Chapter 25 : Management of complications of Heart disease

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? "I don't have the same appetite I used to." "My pants don't fit around my waist." "My feet are bigger than normal." "I sleep on three pillows each night."

"I sleep on three pillows each night."

The nurse is assigned to care for a patient with heart failure. What classification of medication does the nurse anticipate administering that will improve symptoms as well as increase survival? Bile acid sequestrants Diuretic ACE inhibitor Calcium channel blocker

ACE inhibitor

The nurse is administering sublingual nitroglycerin to a client with chest pain. What action will the nurse take after administering two sublingual tablets if the client continues with chest pain and has a blood pressure of 120/82 mm Hg? Administer the third sublingual nitroglycerin tablet. Hold any further treatment until the client's blood pressure increases. Notify the health care provider of the chest pain. Wait ten minutes after the second tablet to assess pain.

Administer the third sublingual nitroglycerin tablet.

A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion? Assess for reduced urine output. Assess for elevated blood urea nitrogen levels. Assess for elevated blood potassium levels. Assess for reduced blood sodium levels.

Assess for elevated blood urea nitrogen levels.

A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client? Hourly administration of a fluid bolus BP and pulse measurements every 15 to 30 minutes Intubation of the airway Insertion of a central venous catheter

BP and pulse measurements every 15 to 30 minutes

The nurse is caring for a client in the hospital with chronic heart failure who has marked limitations in his physical activity. The client is comfortable when resting in the bed or chair, but when ambulating in the room or hall, the client becomes short of breath and fatigued easily. What type of heart failure is this considered according to the New York Heart Association (NYHA)? Class I (Mild) Class IV (Severe) Class II (Mild) Class III (Moderate)

Class III (Moderate)

Which medication reverses digitalis toxicity? Ibuprofen Digoxin immune FAB Amlodipine Warfarin

Digoxin immune FAB

Which diagnostic study is usually performed to confirm the diagnosis of heart failure? Echocardiogram Electrocardiogram (ECG) Serum electrolytes Blood urea nitrogen (BUN)

Echocardiogram

Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest? I II III IV

IV

The pathophysiology of pericardial effusion is associated with all of the following except: Increased right and left ventricular end-diastolic pressures. Increased venous return. Atrial compression. Inability of the ventricles to fill adequately.

Increased venous return.

Which is a manifestation of right-sided heart failure? Increase in forward flow Systemic venous congestion Accumulation of blood in the lungs Paroxysmal nocturnal dyspnea

Systemic venous congestion Explanation: Right-sided heart failure causes systemic venous congestion and a reduction in forward flow. Left-sided heart failure causes an accumulation of blood in the lungs and a reduction in forward flow or cardiac output that results in inadequate arterial blood flow to the tissues. Some clients with left-sided heart failure get episodes of dyspnea at night, known as paroxysmal nocturnal dyspnea.

Assessment of a client on a medical surgical unit finds a regular heart rate of 120 beats per minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 mL over the past hour. What is the reason the nurse anticipates transferring the client to the intensive care unit? The client shows signs of aneurysm rupture. The client is experiencing heart failure. The client is going into cardiogenic shock. The client is in the early stage of right-sided heart failure.

The client is going into cardiogenic shock.

What is the main difference between Class I and Class II heart failure as defined by the New York Heart Association (NYHA)? There is a marked limitation of physical activity. Duration of symptoms The client is unable to carry out any physical activity. The level of physical activity each allows

The level of physical activity each allows

A client with left-sided heart failure reports increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of what condition? right-sided heart failure. pneumonia. acute pulmonary edema. cardiogenic shock.

acute pulmonary edema.

The nurse is providing care to a client with cardiogenic shock requiring a intra-aortic balloon pump (IABP). What is the therapeutic effect of the IABP therapy? decreased right ventricular workload decreased renal perfusion decreased peripheral perfusion to the extremities decreased left ventricular workload

decreased left ventricular workload

The nurse assessing a client with an exacerbation of heart failure identifies which symptom as a cerebrovascular manifestation of heart failure (HF)? Tachycardia Dizziness Ascites Nocturia

dizziness

Frequently, what is the earliest symptom of left-sided heart failure? dyspnea on exertion confusion anxiety chest pain

dyspnea on exertion

The nurse is receiving a client from the emergency in cardiogenic shock. What mechanical device does the nurse anticipate will be inserted into the client? intra-aortic balloon pump cardiac pacemaker defibrillator hypothermia-hyperthermia machine

intra-aortic balloon pump

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

peripheral edema

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

peripheral edema

The nurse completes an assessment of a client admitted with a diagnosis of right-sided heart failure. What will be a significant clinical finding related to right-sided heart failure? oliguria pitting edema S4 ventricular gallop sign decreased O2 saturation levels

pitting edema

A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which assessment finding for this client? Jugular venous distention Pulmonary congestion Nausea Pedal edema

pulmonary congestion?

The nurse recognizes which symptom as a classic sign of cardiogenic shock? High blood pressure Restlessness and confusion Increased urinary output Hyperactive bowel sounds

restlessness and confusion

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

weight.

The nurse is caring for a client with heart failure. What sign will lead the nurse to suspect right-sided heart failure? ascites warm extremities weight loss resting bradycardia

ascites

A nurse caring for a client recently admitted to the ICU observes the client coughing up large amounts of pink, frothy sputum. Lung auscultation reveals coarse crackles in the lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing bilateral pneumonia. decompensated heart failure with pulmonary edema. tuberculosis. acute exacerbation of chronic obstructive pulmonary disease.

decompensated heart failure with pulmonary edema.

A client asks the nurse if systolic heart failure will affect any other body function. What body system response correlates with systolic heart failure (HF)? vasodilation of skin dehydration decrease in renal perfusion increased blood volume ejected from ventricle

decrease in renal perfusion A decrease in renal perfusion due to low cardiac output (CO) and vasoconstriction causes the release of renin by the kidney. Systolic HF results in decreased blood volume being ejected from the ventricle. Sympathetic stimulation causes vasoconstriction of the skin, gastrointestinal tract, and kidneys. Dehydration does not correlate with systolic heart failure.

The nurse is assigned to care for a client with heart failure. What medication does the nurse anticipate administering that will improve client symptoms as well as increase survival? cholestyramine lisinopril bumetanide diltiazem

lisinopril

A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client? Enlargement of joints Flexion contractures nausea and vomiting Vasculitis

nausea and vomiting Explanation: Digitalis medications are potent and may cause various toxic effects. The nurse should monitor the client for signs of digitalis toxicity, not just during the initial period of therapy, but throughout care management. The most common signs and symptoms include nausea and vomiting which can lead to dehydration and electrolyte imbalance. Symptoms of toxicity do not include vasculitis, flexion contractures, or enlargement of joints.

The nurse is assessing a patient who reports no symptoms of heart failure at rest but is symptomatic with ordinary physical activity. Under what classification does the nurse understand this patient would be categorized? II IV III I

II

The nurse is gathering data from a client recently admitted to the hospital. The nurse asks the client about experiencing orthopnea. What question would the nurse ask to obtain this information? "Are you only able to breathe when you are sitting upright?" "How far can you walk without becoming short of breath?" "Are you coughing up blood at night?" "Are you urinating excessively at night?"

"Are you only able to breathe when you are sitting upright?"

The nurse is caring for a client with a history of heart failure and a sudden onset of tachypnea. What is the nurse's priority action? Notify the family of a change in condition. Assess pulse oximetry reading. Report a decrease in urine output. Elevate the head of the bed.

Elevate the head of the bed. Explanation: The nurse's priority action is to elevate the head of bed to help with breathing. The pulse oximetry reading provides more data, but is not the priority intervention. Reporting a decrease urine output is not a priority for the client. Notification of the family is not a priority to help with breathing.

Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure? Increase in the cardiac index Decreased central venous pressure Increased pulmonary artery diastolic pressure Decreased mean pulmonary artery pressure

Increased pulmonary artery diastolic pressure

A nurse is teaching clients newly diagnosed with coronary heart disease (CHD) about the disease process and risk factors for heart failure. Which problem can cause left-sided heart failure (HF)? Myocardial ischemia Pulmonary embolus Cystic fibrosis Ineffective right ventricular contraction

MI

A client who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly reports chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the client for other signs and symptoms of myocardial infarction. pulmonary edema. pulmonary embolism. pneumonia.

PE

What is the main difference between Class I and Class II heart failure as defined by the New York Heart Association (NYHA)? The client is unable to carry out any physical activity. Duration of symptoms The level of physical activity each allows There is a marked limitation of physical activity.

The level of physical activity each allows

A client who has developed congestive heart failure must learn to make dietary adaptations. The client should avoid: canned peas. angel food cake. ready-to-eat cereals. dried peas.

canned peas Explanation: There is a wide variety of foods that the client can still eat; the key is to have low-salt content. Canned vegetables are usually very high in salt or sodium, unless they have labels such as low-salt or sodium free or salt free. It is important to read food labels and look for foods that contain less than 300 mg sodium/serving.

A client arrives at the ED with an exacerbation of left-sided heart failure and reports shortness of breath. Which is the priority nursing action? Administer diuretics Assess oxygen saturation Administer angiotensin II receptor blockers Administer angiotensin-converting enzyme inhibitors

Assess oxygen saturation Explanation: The nurse's priority action is to assess oxygen saturation to determine the severity of the exacerbation. It is important to assess the oxygen saturation in a client with heart failure because below-normal oxygen saturation can be life-threatening. Treatment options vary according to the severity of the client's condition and may include supplemental oxygen, oral and IV medications, major lifestyle changes, implantation of cardiac devices, and surgical approaches. The overall goal of treatment of heart failure is to relieve symptoms and reduce the workload on the heart by reducing afterload and preload.

A health care provider in the outpatient department examines a client with chronic heart failure to investigate recent-onset peripheral edema and increased shortness of breath. The nurse documents the severity of pitting edema as +1. What is the best description of this type of edema? A 5- to 10-mm depression when the thumb is released from the swollen area; foot and leg swelling A depression of more than 1 cm when the thumb is released from the swollen area; severe foot and leg swelling Detectable depression of less than 5 mm when the thumb is released from the swollen area; normal foot and leg contours Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours

Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours

The nursing instructor is teaching their clinical group how to assess a client for congestive heart failure. How would the instructor teach the students to assess a client with congestive heart failure for nocturnal dyspnea? By collecting the client's urine output By questioning how many pillows the client normally uses for sleep By measuring the client's abdominal girth By observing the client's diet during the day

By questioning how many pillows the client normally uses for sleep

The nurse is caring for a client with suspected right-sided heart failure. What would the nurse know that clients with suspected right-sided heart failure may experience? Gradual unexplained weight gain Sleeping in a chair or recliner Increased perspiration Increased urine output

Gradual unexplained weight gain Clients with right-sided heart failure may have a history of gradual, unexplained weight gain from fluid retention. Left-sided heart failure produces paroxysmal nocturnal dyspnea, which may prompt the client to use several pillows in bed or to sleep in a chair or recliner. Right-sided heart failure does not cause increased perspiration or increased urine output.

A client with congestive heart failure is admitted to the hospital after reporting shortness of breath. How should the nurse position the client in order to decrease preload? Head of the bed elevated 30 degrees and legs elevated on pillows Prone with legs elevated on pillows Head of the bed elevated 45 degrees and lower arms supported by pillows Supine with arms elevated on pillows above the level of the heart

Head of the bed elevated 45 degrees and lower arms supported by pillows

The nurse is performing an initial assessment of a client diagnosed with heart failure. The nurse also assesses the client's sensorium and LOC. Why is the assessment of the client's sensorium and LOC important in clients with heart failure? The most significant adverse effect of medications used for heart failure treatment is altered LOC. Heart failure ultimately affects oxygen transportation to the brain. Clients with heart failure are susceptible to overstimulation of the sympathetic nervous system. Decreased LOC causes an exacerbation of the signs and symptoms of heart failure.

Heart failure ultimately affects oxygen transportation to the brain.

The nurse is caring for a client with advanced heart failure. What treatment will be considered after all other therapies have failed? implantable cardiac defibrillator (ICD) heart transplant cardiac resynchronization therapy ventricular access device

Heart transplantation involves replacing a person's diseased heart with a donor heart. This is an option for advanced HF patients when all other therapies have failed. A ventricular access device, ICD, and cardiac resynchronization therapy would be tried prior to a heart transplant.

The nurse is assessing a patient who reports no symptoms of heart failure at rest but is symptomatic with ordinary physical activity. Under what classification does the nurse understand this patient would be categorized? II III I IV

II

A nurse is assessing a client with congestive heart failure for jugular vein distension (JVD). Which observation is important to report to the physician? JVD is noted at the level of the sternal angle. No JVD is present. JVD is noted 4 cm above the sternal angle. JVD is noted 2 cm above the sternal angle.

JVD is noted 4 cm above the sternal angle.

The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following? Left ventricular function Right ventricular function Left atrial function Right atrial function

Left ventricular function

The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following? Right ventricular function Left atrial function Left ventricular function Right atrial function

Left ventricular function

The nurse is preparing a client for a multiple gated acquisition (MUGA) scan. What would be an important instruction for the nurse to give a client who is to undergo a MUGA scan? Avoid any activity at least 2 hours before the test. Lie very still at intermittent times during the test. Avoid dairy products a day before and a day after the test. Drink plenty of fluids during the test.

Lie very still at intermittent times during the test.

The nurse is caring for a client with heart failure who has been prescribed digoxin. What laboratory value for the client can precipitate digoxin toxicity? Sodium 128 milliequivalents per liter Potassium 5.6 milliequivalents per liter Potassium 3.0 milliequivalents per liter Sodium 155 milliequivalents per liter

Potassium 3.0 milliequivalents per liter Explanation: The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur. A potassium level of potassium 3.0 milliequivalents per liter is low or hypokalemic. A potassium level of 5.6 is high or hyperkalemic. The sodium levels do not precipitate digoxin toxicity.

A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client? The development of cor pulmonale The development of left-sided heart failure The development of right-sided heart failure The development of chronic obstructive pulmonary disease (COPD)

The development of left-sided heart failure When the left ventricle fails, the heart muscle cannot contract forcefully enough to expel blood into the systemic circulation. Blood subsequently becomes congested in the left ventricle, left atrium, and finally the pulmonary vasculature. Symptoms of left-sided failure include fatigue; paroxysmal nocturnal dyspnea; orthopnea; hypoxia; crackles; cyanosis; S3 heart sound; cough with pink, frothy sputum; and elevated pulmonary capillary wedge pressure. COPD develops over many years and does not develop after a myocardial infarction. The development of right-sided heart failure would generally occur after a right ventricle myocardial infarction or after the development of left-sided heart failure. Corpulmonale is a condition in which the heart is affected secondarily by lung damage.

The nurse is assisting in the care of a client who is receiving cardiopulmonary resuscitation (CPR). For which reason will the client be prescribed to receive amiodarone during the resuscitation efforts? Reduce the development of torsade de pointes. Correct metabolic acidosis. Prevent the development of hypotension. Treat pulseless ventricular tachycardia.

Treat pulseless ventricular tachycardia.

A client taking an ACE inhibitor has developed a dry, hacking cough. Because of this side effect, the client no longer wants to take that medication. What medication that has similar hemodynamic effects does the nurse anticipate the health care provider ordering? Valsartan Metoprolol Furosemide Isosorbide dinitrate

Valsartan

A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status? Weighing the client daily at the same time each day Measuring and recording fluid intake and output Checking the client's lungs for crackles during every shift Assessing the client's vital signs every 4 hours

Weighing the client daily at the same time each day

The nurse is discussing basic cardiac hemodynamics and explains preload to the client. What nursing intervention will decrease preload? sustained elevation of the client's legs administration of a vasodilating drug (as ordered by a health care provider) increasing activity application of antiembolic stockings

administration of a vasodilating drug (as ordered by a health care provider Explanation: Preload is the amount of blood presented to the ventricles just before systole. Anything that decreases the amount of blood returning to the heart will decrease preload, such as vasodilation or blood pooling in the extremities. Anything that assists in returning blood to the heart (antiembolic stockings) or preventing blood from pooling in the extremities will increase preload

The nurse is teaching a group of clients with heart failure about how to decrease leg edema. What dietary advice will the nurse give to clients with severe heart failure? Encourage increased intake of red meat. Avoid the intake of processed and commercially prepared foods. Encourage increased intake of vegetables with natural sodium. Avoid the intake of canned fruit and fruit juices.

avoid intake of processed and commercially prepared foods. Until edema resolves, a client with severe heart failure requires restriction of sodium to 500 to 1,000 mg/day. Therefore, processed and commercially prepared foods are eliminated. Vegetables with natural sodium, for example, beets, carrots, and "greens," should be avoided. Fresh, frozen, and canned fruit and fruit juices are not restricted. Increased intake of red meat should not be encouraged; it should be restricted to 6 oz per day.

The nurse is assessing a client admitted with cardiogenic shock. What medication will the nurse titrate to improve blood flow to vital organs? enalapril dopamine furosemide metoprolol

dopamine

The nurse monitors a client for side effects associated with furosemide, which is newly prescribed for the treatment of heart failure. Complete the following sentence by choosing from the lists of options. Due to the client's high risk for developing Select...hyponatremia hypokalemia hyperuricemia hypokalemia as a result of the prescribed medication, the nurse focuses on monitoring the client for Select...ventricular arrhythmiajoint swellingnausea ventricular arrhythmia

hypokalemia , ventricular arrthmia

Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole? Ejection fraction Afterload Preload Stroke volume

preload

A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." What additional assessment information would be important for the CSU nurse to obtain? dry mucous membranes hypertension high urine output pulmonary crackles

pulmonary crackles

A client is admitted to the ICU with a diagnosis of heart failure. The client is exhibiting symptoms of weakness, ascites, weight gain, and jugular vein distention. The nurse would know that the client is exhibiting signs of what kind of heart failure? Left-sided heart failure Chronic heart failure Acute heart failure Right-sided heart failure

right sided

The nurse is caring for a client who has developed obvious signs of pulmonary edema. What is the priority nursing action? Update the health care provider. Stay with the client. Notify the family of the client's critical state. Lay the client flat.

stay with patient