Heart Failure + Management AQ
The nurse is assessing a patient with a diagnosis of left-sided heart failure (HF). The nurse should monitor the patient for which characteristic symptom that occurs exclusively with this disorder? Multiple choice question Fatigue Anxiety Anorexia Frothy, pink-tinged sputum
Frothy, pink-tinged sputum Frothy, pink-tinged sputum is a characteristic symptom associated with left-sided HF. Fatigue and anxiety are present as a common symptom both in right-sided and left-sided HF. Anorexia is exclusively a symptom of right-sided HF.
The nurse reviews the medical record of a patient with heart failure (HF). The nurse should question which assessment finding, recognizing that it does not correlate with the patient's diagnosis? Multiple choice question Fatigue Bradycardia Clammy and cold skin Paroxysmal nocturnal dyspnea
Bradycardia Bradycardia is not related to ADHF or chronic heart failure. Fatigue is an indication associated with chronic heart failure. Clammy and cold skin is a result of vasoconstriction during ADHF. Paroxysmal nocturnal dyspnea is also associated with chronic heart failure.
The nurse develops dietary education for a patient with heart failure (HF) and should include what information? Multiple choice question A list of foods high in thiamine Guidelines for a low-sodium diet Guidelines for a high-protein diet Instructions for fluid restriction of less than 500 mL per day
Guidelines for a low-sodium diet 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 mL.
The nurse is caring for a patient with left-sided heart failure and expects what assessment finding? Multiple choice question Hepatomegaly Splenomegaly Pulmonary congestion Vascular congestion of gastrointestinal tract
Pulmonary congestion 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.
A patient with a recent diagnosis of heart failure (HF) has been prescribed furosemide. The nurse recognizes that the medication is appropriate for the patient because of what physiologic effect it has on the body? Multiple choice question Reduces preload Decreases afterload Increases contractility Promotes vasodilation
Reduces preload Diuretics such as furosemide are used in the treatment of heart failure to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not influence directly afterload, contractility, or vessel tone.
The nurse educates a patient with heart failure (HF) about lifestyle changes to avoid complications. Which statement made by the patient indicates that further teaching is needed? Multiple choice question "I can add salt to my food and eat what I want." "I can eat hard candy or ice pops to avoid thirst." "I shouldn't exercise or do anything to strain my heart." "I will take all of my medications at the prescribed times."
"I can add salt to my food and eat what I want." Not following a low-sodium diet may lead to complications such as hypertension, edema, and other conditions. Fluid restriction is not usually prescribed for the patient with mild to moderate HF. However, in chronic HF, fluids are limited to 2 L/day. Use of ice pops and hard candy helps avoid thirst, which is a side effect of the HF medications. Lack of exercise does not increase a patient's sodium level. Taking medication at the prescribed times is correct and does not need further teaching.
A nurse provides discharge instructions to a patient with chronic heart failure related to dietary restrictions. Which statement made by the patient indicates understanding of the teaching? Multiple choice question "I should not use salt at the table." "I should increase the intake of milk." "I should avoid use of lemon juice and spices." "I can eat bread, processed meat, and cheese."
"I should not use salt at the table. Patients with heart failure should avoid salt because it contains sodium. Sodium tends to absorb water and increase edema, which may worsen heart failure. Bread, processed meat, and cheese contain high levels of sodium and should be avoided. Intake of milk should be restricted to only two cups daily because it is rich in fat. Lemon juice and spices can be used instead of salt to flavor food.
The nurse is caring for a patient with chronic heart failure and atrial fibrillation that takes digoxin and a thiazide diuretic. Which statement made by the patient indicates that the patient is experiencing a complication related to the medication? Multiple choice question "My ankles are still slightly swollen." "I have to urinate a lot after I take those pills!" "I'm not really hungry for lunch. I feel so nauseated and tired." "I check my heart rate regularly. It is usually 80-90 beats per minute."
"I'm not really hungry for lunch. I feel so nauseated and tired." Drug therapy with digoxin and potassium-losing diuretics (thiazides or loop diuretics) may lead to hypokalemia. The presence of hypokalemia while the patient is on digoxin may lead to digoxin toxicity. Signs of early digoxin toxicity include anorexia, nausea and vomiting, fatigue, headache, depression, and visual changes. Slightly swollen ankles are an expected finding with chronic heart failure; frequent urination is an expected effect of the diuretic. The heart rate of 90 beats/minute is normal.
A patient dies of irreversible brain injury. The nurse recognizes that which assessments must be performed to determine the suitability of harvesting the heart for cardiac transplantation? Select all that apply. Multiple selection question Gram stain Bronchoscopy ABO blood type Body size and heart size Human leukocyte antigen typing Panel of reactive antibody (PRA) level
ABO blood type Body size and heart size Human leukocyte antigen typing Panel of reactive antibody (PRA) level In order to avoid complications after cardiac transplantation, a careful selection of the donor's heart must be performed. The donor's organ must fulfill certain matching criteria with the recipient. These assessments include: ABO blood type, body size, heart size, human leukocyte antigen, and panel antibody reactive level. Gram stain and bronchoscopy findings are the matching criteria to be fulfilled for lung transplantation.
A patient with chronic heart failure asks the nurse about heart transplantation. The nurse identifies that the surgery is absolutely contraindicated if the patient has what history findings? Select all that apply. Multiple selection question Severe obesity Age over 70 years Recurrent life-threatening dysrhythmias Cardiac abnormalities that severely limit normal function Advanced cerebral or vascular disease not amenable to correction
Age over 70 years Advanced cerebral or vascular disease not amenable to correction Absolute contraindications for heart transplant include chronologic age over 70 and advanced cerebral or vascular disease not amenable to correction. Indications for heart transplant include recurrent life-threatening dysrhythmias not responsive to maximal interventions and cardiac abnormalities that severely limit normal function. Severe obesity is a relative contraindication.
A patient with chronic heart failure receives a prescription for an angiotensin-converting enzyme (ACE) inhibitor. The nurse should monitor the patient for what major side effect? Multiple choice question Hypokalemia Angioedema Inability to swallow Symptomatic hypertension
Angioedema A major side effect of ACE inhibitors is angioedema, which is an allergic condition involving edema of face and airways. It is a life-threatening condition. Other major side effects include symptomatic hypotension, intractable cough, hyperkalemia, and renal insufficiency. An inability to swallow is not a major side effect.
Prior to requesting the family to make health care decisions for the patient, the nurse identifies that what is the priority action? Multiple choice question Assessing the patient's self-efficacy Contacting the agency's ethics committee Assessing the patient's decisional capacity Allowing the health care provider to make choices regarding the patient's treatment
Assessing the patient's decisional capacity Prior to requesting the family to make decisions for the patient, decisional capacity should be assessed without assuming it is absent. The ethics committee is not needed for this situation. Self-efficacy is one's own beliefs about his or her capability to succeed in a situation. Next-of-kin, not the health care provider, are the legal decision makers in the absence of advance directives.
What is the priority assessment of the nurse caring for a patient receiving intravenous nesiritide to treat heart failure? Multiple choice question Urine output Lung sounds Blood pressure Respiratory rate
Blood pressure Although urine output, lung sounds, and respiratory rate are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.
The nurse compares the signs and symptoms of right-sided heart failure and left-sided heart failure. Which symptom is unique to right-sided heart failure? Multiple choice question Fatigue Anxiety Depression Bilateral edema
Bilateral edema Right-sided heart failure is manifested as bilateral edema in the patient. Fatigue, anxiety, and depression are symptoms of both right-sided and left-sided heart failure.
A patient diagnosed with heart failure is treated with an angiotensin-converting enzyme (ACE) inhibitor. The nurse should monitor the patient for what side effect? Multiple choice question Cough Anemia Hyperpigmentation Increased body temperature
Cough Patients treated with angiotensin-converting enzyme (ACE) inhibitors have an increased risk for medication-related cough. Methyldopa causes anemia. Beta blockers alter body temperature. Aspirin can increase melanin production and can cause hyperpigmentation.
The nurse is caring for a patient with chronic heart failure. What is appropriate to be included on the patient's plan of care? Multiple choice question Ultrafiltration (UF) Hemodynamic monitoring Intraaortic balloon pump (IABP) Cardiac resynchronization therapy (CRT)
Cardiac resynchronization therapy (CRT) In chronic HF, neurohormonal effects and cardiac remodeling can result in dyssynchrony of the left ventricle (LV) and the right ventricle (RV). This contributes to poor cardiac output (CO). CRT is ventricular pacing. During the procedure, an extra lead is placed which allows for normal electrical conduction between the RV and LV, which increases left ventricular function and CO. Hemodynamic monitoring, UF, and IABP are included in the plan of care for patients with acute decompensated heart failure (ADHF). Patients with ADHF need continuous monitoring and assessment. The patient may have hemodynamic monitoring, including arterial BP and pulmonary artery pressure. The ideal patients for UF are those with major pulmonary or systemic volume overload. The IABP is helpful in hemodynamically unstable patients.
The nurse presents information to a group of nursing students about heart transplantation. When listing major causes of death after the first year posttransplantation, what should the nurse include? Multiple choice question Infection Acute rejection Immunosuppression Cardiac vasculopathy
Cardiac vasculopathy 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.
The nurse provides medication education to a patient with heart failure. The nurse explains that the drug's mechanism of action is to reverse ventricular remodeling and to decrease cardiac workload by inhibiting catecholamines. Which drug is the nurse referring to? Multiple choice question Digitalis Carvedilol Dopamine Furosemide
Carvedilol Carvedilol is a β-adrenergic blocker that inhibits the sympathetic nervous system, preventing the release of catecholamines. (Catecholamines increase heart rate and myocardial contractility, which increases the workload of the heart.) Carvedilol also promotes reverse remodeling and decreases afterload. Furosemide is a diuretic and does not have those sympathetic nervous system (SNS)-blocking effects. Digitalis and dopamine are inotropic drugs that serve to increase contractility and do not block SNS stimulation.
A patient is prescribed an angiotensin-converting enzyme (ACE) inhibitor for the treatment of heart failure (HF). The nurse recognizes that this type of medication benefits patients with HF because it blocks what action? Multiple choice question Secretion of aldosterone Conversion of pro-renin to renin Conversion of angiotensin I to angiotensin II Conversion of angiotensinogen to angiotensin I
Conversion of angiotensin I to angiotensin II When renal blood flow is reduced, the juxtaglomerular cells secrete renin into circulation. Renin carries out the conversion of angiotensinogen released by the liver to angiotensin I. Angiotensin I is subsequently converted to angiotensin II by the angiotensin-converting enzyme found in the lungs. Angiotensin II also stimulates the secretion of the hormone aldosterone; it causes the reabsorption of sodium and water into the blood, which increases blood pressure.
The nurse recalls that the decreased filling of the ventricles that is associated with diastolic failure results in what primary manifestation? Multiple choice question Decreased afterload Decreased left ventricular ejection fraction Decreased left ventricular end-diastolic pressure Decreased stroke volume and cardiac output (CO)
Decreased stroke volume and cardiac output (CO) Diastolic failure often is referred to as heart failure with normal ejection fraction. Decreased filling of the ventricles results in decreased stroke volume and CO. Diastolic failure is characterized by high filling pressures because of stiff ventricles. This results in venous engorgement in both the pulmonary and systemic vascular systems.
The nurse reviews the laboratory results of a patient with heart failure (HF) and notes an increased calcium level and decreased magnesium level. The nurse should notify the health care provider of the findings and withhold which scheduled medication? Multiple choice question Digoxin Metoprolol Spironolactone Morphine sulfate
Digoxin Hypercalcemia and hypomagnesemia can trigger digitalis toxicity. The dose should be held, and the health care provider should be notified. The lab findings are not indications to withhold morphine sulfate, metoprolol, or spironolactone.
While performing cardiac assessment, the nurse finds that a patient's right atrial pressure is 12 mm Hg. Which other findings will the nurse most likely observe? Select all that apply. Multiple selection question Distended neck veins Enlarged cardiac muscle Engorged or enlarged liver Decreased afterload in the ventricle Decreased resistance to blood ejection
Distended neck veins Enlarged cardiac muscle Engorged or enlarged liver The normal right atrial pressure is in the range of 2 to 6 mm Hg. A right atrial pressure of 12 mm Hg is elevated. The veins of the neck reflect venous tone, blood volume, and right atrial pressure. Therefore distention of neck veins is indicative of elevated right atrial pressure. Elevated arterial blood pressure gives the ventricles increased resistance to eject blood and thus increases the work demand, resulting in ventricular hypertrophy, an enlargement of the cardiac muscle tissue without an increase in cardiac output. Elevated right atrial pressure increases resistance to blood flow and can result in liver engorgement. Elevated right atrial pressure can increase afterload and resistance to blood ejection.
A patient is diagnosed with pulmonary edema. The nurse anticipates a prescription for which type of medication? Multiple choice question Diuretic Vasodilator β-adrenergic blocker Angiotensin-converting enzyme (ACE) inhibitor
Diuretic Diuretics are used to treat pulmonary edema because they act on the ascending loop of Henle to promote sodium, chloride, and water excretion. Vasodilators cause dilation of the blood vessel wall. β-adrenergic blockers help counteract the negative effect of the sympathetic nervous system. Angiotensin-converting enzyme inhibitors block the enzyme that can cause angiotensin I to form angiotensin II, which is a potent vasoconstrictor.
A patient is diagnosed with acute decompensated heart failure (ADHF). The nurse anticipates a prescription for which medication that is a selective β-agonist, does not increase systemic vascular resistance (SVR), and that is preferred for short-term treatment of ADHF? Multiple choice question Milrinone Dobutamine Dopamine Procainamide
Dobutamine Unlike dopamine, dobutamine is a selective β-agonist. It does not increase systemic vascular resistance (SVR) and is preferred for short-term treatment of ADHF. Milrinone and dopamine are also used to treat ADHF but are not preferred for short-term treatment. Procainamide is a class IA antidysrhythmic drug used to treat or prevent dysrhythmias.
A patient develops unexplained heart failure (HF) that remains unresponsive to usual therapy. For what diagnostic test does the nurse prepare the patient? Multiple choice question Chest x-ray Echocardiogram Cardiac catheterization Electrocardiogram (ECG)
Echocardiogram An echocardiogram provides information on the ejection fraction (EF). It also provides information on the structure and function of the heart valves. Heart chamber enlargement or stiffness can also be assessed. An ECG and chest x-ray are also useful but are not as specific. Heart catheterization, such as coronary angiography, is performed to determine ejection fraction (EF) and blockages.
The nurse is caring for a patient with right-sided heart failure. Which assessment findings should the nurse expect? Select all that apply. Multiple selection question Edema Ascites Crackles Anadsarca Wheezes
Edema Ascites Anasarca 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.
An acutely ill patient develops unexplained, new-onset heart failure (HF) that is unresponsive to usual care. The nurse anticipates a prescription for which diagnostic procedure that is commonly done as part of a heart catheterization?? Multiple choice question Chest x-ray Intraarterial BP Endomyocardial biopsy (EMB) Multigated acquisition (MUGA) scan
Endomyocardial biopsy (EMB) Endomyocardial biopsy is an investigation to find out the cause of new-onset heart failure that is unresponsive to routine care. Hemodynamic monitoring (e.g., intraarterial BP) is included in the care plan for a patient with acute decompensated heart failure (ADHF). A chest x-ray and MUGA scan are common diagnostic studies used for many types of patients suspected of having cardiac problems; they are not done as part of a cardiac catheterization.
A patient with chronic heart failure (HF) reports disturbed sleep due to the urge to urinate frequently. The nurse suspects that what condition that is associated with HF is most likely causing the patient's nocturia? Multiple choice question Diabetes An enlarged prostate Increased caffeine intake during the day, resulting in diuresis at night Extravascular fluid being reabsorbed from the interstitial spaces back into the circulatory system, resulting in increased perfusion to the kidneys
Extravascular fluid being reabsorbed from the interstitial spaces back into the circulatory system, resulting in increased perfusion to the kidneys In a patient with chronic heart failure, there is decreased renal perfusion and urine production during the day, because 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.
The nurse recalls that paroxysmal nocturnal dyspnea is a condition indicative of what more serious problem? Multiple choice question COPD Asthma Bronchitis Heart failure
Heart failure A classic symptom of left-sided heart failure is paroxysmal nocturnal dyspnea, which awakens the patient after several hours of sleep. Although a patient with chronic obstructive pulmonary disease, asthma, or bronchitis may experience shortness of breath, these symptoms do not usually manifest while the patient is sleeping.
The nurse assesses a patient with a family history of heart failure. Which primary causes of heart failure are linked to specific genes and gene mutations? Select all that apply. Multiple selection question Hypertension Hyperthyroidism Cardiomyopathy Rheumatic heart disease Coronary artery disease (CAD)
Hypertension Cardiomyopathy Coronary artery disease (CAD) Primary causes of heart failure linked to specific genes and gene mutations include coronary artery disease, cardiomyopathy, and hypertension. Hyperthyroidism and rheumatic heart disease are primary causes of heart failure that are not linked to specific genes and gene mutation. Some of the precipitating causes of heart failure include anemia, hypothyroidism, and infection.
A patient with heart failure (HF) takes digoxin. The nurse recognizes that the patient is at risk for digitalis toxicity if what condition exists? Multiple choice question Hypokalemia Hypocalcemia Hyperuricemia Hypermagnesemia
Hypokalemia Being hypokalemic makes a patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the potassium level. The health care provider may prescribe the digoxin to be given once the potassium level has been treated and increased to the normal range. Hypercalcemia and hypomagnesemia can also trigger digitalis toxicity. Hyperuricemia does not put the patient at risk for digitalis toxicity.
What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure? Multiple choice question Acute anxiety Hypotension and tachycardia Peripheral edema and weight gain Paroxysmal nocturnal dyspnea (PND
Hypotension and tachycardia Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.
A patient has undergone cardiac transplantation. The nurse expects that which treatment will be prescribed? Multiple choice question Antibiotic therapy Antifungal therapy Immunosuppressive therapy Intravenous immunoglobulin (IVIG) therapy
Immunosuppressive therapy Immunosuppressive therapy is used to suppress the immune system and prevent rejection of the transplanted heart. Intravenous immunoglobulin (IVIG) is a blood product that is administered intravenously. It contains the pooled, polyvalent, and IgG antibodies extracted from the plasma of over one thousand blood donors and is used to boost the immune system. Antibiotic therapy is used to prevent infection. Antifungal therapy is used to treat fungal infections.
A patient that is diagnosed with heart failure experiences fatigue. The nurse suspects that the fatigue is caused by what? Multiple choice question Increased cardiac output Increased hemoglobin levels Impaired perfusion to vital organs Increased oxygenation of the tissues
Impaired perfusion to vital organs Fatigue is one of the early signs of heart failure. Due to heart failure, there is inadequate blood circulation, leading to decreased perfusion to the vital organs. An impaired functioning of the vital organs may lead to fatigue. Cardiac output decreases in heart failure, depriving the body tissues of oxygen and nutrients, leading to fatigue. Inadequate blood supply results in inadequate oxygenation of the tissue and causes fatigue when the oxygen demands are not met. Hemoglobin levels are low in heart failure, leading to anemia. A decreased oxygen-carrying capacity of the blood also results in fatigue.
Epinephrine and norepinephrine are released in response to decreased cardiac output that occurs in patients with heart failure. These catecholamines can cause what physiologic change? Multiple choice question Vasodilation Decreased heart rate Decreased blood pressure Increased myocardial oxygen demand
Increased myocardial oxygen demand Catecholamines increase heart rate and contractility, which increase myocardial workload and oxygen demand. Catecholamines cause vasoconstriction (not vasodilation), an increased heart rate (not decreased), and an increase in blood pressure (not decrease).
A patient attends a follow-up visit at a clinic, six months after receiving a heart transplant. The nurse recognizes that the patient is at risk for what major cause of death? Multiple choice question Infection Malignancy Vasculopathy Sudden cardiac death
Infection Because of the use of immunosuppressive therapy, infection is a primary complication after transplant surgery. Malignancy (especially lymphoma) and cardiac vasculopathy are major causes of death later, after the first year following the transplant. Sudden cardiac death rarely occurs posttransplant
The nurse expects that which drug will be prescribed to a patient with heart failure (HF), to treat the compensatory increase in the heart rate and the renin release that occurs as a result of the failure? Multiple choice question Digoxin Milrinone Metoprolol Dobutamine
Metoprolol Metoprolol is a β-adrenergic blocker, which helps prevent an increase in the heart rate and renin release by inhibiting the sympathetic nervous system. Digoxin decreases the heart rate but does not decrease the renin release. Milrinone increases the heart's contractility and decreases the pulmonary vascular resistance. Dobutamine is a β-adrenergic agonist that increases cardiac contractility.
A patient's apical heart rate is 45 beats/minute. The nurse should withhold which scheduled medication? Multiple choice question Morphine Metoprolol Furosemide Rosuvastatin
Metoprolol Metoprolol, which is a β-adrenergic blocker, inhibits the sympathetic nervous system, causing a decrease in heart rate; therefore, this drug should be withheld and the primary health care provider notified. Diuretics, such as furosemide, are used to reduce edema, pulmonary venous pressure, and preload; pulse rate is not affected. Morphine is used to reduce pain and anxiety, and it also decreases preload and afterload; it may be given if the patient is in pain and has a heart rate of 45. Antihyperlipidemic drugs, such as rosuvastatin, are used to help control cholesterol in the patient; a heart rate of 45 does not indicate that it should be withheld.
A patient's assessment findings include an ejection fraction of 34%, high pulmonary pressures, and biventricular failure. The nurse suspects that the patient is experiencing what condition? Multiple choice question Systolic failure Diastolic failure Myocardial ischemia Mixed systolic and diastolic failure
Mixed systolic and diastolic failure Mixed systolic and diastolic failure results in low ejection fraction, high pulmonary pressures, and biventricular failure. Systolic failure results only in low ejection fraction. Diastolic failure is characterized by high filling pressures due to a stiff ventricle. Myocardial ischemia is a condition of insufficient blood flow to the heart muscle.
A patient is diagnosed with left ventricular hypertrophy that resulted from untreated hypertension. The nurse should monitor the patient for symptoms of what condition? Multiple choice question Poor contractility Less O 2 requirement Decreased ventricular irritability Rich coronary arterial circulation
Poor contractility Poor contractility is a complication seen in patients who have hypertrophy of the cardiac walls. The heart muscle, which undergoes hypertrophy, increases in muscle mass and cardiac wall thickness, due to overwork and strain. As a result, the hypertrophic heart muscle exhibits poor contractility over time. Hypertrophic heart muscle is more irritable and, thus, prone to dysrhythmias. A hypertrophic heart requires more oxygen (O 2) to perform work. Because the tissue in a hypertrophic heart becomes ischemic more easily, there is poor coronary artery circulation.
The nurse reviews the laboratory results of a patient with heart failure (HF) who receives a prescription for digoxin. The nurse decides to withhold the medication based on abnormal findings of what blood study? Multiple choice question Potassium Thyroid function tests White blood cells (WBCs) Blood urea nitrogen (B.U.N.)
Potassium Low serum potassium enhances the actions of digitalis, causing a therapeutic dose to reach toxic levels. Similarly, hyperkalemia inhibits the actions of digitalis, resulting in subtherapeutic dose. Monitor serum potassium levels of all patients taking digitalis. The results of a B.U.N., WBCs, or thyroid function tests do not affect the nurse's decision to administer or to withhold digoxin.
The nurse assesses that a patient with acute decompensated heart failure (ADHF) experiences dyspnea. What is the priority nursing action? Multiple choice question Perform ultrafiltration Provide supplemental oxygen Provide mechanical ventilation Obtain arterial blood gases (ABGs)
Provide supplemental oxygen Supplemental oxygen helps increase the percentage of oxygen in inspired air. Ultrafiltration is a process used to remove excess salt and water from the blood in case of volume overload. Mechanical ventilation is used in cases of pulmonary edema, to help decrease the preload. An ABG test will provide information about the amount of oxygen and carbon dioxide is in the blood, but it is not a priority.
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? Multiple choice question Heart failure Hypertension Pulmonary failure Pulmonary congestion
Pulmonary congestion 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.
A patient is diagnosed with left-sided heart failure. The nurse should carefully monitor the patient for what complication? Multiple choice question Hepatomegaly Splenomegaly Vascular congestion Pulmonary congestion
Pulmonary congestion The most common form of heart failure is left-sided heart failure. It results from left ventricular dysfunction. This prevents normal, forward blood flow and causes blood to back up into the left atrium and pulmonary veins. There would be fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli; this manifests as pulmonary congestion and edema. Right-sided heart failure occurs when the right ventricle fails to contract effectively.
A nurse reviews the medical record of a patient with pulmonary embolism and notes the presence of cor pulmonale. The nurse recalls that this refers to a disorder of the heart that is caused by what? Multiple choice question Liver disease Renal disease Pulmonary disease Preexisting heart disease
Pulmonary disease Cor pulmonale is a cardiac condition in which a disease of the pulmonary system causes an increase in right ventricular pressure. This increased right ventricular pressure causes right ventricular failure, which may eventually lead to heart failure. This term is not used for heart disease caused by liver, kidney, or preexisting heart diseases.
A patient with acute decompensated heart failure (ADHF) develops hypotension and thiocyanate toxicity after 48 hours of prescribed drug therapy. The nurse suspects that which medication is responsible for this condition? Multiple choice question Nesiritide Milrinone Spironolactone Sodium nitroprusside
Sodium nitroprusside Hypotension and thiocyanate toxicity are complications of sodium nitroprusside; they can develop after 48 hours of use. Nesiritide causes symptomatic hypotension. Milrinone complications include dysrhythmias, thrombocytopenia, and hepatotoxicity. Spironolactone complications include hyperkalemia and gynecomastia in males (with long-term use).
A male patient with chronic heart failure develops enlarged breasts. The nurse reviews the patient's medication profile and suspects that which medication is the cause of the patient's condition? Multiple choice question Digoxin Captopril Carvedilol Spironolactone
Spironolactone Spironolactone, if used for a prolonged period, may cause breast enlargement or gynecomastia in males. Digoxin may cause bradycardia and atrioventricular block. Captopril may cause conditions such as hypotension and hyperkalemia. Carvedilol may cause side effects of profound bradycardia, hypotension, and bronchospasm.
The nurse recalls that symptoms of right-sided heart failure are caused by what condition? Multiple choice question Decreased preload Increased cardiac output Fluid congestion in the lungs Systemic venous congestion
Systemic venous congestion 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; preload in right-sided heart failure is increased. Increased cardiac output is not correct; cardiac output is decreased in right-sided heart failure.
Diagnostic results of a patient reveal an ejection fraction (EF) of 32%. The nurse recognizes that the finding may be indicative of what conditions? Select all that apply. Multiple selection question Systolic failure Diastolic failure Myocardial infarction Coronary heart disease Mixed systolic and diastolic failure
Systolic failure Mixed systolic and diastolic failure Ejection factor (EF) is defined as the amount of blood ejected from the left ventricle after each contraction. Normal EF is 55-60%. The hallmark of systolic failure is a decrease in EF (less than 45%). Patients with mixed systolic and diastolic failure have extremely low EF (less than 35%). The EF in diastolic failure is normal. Myocardial infarction is the damage to the heart muscle due to decreased blood flow and oxygen supply, which may or may not result in low EF. Coronary heart disease, if not severe, may not affect the EF.
A patient who underwent cardiac transplantation exhibits signs of acute rejection. The nurse recognizes that which medication is often used as posttransplantation therapy to prevent this type of response? Multiple choice question Ibuprofen Metoprolol Tacrolimus Acetaminophen
Tacrolimus Tacrolimus is a calcineurin that is included in most immunosuppressive regimens. Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) used to treat pain. Metoprolol is a beta-blocker that is used to treat hypertension. Acetaminophen is a nonsteroidal antiinflammatory drug (NSAID) that is used to treat pain and fever.
The nurse provides information to a group of nursing students about primary causes of heart failure (HF). The nurse should include what interventions that are associated with the primary causes and that are aimed at reducing the risk of patients developing HF?? Select all that apply. Multiple selection question Blood transfusions for anemia Taking blood pressure medication as prescribed Decreasing dysrhythmias by reducing caffeine intake Initiating lifestyle changes to avoid coronary artery disease (CAD) Taking aspirin every day to reduce the incidence of pulmonary embolism
Taking blood pressure medication as prescribed Initiating lifestyle changes to avoid coronary artery disease (CAD) Hypertension and coronary artery disease (CAD) are considered primary causes of heart failure (HF). Anemia, dysrhythmias, and pulmonary embolism are precipitating causes of heart failure.
The nurse is providing discharge education for a patient with moderate heart failure. What physical activity is recommended and should be included in the plan of care? Multiple choice question Walking briskly every day for two hours Staying on bed rest as much as possible Taking frequent rest breaks during activities Holding all activity until prescribed by the doctor
Taking frequent rest breaks during activities A patient with moderate heart failure should be encouraged to participate in daily moderate physical activity as tolerated and to take frequent breaks to prevent fatigue. Bed rest is not recommended for patients with moderate heart failure. Walking briskly is too strenuous for this patient. Activity is standardized for patients with heart failure and is included in the plan of care.
A patient is admitted to the hospital with heart failure. Following an assessment, the primary health care provider classifies the patient as NYHA II. The nurse recognizes that what is the most likely reason for this classification? Multiple choice question The patient is unable to perform daily chores, like dressing oneself. The patient experiences dyspnea even at rest, and discomfort increases with activities. The patient experiences no dyspnea when resting or when performing daily routine activity. The patient reports feeling comfortable at rest but that ordinary physical activity causes fatigue
The patient reports feeling comfortable at rest but that ordinary physical activity causes fatigue According to the NYHA functional classification of heart disease, the patient belongs to Class II, in which there are no symptoms at rest. The patient can perform daily routine activities but tires easily and experiences palpitations and dyspnea. In Class I, ordinary physical activity does not cause fatigue or dyspnea, and there is no limitation of physical activity. In Class III, there is inability to perform daily chores like dressing oneself. The patient may be comfortable at rest. In Class IV, the patient has symptoms even at rest and is unable to carry out any activity without discomfort.
