Heart Failure

What is the therapeutic serum level for digoxin

0.5 - 2.0 ng/mL

When assessing a client diagnosed with left-sided heart failure, the nurse anticipates which of the following findings? a. Liver enlargement. b. Abdominal distention. c. Edema of the feet and ankles. d Shortness of breath.

d. SHOB

What is the equation to calculate cardiac output?

Stroke Volume x Heart Rate

The force needed to eject blood into the circulation.

afterload

The volume of blood in the ventricles at end diastole (before contraction).

preload

The volume of blood ejected with each contraction.

stroke volume

At what ejection fraction % does the heart fail?

40%

What is the normal ejection fraction % range?

50-70%

The patient has right-sided heart failure. The nurse would expect to find which of the following symptoms upon assessment? a. Crackles in lungs b. Diarrhea or constipation c. Right upper quadrant pain d. S3 heart sound

c. RUQ pain

A patient with heart failure is undergoing hemodynamic monitoring with a pulmonary catheter and an arterial line (A-line). Nursing care includes: (Select all that apply.) a. Set alarm limits. b. Secure connections and stopcocks. c. Change IV solutions every 24 hours. d. Tightly restrain the affected extremity. e. Assess pulse and perfusion distal to the site.

a b c e no d

A nurse is teaching a client who has heart failure about the need to limit sodium in the diet to 2,000 mL/day. Which of the following foods should be consumed in limited quantities? (select all) a. cheddar cheese, 2 oz. b. hot dog c. canned tuna, 3 oz. d. roast chicken breast, 3 oz e. baked ham, 3 oz

a. cheese 800 mg of NA b. hot dog 615 mg of NA c. canned tuna 350 mg of NA e. baked ham 1020 mg of NA d. lean meats, fish and poultry contain 30-90 mg of sodium /3 oz.

A patient with heart failure is complaining of fatigue, shortness of breath, chronic cough, and difficulty breathing when lying down. The nurse would focus the physical examination on: (Select all that apply.) a. Auscultate for crackles. b. Assess lower extremities for edema. c. Auscultate for an S3 gallop. d. Assess ability to ambulate.

a. crackles b. edema c. S3 gallop

A nurse is providing teaching to a client who has a new Rx for digoxin. Which of the following may indicate digoxin toxicity and should be reported to the provider? (select all) a. fatigue b. constipation c. anorexia d. rash e. diplopia

a. fatigue/weakness c. GI disturbances e. visual changes, such as yellow-tinged vision b. NVD rather than constipation

The physician orders morphine 2 mg to 5 mg IV as needed for pain and dyspnea for a client with pulmonary edema from heart failure. The nurse appropriately: a. Administers the drug as ordered, monitoring respiratory function. b. Questions the order because the order does not have a time interval. c. Administers the drug only when the client complains of chest pain. d. Withholds the medication until respiratory status improves.

a. monitor respiratory function

The nurse is examining a client in the clinic for follow-up care for heart failure. Which of the following, if reported by the client, would not be associated with exacerbating heart failure? a. Peptic ulcer disease. b. Nutritional anemia. c. Atrial fibrillation. d. Recent upper respiratory infection.

a. peptic ulcer disease

When repositioning the patient's leg, the nurse observes a large depression in the skin that does not immediately refill. The nurse should: a. Inspect and palpate the leg for pitting edema. b. Palpate the pedal pulse for amplitude. c. Place a pillow between the patient's legs. d. Assist the patient from the bed to the chair.

a. pitting edema

A nurse is caring for a client who has heart failure and asks how to limit fluid intake to 2.000 mL/day. Which of the following is an appropriate response by the nurse? a. pour the amount of fluid you drink into an empty 2L bottle to keep tract of how much you drink b. each glass contains 8 oz. There are 30 mL per oz, so you can have a total of 8 glasses or cups of fluid each day. c. this is the same as 2 quarts, or about the same as two pots of coffee d. take sips of water or ice chips so you will not take in too much fluid

a. provides a visual guide for the client as to the amount consumed and how to plan daily intake b. glasses and cups vary in size c. vague frame of reference d. does not assist with accurate fluid measurement

A nurse is completing the admission assessment of a client who has suspected pulmonary edema. Which of the following are expected findings? (select all) a. tachypnea b. persistent cough c. increased urinary output d. thick, yellow sputum e. orthopnea

a. s/s of pulmonary edema b. s/s of pulmonary edema e. s/s of pulmonary edema c. decreased urinary output d. pink, frothy sputum

A nurse is monitoring the digoxin level for a client who has been taking a daily dose of digoxin for 1 month. The digoxin level is 0.25 ng/mL. The nurse should notify the provider and anticipate which of the following? a. an increase in the client's digoxin dose b. a decrease in the client's digoxin dose c. no change in the dose d. d/c of the client's digoxin Rx

a. the client's digoxin level is below the therapeutic range

A nurse is caring for a client who has heart failure and reports increased SHOB. The nurse increases the O2 per protocol. Which of the following actions should the nurse take first? a. obtain the clients weight b. assist the client into high-fowlers position c. auscultate lung sounds d. check O2 sat

b. ABC priority...this will decrease venous return to the heart (preload) and help relieve lung congestion. a, c & d do not improve the client's oxygenation

The nurse in a long-term care facility is talking with a client diagnosed with heart failure, diabetes, hypertension, and chronic renal failure. The nurse notes mild edema of the ankles while the client is sitting in the chair. Breath sounds are clear, equal, and with good chest excursion, and the client denies any feeling of shortness of breath. The nurse reviews the medical record and sees no significant change in the client's daily weights over the last week. What are the nurse's priority interventions for this client? (Select all that apply.) a. Call the doctor for an order to increase the client's diuretic. b. Apply antiembolism stockings. c. Review the client's BUN and creatinine. d. Encourage the client to elevate feet when sitting. e. Review the client's diet to determine sodium intake.

b. apply anti embolism stockings d. elevate feet

A nurse is completing d/c teaching to a client who has heart failure and is encouraged to increase K in his diet. Which of the following statements by the client indicated understanding of the teaching? a. I will consume more white rice b. I will eat more baked potatoes c. I will drink more grape juice d. I will use more powdered cocoa mixes

b. baked potatoes a. white rice is low in K c. tomato/orange good source of K not grape d. high in NA

A nurse is caring for an older adult client who has a new Rx for digoxin and takes multiple other medications. Concurrent use of which of the following medications places the client at risk for digoxin toxicity? a. phenytoin (Dilantin) b. verapamil (Calan) c. warfarin (Coumadin) d. aluminum hydroxide (Amphojel)

b. calcium-channel blockers can increase digoxin levels

Because a patient is admitted to the Intensive Care Unit (ICU) with extremely labored respirations, orthopnea, cyanosis, and a large amount of pink, frothy sputum, the nurse teaches which of the following? a. Side effects of penicillin b. Side effects of lanoxin (Digoxin) c. Side effects of ethambutol (Myambutol) d. Side effects of protamine sulfate

b. digoxin

A nurse is administering a dopamine infusion at a moderate dose to a client who has severe heart failure. Which of the is an expected effect? a. lowered HR b. increased myocardial contractility c. decreased conduction through the AV node d. vasoconstriction of renal blood vessels

b. dopamine increases myocardial contractility, which also increases cardiac output.

When assessing a patient with increased venous pressure, the nurse should expect: a. Diminished pulses in the extremities. b. Jugular vein distension over 3 cm above the sternal angle. c. Toes are pale and feet are cold to palpation. d. Capillary refill of 2 seconds or less.

b. jugular vein distension

If a 78-year-old patient is diagnosed with heart failure, the nurse is most likely to assess for the following signs/symptoms? a. Dyspnea and crackles b. Weakness and somnolence c. Peripheral edema and limited mobility d. Anemia and hypertension

b. weakness and somnolence

In assessing a client admitted 24 hours ago with heart failure, the nurse notes that the client has lost 2.5 pounds, heart rate is down from 105 to 88, and there are fine crackles only in the bases of the lungs. The nurse correctly interprets these data as indicating: a. A need for more aggressive treatment. b. Heart failure has resolved. c. The treatment regimen is achieving the desired effect. d. The client's condition is unchanged.

c. desired effect

A patient with acute heart failure is critically ill, and his blood pressure is monitored by an arterial line (A-line). Another purpose for the A-line in this patient is to: a. Give vasoactive drugs. b. Obtain blood for arterial blood gas measurements. c. Measure direct heart pressures. d. Monitor for respiratory changes.

c. heart pressures

Because physical activity is included in the treatment plan of a patient with chronic heart failure who leads a sedentary lifestyle, the nurse should advise which of the following the first week of activity? a. Walk 30 minutes per day, 2 days per week; set a moderate walking pace. b. Join a walking club and walk at least five times per week; try to keep up with the faster walkers as much as possible. c. Walk at a slow, comfortable pace two times per day, 3 days a week; Increase rate and distance at her own pace. d. Walk in her neighborhood at a moderate pace every day and increase pace as quickly as possible.

c. slow, comfortable pace

A nurse in a provider's office is monitoring serum electrolytes for four older adult clients who take digoxin and furosemide. Which of the following electrolyte values puts a client at risk for digoxin toxicity? a. calcium 9.2 mg/dL b. calcium 10.3 mg/dL c. potassium 3.4 mEq/L d. potassium 4.8 mEq/L

c. this potassium level is low, low K can cause fatal dysrhythmias, especially in older clients who take digoxin.

In reviewing the physician's admitting notes for a client with heart failure, the nurse notes that the client has an ejection fraction of 25%. The nurse recognizes this as meaning which of the following? a. 25% of the blood in the ventricle remains after systole. b. The amount of blood ejected from the ventricles is within normal limits. c. Ventricular function is severely impaired. d. Cardiac output is greater than normal.

c. ventricular function impaired

The amount of blood ejected from the left ventricle into the aorta per minute.

cardiac output

The nurse caring for a client undergoing pulmonary artery pressure monitoring for heart failure provides appropriate care when the nurse: a. Calibrates and levels the system every shift. b. Secures IV tubing to the bed linens. c. Maintains flush solution flow by gravity. d. Reports waveform dampening during wedge pressure measurements.

d. calibrates and levels the system every shift

The nurse observes a decrease in the patient's mean arterial pressure (MAP) on the monitor. The nurse obtains the vital signs and estimates the MAP by: a. Obtaining the apical heart rate and rhythm. b. Subtracting the difference between the systolic and diastolic pressures. c. Assessing the patient's cardiac output. d. Calculating the diastolic pressure plus one-third of the pulse pressure.

d. diastolic pressure + 1/3 of the pulse pressure

A patient with acute heart failure is receiving digoxin (Lanoxin) IV. Safe nursing practice includes: a. Mixing digoxin preparation in 100 ml D5W before infusing. b. Teaching the patient to take an antacid with the oral form of the drug at home daily. c. Monitoring younger adult patients carefully since, they are most susceptible to the drug effects. d. Holding the drug if fewer than 60 beats per minute are observed, and notifying the health care provider.

d. hold drug for HR < 60

The nurse is caring for a client diagnosed with heart failure who is taking digoxin and furosemide. Which of the following laboratory values will the nurse monitor closely? a. Sodium. b. Calcium. c. Phosphorus. d. Potassium.

d. potassium

The percentage of blood that leaves the heart on contraction

ejection fraction