Heart Failure

After the first year following a heart transplant, the nurse knows that which is the major cause of death?

Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated coronary artery disease [CAD]) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increase the patient's risk of an infection.

A patient with a diagnosis of heart failure is being discharged from the hospital. Which instructions should the nurse include in the patient's discharge teaching plan?

Daily weight is the best indicator of changes in fluid status. An activity such as daily exercise is encouraged because exercise improves the patient's sense of well-being. A fluid restriction may be recommended for advanced heart failure but is not a method of monitoring fluid status. The patient should never adjust medications without consulting with the primary health care provider.

Dietary education for the patient with heart failure should include information on:

A low sodium diet is advised for heart failure patients. Protein levels should not be increased for heart failure patients. High levels of thiamine are not part of the dietary plan for heart failure patients. Fluid restrictions are not necessary for all patients and would not be as low as 500 mLs.

The nurse is administering a dose of digoxin (Lanoxin) to a patient with heart failure. The nurse would become concerned with the possibility of digitalis toxicity if the patient reported which symptom(s)?

Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms. Muscle aches, constipation, and a pounding headache are not signs of digitalis toxicity.

A patient is diagnosed with heart failure. The nurse identifies that which factors may influence the patient's cardiac output? Select all that apply.

Cardiac output depends on various factors such as preload, heart rate, and myocardial contractility. If preload increases, there is volume overload on the right ventricle, which can cause heart failure. An increase in heart rate increases cardiac output. Impaired myocardial contractility decreases cardiac output. Respiratory rate and portal pressure do not alter cardiac output.

Catecholimines, such as epinephrine and norepinephrine, released in response to the decreased cardiac output seen in heart failure can cause:

Catecholimines increase heart rate and contractility, which increase myocardial workload and oxygen demand. Catecholimines cause vasoconstriction (not vasodilation), an increased heart rate (not decreased), and an increase in blood pressure (not decrease).

The nurse recognizes the need for more frequent monitoring of electrolytes when a patient prescribed digitalis (Lanoxin) receives

Diuretics can either waste or spare potassium causing hypokalemia or hyperkalemia, both of which can cause issues when occurring in the patient on digitalis. Nitroglycerin and ACEI are not correct as they do not impact the levels of electrolytes. Beta blockers and lanoxin together can cause a decrease in heart rate, but no electrolyte imbalances.

The nurse is caring for a patient with right-sided heart failure. Which assessment findings should the nurse expect? Select all that apply.

Edema, ascites, and anasarca are manifestations of right-sided heart failure caused by fluid retention. Crackles and wheezes are manifestations of left-sided heart failure because fluid moves from the pulmonary capillary bed into the pulmonary interstitium and alveoli.

A patient with a history of left-sided heart failure arrives in the emergency department with complaints of extreme shortness of breath and a persistent cough with pink frothy sputum. On auscultation of the heart, the nurse notes aS3 gallop. The nurse recognizes those symptoms as being caused by:

Extreme shortness of breath and a persistent cough with pink frothy sputum are symptoms of pulmonary edema. Pneumonia, an asthma attack, and a myocardial infarction are not correct because pink frothy sputum and an S3 gallop are not symptoms of any of these.

A nurse performing an assessment of a patient with acute decompensated heart failure auscultates fine crackles bilaterally. The nurse knows that crackles are an indicator of:

Fluid in the alveoli is the correct answer as crackles are made by the sound of air moving through fluid filled alveoli. Atelectasis is the collapsing of alveoli and would not produce sound. Mucous in the airways would sound like rhonchi or would be diminished if there was consolidation. Bronchoconstriction would result in wheezing

The patient's laboratory results reveal a potassium level of 2.6 mEq/L. The nurse should notify the health care provider and withhold which scheduled medication?

Hypokalemia is the most significant risk factor for digoxin toxicity. The dose should be held and the health care provider should be notified with a plan to provide additional potassium supplementation. Potassium should be administered, not held, in the patient with hypokalemia. Metoprolol has no effect on potassium and will not become more or less potent in the setting of hypokalemia. Spironolactone is a potassium-sparing diuretic, which may help prevent further hypokalemia.

A patient with chronic heart failure reports disturbed sleep due to the urge to urinate frequently. What is the most likely cause of this patient's nocturia?

In a patient with chronic heart failure, there is decreased renal perfusion and urine production during the day, as most fluid gets accumulated in the peripheral tissues. However, while lying down at night in a recumbent position, the fluid from the peripheral interstitial tissues enters the central circulation. This leads to an increase in renal function, causing nocturia. Diabetes, an enlarged prostate, and caffeine intake before going to bed also cause nocturia but are less likely in this case.

A nurse is caring for a patient with a dry cough who is not responding to conventional medical treatment. On auscultation the nurse finds S3 and S4 heart sounds, crackles, and an increased heart rate in this patient. Which condition is most likely affecting the patient?

In left-sided heart failure, there is a dry cough along with S3 and S4 heart sounds, crackles, and increased heart rate. These symptoms indicate a low cardiac output. Cor pulmonale is the dilation of the right ventricle caused by pulmonary diseases. It manifests as right heart failure. Right-sided heart failure causes edema, murmurs, and jugular vein distention. Pulmonary edema manifests as dyspnea, orthopnea, anxiety, and cold and clammy skin.

The nurse notices that a patient with pulmonary edema experiences shortness of breath while lying down. What is the most likely reason for the development of orthopnea in this patient?

In pulmonary edema, there is congestion in the lungs, which causes inadequate oxygenation. In a recumbent position, the congestion is further increased, causing further hypoxemia, which causes orthopnea or shortness of breath while lying down. Orthopnea does not indicate heart failure but is an early sign of heart failure. Hypertension and pulmonary failure are found in later stages of heart failure.

The nurse is caring for a patient with biventricular heart failure. Which is a manifestation of left-sided heart failure?

Left-sided heart failure results from left ventricular dysfunction; this is manifested as pulmonary congestion and edema. Venous congestion in the systemic circulation results in jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract, and peripheral edema.

The Heart Failure Society of America (HFSA) has developed the acronym FACES that a nurse can use to teach patients about the symptoms of heart failure. What are the symptoms that are included in FACES? Select all that apply.

The acronym FACES includes the symptoms fatigue, limitation of activities, chest congestion/cough, edema, and shortness of breath. In heart failure, inadequate oxygenation of the blood causes fatigue even while performing routine activities. Edema is due to change in cardiac output, which leads to accumulation of fluid in the interstitial spaces. This causes shortness of breath and chest congestion. All these factors lead to limitation of activities in the patient. Asphyxia is not associated with HF.

A patient admitted to the emergency department is diagnosed with acute decompensated heart failure manifesting as pulmonary edema. Which clinical manifestations should the nurse observe in this patient? Select all that apply.

The clinical manifestations of pulmonary edema include dyspnea; rapid heart rate; and frothy, blood-tinged sputum. The skin usually becomes clammy and cold from the vasoconstriction caused by the stimulation of the sympathetic nervous system. The respiratory rate is often greater than 30 breaths per minute.

The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to acute decompensated heart failure (ADHF)?

The goal for the patient with chronic heart failure is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies, such as alternating activity with rest, will help the patient meet this goal. If the patient needs to use oxygen at home, it probably will be used all the time or with activity to prevent respiratory acidosis. Many heart failure patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient. The nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening heart failure.

Symptoms of right-sided heart failure are caused by:

The symptoms of right-sided heart failure are caused by the backup of blood into the venous system. Fluid congestion in the lungs is a symptom of left-sided heart failure. Decreased preload is not correct as preload in right-sided heart failure is increased. Increased cardiac output is not correct as cardiac output is decreased in right-sided heart failure.