative of infective endocarditis. Friction rub in the left lower sternal border is a sign of chronic constrictive pericarditis. Pain aggravated by breathing, coughing, and swallowing is indicative of signs and symptoms of chronic constrictive pericarditis. Thickening of the endocardium is indicative of rheumatic carditis.

A client who recently had a heart valve replacement is taking warfarin (Coumadin) as prescribed. What health teaching will the nurse include before the client is discharged? A. "Take your pulse every day and call your doctor if it is below 60." B. "Weigh yourself every day in the morning using the same scale." C. "Purchase a home kit to monitor your blood pressure every day." D. "Avoid foods that are high in vitamin K, such as kale and spinach."

D. "Avoid foods that are high in vitamin K, such as kale and spinach." - To help warfarin work effectively, it is important to instruct the client to keep his or her vitamin K intake as consistent as possible. Sudden increases in vitamin K intake may decrease the effect of warfarin. On the other hand, greatly lowering vitamin K intake could increase the effect of warfarin. Warfarin is an anticoagulant and does not increase or decrease the heart rate, so checking the pulse daily is not necessary with warfarin therapy. Warfarin does not cause fluid loss or retention, so daily weights are not necessary. Warfarin does not increase or decrease blood pressure.

The nurse prepares to administer digoxin to a client with heart failure and notes the following information: Temperature: 99.8 Pulse: 48 and irregular Respirations: 20 Potassium level: 3.2 mEq/L What action does the nurse take? A. Give digoxin; reassess the heart rate in 30 minutes. B. Give the digoxin; document assessment findings in the medical record. C .Hold the digoxin, and obtain a prescription for an additional dose of furosemide. D. Hold the digoxin, and obtain a prescription for a potassium supplement.

D. Hold the digoxin, and obtain a prescription for a potassium supplement. - Digoxin causes bradycardia; hypokalemia potentiates digitalis. The nurse seeks to correct this situation through collaboration with the provider. Digoxin causes bradycardia; the medication should be held. Digoxin is given to treat heart failure and atrial fibrillation, an irregular heart rate. hypokalemia potentiates digitalis toxicity. Lasix decreases circulating blood volume and depletes potassium; no indication suggests that the client has fluid excess at this time. .

The nurse caring for a client discusses the importance of restricting sodium in the diet. Which statement made by the client indicates that he needs further teaching? A "I should avoid grilling hamburgers." B "I must cut out bacon and canned foods." C "I shouldn't put the salt shaker on the table anymore." D "I should avoid lunch meats but may cook my own turkey."

A "I should avoid grilling hamburgers." - Cutting out beef or hamburgers made at home is not necessary; however, fast food hamburgers are to be avoided owing to higher sodium content. Bacon and canned foods are high in sodium, which promotes fluid retention; these are to be avoided. The client should avoid adding salt to food; he does not need further teaching. This client understands that all lunch meats and processed foods are high in sodium and are to be avoided.

The nurse is providing discharge teaching to the client with heart failure, focusing on when to seek medical attention. Which statement by the client indicates understanding of the teaching? A "I will call the provider if I have a cough lasting 3 or more days." B "I will report to the provider weight loss of 2 to 3 pounds in a day." C "I will try walking for 1 hour each day." D "I should expect occasional chest pain."

A "I will call the provider if I have a cough lasting 3 or more days."- Cough, a symptom of heart failure, is indicative of intra-alveolar edema; the provider should be notified. The client should call the provider for weight gain of 3 pounds in a week. The client should begin by walking 200 to 400 feet per day. Chest pain is indicative of myocardial ischemia and worsening of heart failure; the provider should be notified.

The nurse is caring for a client with heart failure. For which symptoms should the nurse assess? Select all that apply. A Chest discomfort or pain B Tachycardia C Expectorates thick, yellow sputum D Sleeps on back without a pillow E Shortness of breath with exertion

A Chest discomfort or pain - Decreased tissue perfusion may cause chest pain or discomfort. B Tachycardia -Tachycardia may occur as compensation for or as a result of decreased cardiac output. E Shortness of breath with exertion - Dyspnea results as pulmonary venous congestion ensues. Thick, yellow sputum is indicative of infection; clients with acute heart failure have dry cough and, when severe, pink, frothy sputum. Orthopnea, the inability to lie flat, occurs in clients with heart failure.

.Which priority problems may be considered for the client with heart failure? Select all that apply. A Decreased fluid volume related to compromised regulatory mechanism B Impaired Physical Mobility related to limited cardiovascular endurance Correct C Impaired Gas Exchange related to ventilation-perfusion imbalance Correct D Potential for pulmonary edema Correct E Risk for Ineffective renal Perfusion related to hypervolemia .

A Decreased fluid volume related to compromised regulatory mechanism - Owing to intra-alveolar edema and poor cardiac output, the client is fatigued and has limited endurance. B Impaired Physical Mobility related to limited cardiovascular endurance - Owing to intra-alveolar edema and poor cardiac output, the client may develop hypoxemia. C Impaired Gas Exchange related to ventilation-perfusion imbalance Correct - Owing to limited cardiac reserve, the client is at risk for pulmonary edema. D Potential for pulmonary edema -The client with heart failure has poor cardiac output, reduced blood flow to the kidney, and accumulation of pulmonary and peripheral fluid. The client with heart failure has poor cardiac output, reduced blood flow to the kidney, and accumulation of pulmonary and peripheral fluid. Awarded 3.0 points out of 4.0 possible points.

.After receiving change-of-shift report about these four clients, which client should the nurse assess first? A The 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset, frequent premature ventricular complexes B The 55-year-old admitted with pulmonary edema who received furosemide (Lasix) and whose current O2 saturation is 94% C The 68-year-old with pericarditis who is reporting sharp, stabbing chest pain when taking deep breaths D The 79-year-old admitted for possible rejection of a heart transplant who has sinus tachycardia, rate 104

A The 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset, frequent premature ventricular complexes - This client's premature ventricular complexes may be indicative of digoxin toxicity. Further assessment for clinical manifestations of digoxin toxicity should be done and the physician notified about the dysrhythmia. current O2 saturation is 94% is stable and can be assessed after Client A. This type of sharp, stabbing chest pain is expected in pericarditis; the client may be assessed after Client A. Tachycardia is expected in heart transplant rejection because rejection will cause signs of decreased cardiac output, including tachycardia; this client may be seen after Client A.

The nurse is caring for an 82-year-old client admitted for exacerbation of heart failure. The nurse questions the client about the use of which medication because it raises an index of suspicion as to the cause of heart failure? A. Ibuprofen (Motrin) . B. Hydrochlorothiazide (HydroDIURIL) C. NPH Insulin Incorrect: D. Levothyroxine (Synthroid)

A. Ibuprofen (Motrin) - Long-term use of NSAIDs, such as ibuprofen (Motrin), causes fluid and sodium retention. A diuretic (HydroDIURIL) may be used in the treatment of heart failure and hypertension. Although diabetes may be a risk factor for cardiovascular disease, it does not directly cause heart failure. In proper doses, Synthroid replaces thyroid hormone for those with hypothyroidism; it does not cause heart failure.

A client is diagnosed with right-sided heart failure. Which assessment findings will the nurse expect the client to have? Select all that apply. A. Peripheral edema B. Crackles in both lungs C. Breathlessness D. Ascites E. Lung congestion

A. Peripheral edema D. Ascites - Clients diagnosed with right-sided heart failure generally retain fluid in interstitial body tissues and the abdomen due to portal (liver) congestion. Assessment findings related to this fluid gain include increased body weight, peripheral edema, and ascites (the accumulation of fluid in the peritoneal cavity). Lung congestion causing crackles and shortness of breath or breathlessness results from left-sided heart failure because fluid backs up from the left heart into the lungs.

The nurse recognizes that which medication when given in heart failure may improve morbidity and mortality? A Dobutamine (Dobutrex) B Carvedilol (Coreg) C Digoxin (Lanoxin) D Bumetamide (Bumex)

B Carvedilol (Coreg) - Beta-adrenergic blockers reverse consequences of sympathetic stimulation and catecholamine release that worsen heart failure; they improve morbidity, mortality, and quality of life. Dobutamine is an inotropic agent used in acute heart failure; it does not improve mortality. Digoxin is an inotropic agent used in acute heart failure; it does not improve mortality. Bumetamide is a high-ceiling diuretic that promotes fluid excretion; it does not improve morbidity and mortality.

How does the nurse in the cardiac clinic recognize that the client with heart failure has demonstrated a positive outcome related to the addition of metoprolol (Lopressor) to the medication regimen? A Ejection fraction is 25%. B Client states that she is able to sleep on one pillow. C Client was hospitalized five times last year with pulmonary edema. D Client reports that she experiences palpitations.

B Client states that she is able to sleep on one pillow. - Improvement in activity tolerance, less orthopnea, and improved symptoms represent a positive response to beta blockers. Normal ejection fraction of 50% to 70% a level below indicates poor cardiac output. Repeated hospitalization for acute exacerbation of left-sided heart failure does not demonstrate a positive outcome. Although metoprolol decreases the heart rate, palpitations are defined as the feeling of the heart beating fast in the chest; this is not a positive outcome.

The client who has been admitted for the third time this year for cardiac failure says, "This isn't worth it anymore. I just want it all to end." What is the nurse's best response? A Calls the family to lift the client's spirits B Considers further assessment for depression C Sedates the client to decrease myocardial oxygen demand D Tells the client that things will get better

B Considers further assessment for depression -This client is at risk for depression because of the diagnosis of heart failure, and further assessment should be done. Calling the family to help distract the client does not address the core issue. Sedation is inappropriate in this situation because it ignores the client's feelings. And telling the client that things will get better may give the client false hope and ignores his feelings.

The home health nurse visits a client with heart failure who has gained 5 pounds in the past 3 days. The client states, "I feel so tired and short of breath." Which action should the nurse take first? A Assess the client for peripheral edema. B Listen to the client's posterior breath sounds. C Notify the physician about the client's weight gain. D Remind the client about dietary sodium restrictions.

B Listen to the client's posterior breath sounds. - Because the client is at risk for pulmonary edema and hypoxemia, the first action should be to assess breath sounds. Assessment of edema may be delayed while the nurse focuses on breathing and breath sounds. After a full assessment, the nurse should notify the physician. Defer dietary sodium restrictions until physiologic stability is attained; then ask the client about behaviors that may have caused the weight gain, such as increased sodium intake or changes in medications.

The nurse caring for the client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider? Select all that apply. A Hypokalemia Incorrect B Sinus bradycardia Correct C Fatigue Correct D Serum digoxin level of 1.5 E Anorexia Correct

B Sinus bradycardia - Digoxin toxicity may cause bradycardia. C Fatigue - a symptom of digoxin toxicity. E Anorexia - a symptom of digoxin toxicity. Hypokalemia causes increased sensitivity to the drug and toxicity, but it is not a symptom of toxicity. Therapeutic serum Digoxin level is between 0.8 - 2.0

. The client, a college athlete who has collapsed during soccer practice, has been diagnosed with hypertrophic cardiomyopathy. The client says, "This can't be. I am in great shape. I eat right and exercise." What is the nurse's best response? A "How does this make you feel?" Incorrect: Exploring the client's feelings is important, but this response does not address the client's question. B "This can be caused by taking performance-enhancing drugs." Incorrect: Hypertrophic cardiomyopathy is not caused by performance-enhancing drugs. C "This may be caused by a genetic trait." Correct Correct: Hypertrophic cardiomyopathy is often transmitted as a single-gene autosomal dominant trait. D "Just imagine how bad it would be if you weren't in good shape." Incorrect: This response is not at all therapeutic and does not address the client's question. . Correct Awarded 1.0 points out of 1.0 possible points.

C "This may be caused by a genetic trait." -Hypertrophic cardiomyopathy is often transmitted as a single-gene autosomal dominant trait. Exploring the client's feelings is important, but this response does not address the client's question. Hypertrophic cardiomyopathy is not caused by performance-enhancing drugs. "Just imagine how bad it would be if you weren't in good shape." This is not at all therapeutic and does not address the client's question. .

CHART EXHIBIT .Physical Assessment: Crackles in all fields, Ejection fraction 30%, Oliguria Diagnostic Findings: Diagnosis heart failure, S3 present, BNP 560, Strict I & O Provider Prescriptions: Enalapril 10 mg orally daily, Sodium 130 mEq/L, Heparin 5000 units subcutaneously every 12 hours, Furosemide 40 mg IV daily . The nurse in the emergency department is caring for a client with acute heart failure who is experiencing severe dyspnea, pink, frothy sputum, and crackles throughout the lung fields. Which prescription should the nurse carry out first? A Enalapril B Heparin C Furosemide D I & O

C Furosemide - The client is displaying typical signs of acute pulmonary edema, secondary to fluid-filled alveoli and pulmonary congestion; a diuretic will promote fluid loss. Although this Enalapril will promote vasodilation and decrease cardiac workload, the client is demonstrating signs of acute pulmonary edema secondary to intra-alveolar fluid. Heparin will prevent deep vein thrombosis (DVT) secondary to immobility but will not reduce fluid excess. Although all clients with congestive heart failure (CHF) should have I & O maintained, this is not a priority; removing fluid volume and treating dyspnea are matters of priority.

.When caring for a client who has undergone a partial left ventriculectomy, which of these new-onset clinical manifestations indicates the need for immediate action by the nurse? A Chest pain with movement B Fatigue after ambulation C Muffled heart sounds D. Bi-basilar fine crackles

C Muffled heart sounds - Muffled heart sounds may be a clinical manifestation of bleeding into the pericardial space; the nurse should assess the client for possible decreased cardiac output and should notify the surgeon. Surgery will result in pain with mobility; pain should be treated but not until physiologic stability is ensured. Left Ventriculectomy was performed for heart failure; fatigue after ambulation is common pt will need some time to recover his energy. Although the nurse should strive to prevent atelectasis or dependent crackles, fine crackles are common after chest surgery. This client should be gotten out of bed and shown how to use an incentive spirometer

Which intervention will best assist the client with acute pulmonary edema in reducing anxiety and dyspnea? A Monitor pulse oximetry and cardiac rate and rhythm. B Reassure the client that his distress can be relieved with proper intervention. C Place the client in high Fowler's position with the legs down. D Ask a family member to remain with the client.

C Place the client in high Fowler's position with the legs down. - High Fowler's position and placing the legs in a dependent position will decrease venous return to the heart, thus decreasing pulmonary venous congestion. Monitoring of vital signs will detect abnormalities but will not prevent them. Reassuring may help to alleviate anxiety, but dyspnea and anxiety result from hypoxemia secondary to intra-alveolar edema, which must be relieved. Asking family to remain with the client may help to alleviate anxiety, but dyspnea and anxiety result from hypoxemia secondary to intra-alveolar edema, which must be relieved.

Which nursing intervention for a client admitted today with heart failure will assist the client to conserve energy? A Client ambulates around the nursing unit with a walker. B The nurse monitors the client's pulse and blood pressure frequently. C The nurse obtains a bedside commode before administering furosemide. D The nurse returns the client to bed when he becomes tachycardic.

C The nurse obtains a bedside commode before administering furosemide. - Limiting the need for ambulation on the first day of admission to sitting in a chair or performing basic leg exercises promotes physical rest and reduced oxygen demand. On the day of admission, the client is experiencing dyspnea, fatigue, and weakness; ambulation will increase oxygen demand. Monitoring of vital signs will alert the nurse to increased energy expenditures but will not prevent them. Waiting until tachycardia occurs permits increased oxygen demand; the nurse should prevent this situation.

In monitoring the diagnostic test of a client admitted with heart failure (HF), which finding is consistent with this diagnosis? A. Serum potassium level of 3.2 mEq/L Incorrect: Hypokalemia may occur in response to diuretic therapy for heart failure but may also occur with other conditions; it is not specific to heart failure. B. Ejection fraction of 60% Incorrect: This represents a normal value of 50% to 70%. C. B-type natriuretic peptide (BNP) of 760 ng/dL Correct Correct: BNP is produced and released by the ventricles when the client has fluid overload as a result of HF; a normal value is less than 100 pg/mL. D. Chest x-ray report showing right middle lobe consolidation Incorrect: Consolidation on chest x-ray may indicate pneumonia.

C. B-type natriuretic peptide (BNP) of 760 ng/dL - BNP is produced and released by the ventricles when the client has fluid overload as a result of HF; a normal value is less than 100 pg/mL. Hypokalemia may occur in response to diuretic therapy for heart failure but may also occur with other conditions; it is not specific to heart failure. Normal ejection fraction is between 50% to 70%. Consolidation on chest x-ray may indicate pneumonia.

Although the client with cardiac failure is asymptomatic, the nurse suspects noncompliance with prescribed home therapy. Which laboratory test confirms the nurse's suspicions? A B-type natriuretic peptide (BNP) 90 pg/mL B Serum electrolytes C Hemoglobin and hematocrit D Digoxin level of 0.2 ng/dL

D Digoxin level of 0.2 ng/dL - A therapeutic digoxin level is 0.8 to 2.0 ng/dL. A level of 0.2 ng/dL indicates that the client has not been taking his digoxin as prescribed. A BNP test is a cardiac failure diagnostic tool but is not the best indicator of decreased compliance. Electrolytes are not an early indicator of decreased cardiac compliance. Hemoglobin and hematocrit are not early indicators of decreased cardiac compliance.

The nurse is caring for the client with congestive heart failure (CHF) in the coronary care unit (CCU). The client is now exhibiting signs of air hunger and anxiety. Which nursing intervention does the nurse perform first for this client? A Determines the client's physical limitations B Encourages alternate rest and activity periods C Monitors and documents heart rate, rhythm, and pulses I D Positions the client to alleviate dyspnea

D Positions the client to alleviate dyspnea -Positioning the client to alleviate dyspnea will help ease air hunger and anxiety. Determining the client's physical limitations is not a priority in this situation. Encouraging alternate rest and activity periods is not the immediate priority for this client. Monitoring of heart rate, rhythm, and pulses is important but is not the priority for this client.

A client admitted for heart failure has a priority problem of Excess Fluid Volume related to compromised regulatory mechanisms. Which of these assessment data obtained the day after admission is the best indicator that the treatment has been effective? A The client has a diuresis of 400 mL in 24 hours. B The client's blood pressure is 122/84 mm Hg. C The client has an apical pulse of 82 beats/min. D The client's weight decreases by 2.5 kg.

D The client's weight decreases by 2.5 kg. - The best indicator of fluid volume loss is daily weight; because each kilogram represents approximately 1 L, this client has lost approximately 2500 mL of fluid. A The client has a diuresis of 400 mL in 24 hours. Incorrect: This volume of urine represents oliguria, not the needed response of diuresis.