Chapter 25: Management of Patients with Complications of Heart Disease PrepU

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? "How far can you walk without becoming short of breath?" "Are you urinating excessively at night?" "Are you only able to breathe when you are sitting upright?" "Are you coughing up blood at night?"

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

The nurse assists the client to the bathroom, which is approximately 10 feet from the bed. The client ambulates 3 feet and states, "I cannot catch my breath." How would the nurse document this finding? "Has paroxysmal nocturnal dyspnea when walking" "Can't walk without becoming short of breath" "Experiences exertional dyspnea when walking 3 feet; states, I cannot catch my breath." "Has orthopnea when walking"

"Experiences exertional dyspnea when walking 3 feet; states, I cannot catch my breath."

The nurse is admitting a client with heart failure. What client statement indicates that fluid overload was occurring at home? "I eat six small meals a day when I am hungry." "I'm having trouble going up the steps during the day." "I've stopped eating foods with salt, though I miss the taste." "My best time of the day is the morning."

"I'm having trouble going up the steps during the day."

A client has been diagnosed with systolic heart failure. What percentage will the nurse expect the patient's ejection fraction to be? 55% 65% 30% 5%

30%

A client in the emergency room is in cardiac arrest and exhibiting pulseless electrical activity (PEA) on the cardiac monitor. What will be the nurse's next action? Change oxygen delivery to a mask. Stop all emergency measures. Analyze the arterial blood gas. Administer epinephrine.

Administer epinephrine.

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? Hold any further treatment until the client's blood pressure increases. Administer the third sublingual nitroglycerin tablet. Wait ten minutes after the second tablet to assess pain. Notify the health care provider of the chest pain.

Administer the third sublingual nitroglycerin tablet.

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

Afterload

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 angiotensin II receptor blockers Assess oxygen saturation Administer angiotensin-converting enzyme inhibitors Administer diuretics

Assess oxygen saturation

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? 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. Encourage increased intake of red meat.

Avoid the intake of processed and commercially prepared foods.

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? Detectable depression of less than 5 mm when the thumb is released from the swollen area; normal foot and leg contours A depression of more than 1 cm when the thumb is released from the swollen area; severe foot an

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

The nurse recognizes that which laboratory test is a key diagnostic indicator of heart failure? Creatinine Brain natriuretic peptide (BNP) Complete blood count (CBC) Blood urea nitrogen (BUN)

Brain natriuretic peptide (BNP)

Which is a key diagnostic indicator of heart failure? Brain natriuretic peptide (BNP) Complete blood count (CBC) Blood urea nitrogen (BUN) Creatinine

Brain natriuretic peptide (BNP)

A patient in severe pulmonary edema is being intubated by the respiratory therapist. What priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea? Attach a pulse oximeter probe and obtain values. Listen for breath sounds over the epigastrium. Call for a chest x-ray. Observe for mist in the endotracheal tube.

Call for a chest x-ray.

A client has been prescribed furosemide 80 mg twice daily. The asymptomatic client begins to have rare premature ventricular contractions followed by runs of bigeminy with stable signs. What action will the nurse perform next? Calculate the client's intake and output. Administer potassium. Notify the health care provider. Check the client's potassium level.

Check the client's potassium level.

A client with chronic heart failure is able to continue with his regular physical activity and does not have any limitations as to what he can do. According to the New York Heart Association (NYHA), what classification of chronic heart failure does this client have? Class I (Mild) Class II (Mild) Class IV (Severe) Class III (Moderate)

Class I (Mild)

A client is exhibiting digitalis toxicity. Which of the following medications would the nurse expect to be ordered for this client? Ibuprofen Warfarin Amlodipine Digoxin immune FAB

Digoxin immune FAB

Which is a cerebrovascular manifestation of heart failure? Nocturia Ascites Tachycardia Dizziness

Dizziness

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

heart transplant

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

Echocardiogram

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. Elevate the head of the bed. Report a decrease in urine output.

Elevate the head of the bed.

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? Supine with arms elevated on pillows above the level of the heart Prone with legs elevated on pillows Head of the bed elevated 45 degrees and lower arms supported by pillows Head of the bed elevated 30 degrees and legs elevated on pillows

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

The nurse visits the home of a client with heart failure. Which assessment finding indicates to the nurse that the client's tolerance to activity is deteriorating? Fatigue after walking to answer the door Bilateral lower extremity edema +1 Weight loss of 0.5 kg (1.1 lbs.) Needs to use a scooter for shopping

Fatigue after walking to answer the door

Which medication is categorized as a loop diuretic? Furosemide Chlorthalidone Chlorothiazide Spironolactone

Furosemide

The nurse is performing an initial assessment of a client diagnosed with heart failure (HF) that includes the client's sensorium and level of consciousness (LOC). Why is the assessment of the client's sensorium and LOC important in clients with HF? Clients with HF are susceptible to overstimulation of the sympathetic nervous system. HF ultimately affects oxygen transportation to the brain. Decreased LOC causes an exacerbation of the signs and symptoms of HF. The most significant adverse effect o

HF ultimately affects oxygen transportation to the brain.

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

potassium level of 2.8 mEq/L

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

Heart failure

The nurse is preparing to administer hydralazine and isosorbide dinitrate. When obtaining vital signs, the nurse notes that the blood pressure is 90/60. What is the priority action by the nurse? Administer the medication and check the blood pressure in 30 minutes. Administer the hydralazine and hold the dinitrate. Administer a saline bolus of 250 mL and then administer the medication. Hold the medication and call the health care provide

Hold the medication and call the health care provider

A client is already being treated for hypertension. The doctor is concerned about the potential for heart failure, and has the client return for regular check-ups. What does hypertension have to do with heart failure? Hypertension causes the heart's chambers to shrink. Heart failure occurs when blood pressures drops. Hypertension causes the heart's chambers to enlarge and weaken. Hypertension in older males regularly leads to heart failure.

Hypertension causes the heart's chambers to enlarge and weaken.

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

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

Increased pulmonary artery diastolic pressure

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

JVD is noted 4 cm above the sternal angle.

Which is a characteristic of right-sided heart failure? Cough Dyspnea Pulmonary crackles Jugular vein distention

Jugular vein distention

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 atrial function Right ventricular function Left ventricular function Right atrial function

Left ventricular function

A client is in the early stage of heart failure. During this time, which compensatory mechanism occurs? Decreased renal blood flow causes the renin-angiotensin-aldosterone system to decrease secretion of aldosterone and antidiuretic hormone. Low blood pressure triggers the baroreceptors to increase sympathetic nervous system stimulation. Low blood pressure triggers the baroreceptors to decrease sympathetic nervous system stimulation. Increased renal blood flow causes the renin-angiotensin-aldost

Low blood pressure triggers the baroreceptors to increase sympathetic nervous system stimulation.

Which feature is the hallmark of systolic heart failure? Pulmonary congestion Low ejection fraction (EF) Limited activities of daily living (ADLs) Basilar crackles

Low ejection fraction (EF)

The nurse is providing discharge instructions to a client with heart failure preparing to leave the following day. What type of diet should the nurse request the dietitian to discuss with the client? Low-potassium diet Low-cholesterol diet Low-sodium diet Low-fat diet

Low-sodium diet

A nurse is assessing a client with suspected cardiac tamponade. How should the nurse assess the client for pulsus paradoxus? Measure blood pressure in the right arm, then in the left arm as the client slows the pace of his inhalations and exhalations. Measure the blood pressure in right arm as the client inhales slowly, then measure the blood pressure in the left arm as the client exhales slowly. Measure the blood pressure in either arm as the client slowly exhales and then as the client breathe

Measure the blood pressure in either arm as the client slowly exhales and then as the client breathes normally.

Which action will the nurse include in the plan of care for a client admitted with acute decompensated heart failure (ADHF) who is receiving milrinone? Titrate milrinone rate slowly before discontinuing Monitor blood pressure frequently Teach the client about safe home use of the medication Encourage the client to ambulate in room

Monitor blood pressure frequently

The nurse is working in a long-term care facility with a group of older adults with cardiac disorders. Why would it be important for the nurse to closely monitor an older adult receiving digitalis preparations for cardiac disorders? Older adults are at increased risk for cardiac arrests. Older adults are at increased risk for hyperthyroidism. Older adults are at increased risk for toxicity. Older adults are at increased risk for asthma.

Older adults are at increased risk for toxicity.

The client with cardiac failure is taught to report which symptom to the health care provider or clinic immediately? Persistent cough Ability to sleep through the night Increased appetite Weight loss

Persistent cough

The nurse is preparing to administer furosemide to a client with severe heart failure. What lab study should be of most concern for this client while taking furosemide? Hemoglobin of 12 BNP of 100 Sodium level of 135 Potassium level of 3.1

Potassium level of 3.1

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? Nausea Jugular venous distention Pedal edema Pulmonary congestion

Pulmonary congestion

A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.) Pulmonary crackles Dyspnea Ascites Jugular vein distention Cough

Pulmonary crackles Dyspnea Cough

A hospitalized client with heart failure puts on the call light and states, "I've become very short of breath, and I've been coughing up this pink frothy sputum." The nurse immediately suspects which of the following complications? Decreased cardiac workload Hepatomegaly Pulmonary edema Decreased renal perfusion pressure

Pulmonary edema

The nurse is developing a plan of care for a client following pericardiocentesis. Which interventions should the nurse implement? Choose all that apply. Place the client in a supine position. Record fluid output. Evaluate the cardiac rhythm. Assess vital signs every 15 minutes for the first hour. Monitor heart and lung sounds.

Record fluid output. Evaluate the cardiac rhythm. Assess vital signs every 15 minutes for the first hour. Monitor heart and lung sounds.

A client has been diagnosed with heart failure. What is the major nursing outcome for the client? Walk 30 minutes three times a week. Maintain a healthy diet. Sleep 8 hours per night. Reduce the workload on the heart.

Reduce the workload on the heart.

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

Restlessness and confusion

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 heart failure

Which is a potassium-sparing diuretic used in the treatment of heart failure? Spironolactone Bumetanide Chlorothiazide Ethacrynic acid

Spironolactone

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

Stay with the client.

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

Systemic venous congestion

A client with a history of heart failure is returning from the operating room after inguinal hernia repair and the nurse assesses a low pulse oximetry reading. What is the most important nursing intervention? Assess for jugular vein distention. Titrate oxygen therapy. Assess the surgical incisional area. Administer pain medication.

Titrate oxygen therapy.

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? Prevent the development of hypotension. Treat pulseless ventricular tachycardia. Correct metabolic acidosis. Reduce the development of torsade de pointes.

Treat pulseless ventricular tachycardia.

The physician writes orders for a patient to receive an angiotensin II receptor blocker for treatment of heart failure. What medication does the nurse administer? Digoxin (Lanoxin) Carvedilol (Coreg) Valsartan (Diovan) Metolazone (Zaroxolyn)

Valsartan (Diovan)

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? acute pulmonary edema. right-sided heart failure. cardiogenic shock. pneumonia.

acute pulmonary edema.

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 admitting a client with heart failure. What factor will worsen the client's myocardial function? potassium 3.9 mEq/L hemoglobin 11.9 g/dL blood urea nitrogen 22 mg/dL arterial pH 7.28

arterial pH 7.28

The nurse is caring for a client with heart failure. What sign will lead the nurse to suspect right-sided heart failure? warm extremities ascites 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. tuberculosis. acute exacerbation of chronic obstructive pulmonary disease. decompensated heart failure with pulmonary edema.

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)? increased blood volume ejected from ventricle decrease in renal perfusion vasodilation of skin dehydration

decrease in renal perfusion

The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema? decreased right ventricular elasticity increased left atrial contractility increased right atrial resistance decreased left ventricular pumping

decreased left ventricular pumping

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 peripheral perfusion to the extremities decreased renal perfusion decreased left ventricular workload

decreased left ventricular workload

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

dyspnea on exertion

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

The nurse is caring for a client with heart failure who is receiving a diuretic medication. What implementation will help the nurse evaluate the client's response of the medication? measuring intake and output using mechanical ventilation asking the client about comfort level obtaining cardiac output with a pulmonary catheter

measuring intake and output

A nurse reviews the client's medical record and reads in the progress notes that the client has decreased left ventricular function. What assessment will validate the diagnosis? bibasilar rales cleared with coughing increased appetite orthopnea resting bradycardia

orthopnea

When a client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating orthopnea. hyperpnea. paroxysmal nocturnal dyspnea. dyspnea upon exertion.

orthopnea

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 decreased O2 saturation levels pitting edema S4 ventricular gallop sign

pitting edema

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 pulmonary edema. pneumonia. pulmonary embolism. myocardial infarction.

pulmonary embolism.