HF EAQ missed questions

the nurse is caring for a pt developing pulmonary edema. What respiratory rate does the nurse anticipate when assessing this pt? 10-14 16-20 22-28 32-36

32-36 breaths/min (a respiratory rate higher than 30 breaths/min is often found in pts with pulmonary edema pt experiences dyspnea and orthopnea due to the accumulation of edematous fluid in the lung tissues which affects the pts respiratory rate respiratory rates in the ranges of 12-24 breaths/min indicate normal respiration)

a pt with valvular heart disease has not experienced any symptoms of HF. How should the nurse classify this pt according to the ACC/AHA stages of HF?

Stage B (stage B pts have STRUCTURAL heart disease w/o any s/s stage A pts are at high risk for HF, but w/o structural heart disease or symptoms of HF stage C pts have prior or current symptoms of HF associated with a known structural heart disease stage D: refractory HF requiring specialized interventions)

a pt is diagnosed with HF, which was caused by thyrotoxicosis (excess of thyroid hormone). The nurse identifies what other precipitating causes of HF? anemia myocarditis Paget's disease PE CAD

Anemia, Paget's disease, Pulmonary embolism (precipitating causes of HF: anemia (o2 carrying capacity in the blood is reduced, hypoxemia leads to an increase in CO which increases the workload on the heart) Paget's disease: increase in the vascular bed in the skeletal muscles, which causes an increase In the cardiac workload Pulmonary embolism: increase in pulmonary pressure decreases cardiac output myocarditis and CAD are the primary CAUSES of HF but are unlikely in this patient)

the nurse provides medication education to a pt with HF. 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?

Carvedilol (carvedilol is a beta blocker that inhibits the SNS, preventing the release of catecholamines (catecholamines increase HR and myocardial contractility which increases the workload of the heart) carvedilol also promotes reveres remodeling and decreases afterload furosemide is a diuretic and does NOT have the SNS blocking effects Digitalis and dopamine are Inotropic drugs that serve to increase contractility and do not block SNS stimulation)

epinephrine and norepinephrine are released in response to decreased CO that occurs in pts with heart failure. These catecholamines can cause what physiologic change?

increased myocardial oxygen demand (catecholamines increase HR and contractility, which increase myocardial workload and oxygen demand. Catecholamines cause vasoconstriction, an increased heart rate, and an increase in BP)

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?

Endomyocardial Biopsy (EMB) (endomyocardial biopsy is an investigation to find out the cause of NEW-onset HF that is UNRESPONSIVE to routine care. Hemodynamic monitoring (intraarterial BP) is included in the care plan for a pt with (ADHF) a chest x-ray and multigated acquisition (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)

the HFSA has developed the acronym FACES that a nurse can use to teach pts about the symptoms of HF. What are they symptoms that are included in FACES?

Fatigue, limitation of Activities, Chest congestion/Cough, Edema, Shortness of breath (FACES includes the symptoms Fatigue, limitation of Activities, Chest congestion/cough, Edema, and Shortness of breath In HF, inadequate O2 of the blood causes fatigue even while performing routine activites Edema Is due to change in CO which leads to accumulation of fluid in the interstitial spaces. This causes SOB and chest congestion All of these factors lead to a limitation of Activities in the pt)

the nurse is assessing a pt with a diagnosis of left sided HF. The nurse should monitor the pt for which characteristic symptom that occurs exclusively with this disorder?

Frothy, pink-tinged sputum (frothy, pink tinged sputum is a characteristic symptom associated with left HF. Fatigue and anxiety are present as a common symptom in BOTH right and left sided HF Right sided HF: anorexia is exclusively a symptom)

the nurse reviews a pt's medical Hx and identifies what risk factors for HF? cirrhosis HTN Multiple sclerosis Marfan's syndrome metabolic syndrome

HTN, Metabolic syndrome (HTN and CAD are the primary risk factors for HF. DM, metabolic syndrome, advanced age, tobacco use, and vascular disease also contribute to the development of HF Cirrhosis, Multiple sclerosis, and Marfan's syndrome are NOT precipitating causes of HF)

the nurse assesses a pt with a family Hx of HF. Which PRIMARY causes of HF are linked to specific genes and gene mutations? HTN hyperthyroidism CMP Rheumatic heart disease CAD

HTN, cardiomyopathy, CAD (primary causes of HF that are linked to specific genes and gene mutations include CAD, CMP, and HTN hyperthyroidism and rheumatic heart disease are primary causes of HF that are NOT linked to specific genes and gene mutation)

a pt is admitted with ADHF. Which part of the treatment plan will increase fatigue in this pt?

IV furosemide 40 mg every 6 hours (furosemide will cause diuresis and frequent trips to the bedside commode or bathroom, leading to fatigue.)

a nurse is caring for a pt with pleural effusion who is not responding to conventional medical treatment. Assessment findings include S3 and S4 heart sounds, crackles, and an increased heart rate Which condition is most likely affecting the pt?

Left-sided HF (manifestations of left sided HF: pleural effusion, s3 and s4 heart sounds, crackles, and an increased heart rate. these indicate a low CO cor pulmonale is the dilation of the right ventricle caused by pulmonary disease (manifests as right HF) Right sided HF causes edema, murmurs, and JVD Pulmonary edema manifests as dyspnea, orthopnea, anxiety, and cold and clammy skin)

What events occur as a result of ventricular remodeling? 1. increased contractility 2. increased wall tension 3. more effective pumping 4. increased ventricular mass 5. increased O2 consumption

increased wall tension, increased ventricular mass, increased O2 consumption (remodeling involves the hypertrophy of the ventricular myocytes. This means large, abnormally shaped contractile cells. This altered shape leads to increased ventricular mass, increased wall tension, increased O2 consumption, and impaired contractility. The ventricles become larger, but they become less effective pumps)

which compensatory mechanisms are initially effective in maintaining adequate CO? Ventricular dilation ventricular hypertrophy production of endothelin release of renin by the kidneys activation of the SNS

Ventricular dilation, ventricular hypertrophy, activation of SNS (increased contraction due to dilation initially leads to increased CO and maintenance of BP and perfusion increased contractile power of the heart's muscle fibers due to hypertrophy initially leads to an increase in CO and maintenance of tissue perfusion SNS responds by releasing catecholamines (epinephrine and norepinephrine) which enhance peripheral vasoconstriction and cause an increase in HR and myocardial contractility; initially this is beneficial with a result of increased CO endothelin is a potent vasoCONSTRICTOR; contributes to the development of HF release of renin by the kidneys starts a cascade of events, which results in further water and sodium retention in an already overloaded state)

the nurse recalls that many disease conditions predispose a pt to HF. Which pts need further assessment to evaluate their risk of developing HF? 1. pt with anemia 2. pt with thyrotoxicosis 3. patient with Paget's disease 4. pt with a fracture of ribs 5. pt with bacterial endocarditis

a patient with anemia, a patient with thyrotoxicosis, a patient with Paget's disease, and a patient with bacterial endocarditis (many diseases can increase the risk of HF in patients. Anemia: decreased oxygen carrying capacity of the blood stimulates an increase in CO to meet the demands of the body. This causes an increase in the cardiac workload, leading to an increase in the size of the left ventricle. The increased workload results in HF. The infection in bacterial endocarditis increases metabolic demands and oxygen requirements Valvular dysfunction in bacterial endocarditis may lead to stenosis and regurgitation. All of these factors lead to enlargement of the ventricle, resulting in HF. Paget's disease causes increased workload of the heart due to an increased vascular bed in the skeletal muscles)

a pt with chronic HF asks the nurse about heart transplantation. The nurse identifies that the surgery is absolutely contraindicated if the pt has what history findings? -severe obesity -age over 70 -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 are: recurrent life threatening dysrhythmias not response to maximal interventions and cardiac abnormalities that severely limit normal function severe obesity is a relative contraindication)

the nurse is preparing to administer digoxin to a pt with HF. The nurse should suspect digitalis toxicity if the pt reports which symptom?

anorexia (anorexia, nausea and vomiting, fatigue, headache, depression, and visual changes are early signs of toxicity. nurse should be concerned and notify HCP if pt exhibits any of these symptoms muscle aches, constipation, and restlessness are NOT signs of digitalis toxicity)

prior to requesting the family to make health care decisions for the pt, the nurse identifies that what is the priority action?

assessing the patient's decisional capacity (decisional capacity should be assessed without assuming it is absent)

what is the PRIORITY assessment of the nurse caring for a pt receiving IV nesiritide to treat HF? urine output lung sounds BP respiratory rate

blood pressure (urine output, lung sounds, and respiratory rate are appropriate for a pt receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main AE of nesiritide)

the nurse provides education about a 2 gram sodium diet to a pt with HF. What statement made by the pt indicates the need for further teaching? I can eat fresh fruits, such as bananas and peaches I will limit my intake of milk products to two cups a day bread is a good food choice because it has a very low salt content when I eat canned soups, I will need to choose soups low in sodium

bread is a good food choice because it has a very low salt content (bread has a high sodium content and should be avoided/limited fresh fruits have very little sodium one medium banana as a sodium content of 1 mg, and one medium peach has a sodium content of 7 mg milk products are limited to two cups daily to adhere to a low sodium diet canned soups have high sodium content, if canned soup is used choose a low sodium soup)

a pt receives immunosuppressive therapy after cardiac transplantation. the nurse identifies that the pt is at risk for what? cancer cataracts DVT cytomegalovirus (CMV) infection epstein-Barr virus (EBV) infection

cancer, cytomegalovirus infection, epstein-barr virus infection (risk of cancer is increased following long-term immunosuppressive therapy first year after transplantation causes of death are infection and acute rejection CMV infection may occur within the first few months after transplantation EBV infection may happen in the first year, and it is a major cause of death after immunosuppressive therapy cataracts are not a consequence of reduced immunity dVT usually arises as a result of surgical complications)

a pt who underwent cardiac transplantation has a BP of 150/98 mm Hg. The nurse anticipates that which medication will be prescribed to prevent excessive workload on the transplanted heart? captopril tacrolimus cyclosporine mycophenolate mofetil

captopril (ACE inhibitors such as captopril, are the first-line drug therapy prescribed for HTN in pts after cardiac transplantation. ACE inhibitors dilate venules and arterioles, improve renal blood flow, and relieve symptoms of HF. Tacrolimus, cyclosporine, and mycophenolate mofetil are immunosuppressants that are administered to prevent acute rejection)

the nurse is caring for a pt with chronic HF. What is appropriate to be included on the pt's plan of care? 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 and the right ventricle. This contributes to poor 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 POC for pts with ACUTE decompensated HF (ADHF). these pts need continuous monitoring and assessment)

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?

cardiac vasculopathy (beyond the first year after a transplant, malignancy and cardiac vasculopathy (accelerated 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 pt's risk of an infection)

a pt is suspected of having HF. The nurse recognizes that which diagnostic tests are commonly used to make this diagnosis? Chest x-ray echocardiogram pulmonary function tests electrocardiogram (ECG) electroencephalogram (EEG)

chest x-ray, echocardiogram, electrocardiogram (HF can be determined by tests such as ECG, echocardiogram, and chest x-ray. ECG is useful in examining the electrical conduction system of the heart which becomes impaired during HF echocardiogram is used to assess the functioning of the cardiac chambers chest x-ray may show cardiomegaly EEG diagnosing diseases of the BRAIN, especially seizures pulmonary function tests are advised In lung diseases associated with cardiac symptoms)

a pt is prescribed an ACE inhibitor for the treatment of HF. The nurse recognizes that this type of medication benefits pts with HF because it blocks what action?

conversion of angiotensin I to angiotensin II (angiotensin I is converted to angiotensin II by the angiotensin-converting enzyme found in the lungs. Angiotensin II stimulates the secretion of the hormone aldosterone; it causes the reabsorption of sodium and water into the blood, which increases BP)

a pt diagnosed with HF is treated with an angiotensin-converting enzyme inhibitor. The nurse should monitor the pt for what side effect?

cough (patients treated with ACE inhibitors have an increased risk for medication-related cough methyldopa causes anemia Beta blockers alter body temp aspirin can increase melanin production and cause hyperpigmentation)

the nurse recalls that the decreased filling of the ventricles that is associated with diastolic failure results in what primary manifestation?

decreased stroke volume and cardiac output (diastolic failure often is referred to as HF with normal EF. 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)

a pt with HF is hospitalized with a diagnosis of digitalis toxicity. The nurse expects what assessment findings? depression poor appetite heart rate of 52 distant heart sounds seeing halos around lights weight gain of 3 pounds in the past two days

depression, poor appetite, heart rate of 52, seeing halos around lights (poor appetite, decreased HR due to digitalis preparations causing a decrease in HR, depression, and visual changes ex seeing halos around lights, are all symptoms of digitalis toxicity)

the nurse is caring for a pt with ADHF who is receiving IV milrinone. The nurse recognizes that this medication is beneficial because of what effects it has on the body? increased diuresis dilation of renal blood vessels increased myocardial contractility promotion of peripheral vasodilation increased systemic vascular resistance

increased myocardial contractility, promotion of peripheral vasodilation (milrinone is a phosphodiesterase inhibitor. It increases myocardial contractility and promotes peripheral vasodilation does NOT dilate renal blood vessels and promote diuresis, nor does it increase systemic vascular resistance)

a pt states "for my HF, I take hydrochlorothiazide. I take a second medication that helps improve my heart's contractility." The pt assessment findings include hypokalemia, headache, and anorexia. The nurse suspects that the second medication the pt is referring to is what drug?

digoxin (digitalis preparations increase the force of cardiac contractility. Patients taking a digitalis preparation are at risk for digitalis toxicity. Early signs of toxicity include anorexia and headache. Hypokalemia, secondary to the use of potassium-depleting diuretics, is one of the most common causes of digitalis toxicity. Severe hypotension and hypokalemia is seen with captopril carvedilol may cause profound bradycardia, hypotension, and cardiogenic shock metolazone causes severe reduction in potassium levels and inhibits sodium reabsorption)

a pt is diagnosed with ADHF. The nurse anticipates a prescription for which medication that is a selective B-agonist, does not increase systemic vascular resistance, and that is preferred for short-term treatment of ADHF? milrinone dobutamine dopamine procainamide

dobutamine (unlike dopamine, dobutamine is a selective B-agonist. It does not increase systemic vascular resistance 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 1A antidysrhythmic drug used to treat or prevent dysrhythmias)

a pt presents with edema of the legs, dyspnea, and fatigue. The pt is diagnosed with ADHF. the nurse expects that which medications will be included in the pt's immediate treatment plan? digitalis dopamine furosemide morphine sulfate sodium nitroprusside

dopamine, furosemide, morphine sulfate, sodium nitroprusside (ADHF should be treated immediately to prevent complications. Furosemide is a loop diuretic used to promote sodium and water loss. Water loss decreases the preload and enhances the cardiac contractility. Sodium nitroprusside is a potent vasodilator and reduces both the preload and afterload. this results in improved cardiac contractility. dopamine is a beta blocker and is used to dilate the renal vessels and promote water loss Morphine sulfate reduces preload and afterload; it is frequently used in the treatment of HF and acute coronary syndrome. It dilates pulmonary and systemic blood vessels, resulting in decreased pulmonary pressure and increased gas exchange. Digitalis is a positive inotrope that improves the myocardial contractility. It requires a loading dose and time to work, so it is not recommended for the INITIA treatment of ADHF)

a pt that is admitted to the ER is diagnosed with ADHF, manifesting as pulmonary edema. The nurse expects to observe which clinical manifestations?

dyspnea, rapid heart rate, frothy-blood tinged sputum (pulmonary edema clinical manifestations are dyspnea, rapid heart rate, and frothy blood-tinged sputum skin becomes clammy and cold from the vasoconstriction caused by the stimulation of the SNS respiratory rate is often greater than 30 breaths per min)

a pt develops unexplained HF that remains unresponsive to usual therapy. For what diagnostic test does the nurse prepare the pt?

echocardiogram (echocardiogram provides information on the 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 EF and blockages)

a pt is admitted to the ER with pain, dyspnea, and LE edema. The pt is diagnosed w diastolic HF. The nurse recognizes that which clinical finding aids in the diagnosis of diastolic HF? low filling pressures EF of 55% impaired contractile function EF less than 45%

ejection fraction of 55% (diastolic failure is known as HF with preserved EF (HFpEF) meaning the finding should be a normal EF. a normal EF is 55-60%. Diastolic failure is characterized by high filling pressures because of stiff ventricles.)

what should the nurse recognize as an indication for the use of dopamine in the care of a pt with HF?

hypotension and tachycardia (dopamine is a Beta agonist whose inotropic action is used for treatment of severe HF 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 HF, but these do not necessarily warrant the use of dopamine)

a pt with HF receives a prescription for digoxin. The nurse recognizes that this medication benefits pts with HF because of what positive inotropic effect?

increased myocardial contractility (increase in myocardial contractility is called positive inotropic effect. increase in HF is called positive chronotropic effect. Positive inotropic effect results in an increase in stroke volume and cardiac output)

a nurse is caring for a pt with worsening HF that is hemodynamically unstable. What is likely to be included in the pt's treatment plan to increase coronary blood flow to the heart muscle? vasodilators ultrafiltration intraaortic ballon pump (IABP) ventricular assist device (VAD)

intraaortic balloon pump (IABP) (IABP increases coronary blood flow to the heart muscle and decreases the heart's workload through a process called "counterpulsation". vasodilators improve the coronary artery circulation by dilating the coronary arteries ultrafiltration is the process of removing excess salt and water from the pt's blood. Ventricular assist devices are used to maintain the pumping action of the blood, because the contracting ability of the heart decreases, thereby affecting its ability to function)

the nurse identifies that which intervention is the MOST suitable for a pt with worsening acute decompensated heart failure (ADHF) that is hemodynamically unstable? ultrafiltration (UF) endotracheal intubation intraaortic balloon pump (IABP) Bilevel positive airway pressure (BiPAP)

intraaortic balloon pump (IABP) (uses a process called counterpulsation to increase coronary blood flow and decrease the heart's workload UF removes excess salt and water from the blood endotracheal intubation and BiPAP help maintain an open airway)

a patients apical heart rate is 45 beats/minute. The nurse should withhold which scheduled medication? morphine metoprolol furosemide rosuvastatin

metoprolol (metoprolol is a Beta Blocker that inhibits the SNS causing a decrease in heart rate; therefore this should be withheld and the HCP notified Diuretics (furosemide) used to reduce edema, pulmonary venous pressure, and preload; pulse rate Is not affected Morphine is used to reduce pain and anxiety, it also decreases preload and afterload; may be given if the pt is in pain and has a heart rate of 45 Antihyperlipidemic drugs (rosuvastatin) are used to help control cholesterol in the pt; a heart rate of 45 does not indicate that it should be withheld)

a pt has been diagnosed with dilated cardiomyopathy (DCM). the nurse identifies that the pt is at risk for what condition?

mixed systolic and diastolic failure (DCM is a condition in which already compromised systolic function is further compromised by dilated left ventricular walls that are unable to relax. Pts usually have very low EF, as well as BIventricular failure which is a characteristic of mixed systolic and diastolic failure. Systolic Failure: decrease in left ventricular EF because of the heart's inability to pump blood effectively Diastolic failure: heart failure with normal EF Left ventricular Hypertrophy is not a type of HF itself)

the nurse is caring for a pt admitted to the ICU with HF. The pt is prescribed IV sodium nitroprusside. Which actions should the nurse take when administering the medication? monitor arterial BP ensure a slow rate of administration place the patient in high Fowler's position monitor the IV site carefully since the patient is at high risk of extravasation record baseline BP and continuously throughout administration

monitor arterial BP, ensure a slow rate of administration, record baseline blood pressure and continuously throughout administration (hypotension is the MAIN adverse effect. When preparing to administer the vasodilator nitroprusside, the nurse should assess the pt's BP before and during the administration. Arterial BP monitoring is also recommended during drug infusion the nurse should ensure a slow rate of IV administration to prevent a sudden reduction in BP the pt is not at an increased risk of extravasation when receiving this medication. A patient with dyspnea is placed in high Fowler's position)

a pt is admitted to the hospital with HF. The nurse should monitor the pt for what complications? pleural effusion dysrhythmias hepatomegaly renal failure thyrotoxicosis

pleural effusion, dysrhythmias, hepatomegaly, renal failure (a pleural effusion occurs when excess fluid builds up in the pleural cavity of the lungs secondary to increasing pressure in the pleural capillaries. Fluid then moves from these capillaries into the pleural space chronic HF causes enlargement of the chambers of the heart. This enlargement can cause changes in the normal electrical pathways HF can lead to severe hepatomegaly. The liver becomes congested with venous blood The decreased CO that accompanies chronic HF results in decreased perfusion to the kidneys and can lead to renal insufficiency or failure)

the nurse assesses that a pt with acute decompensated HF (ADHF) experiences dyspnea. What is the PRIORITY nursing action? perform ultrafiltration provide supplemental O2 provide mechanical ventilation obtain arterial blood gases (ABGs)

provide supplemental oxygen (supplemental O2 helps increase the percentage of O2 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 ABG test will provide information about the amount of O2 and CO2 in the blood, but it is not a priority )

a pt with a recent diagnosis of HF has been prescribed furosemide (diuretics, Lasix). the nurse recognizes that the medication is appropriate for the pt because of what physiologic effect it has on the body?

reduces preload (diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do NOT influence directly afterload, contractility, or vessel tone)

what effect does nitroglycerin have on the body that benefits a pt with ADHF? reduces preload prevents dysrhythmias prevents thromboembolism dilates the coronary arteries increases myocardial oxygen supply

reduces preload, dilates the coronary arteries, increases myocardial oxygen supply (nitroglycerin is a vasodilating medication that improves blood flow to the myocardium and, by vasodilating, decreases preload as well. nitroglycerin has no dysrhythmic properties and does not prevent thromboembolism)

a pt in HF experiences a neurohormonal response of the RAAS. What does this response trigger?

retention of sodium and water (the RAAS triggers retention of fluid and sodium. It causes vasoconstriction to increase BP, not vasodilation. CO is increased, not decreased, and ADH release is increased, not decreased)

the nurse recognizes what indications for cardiac transplantation?

severe, decompensated, inoperable valvular disease end stage heart failure refractory to medical care cardiac abnormality that has a mortality rate of more than 50% within two years recurrent life-threatening dysrhythmias not responsive to maximal interventions (severe valvular disease may not compromise the vital functions of the heart. End stage heart failure refractory to medical care may prove to be fatal if the heart is not transplanted Cardiac transplantation would be the only option left for a cardiac abnormality that has a mortality rate of more than 50% within two years. Recurrent life-threatening dysrhythmias not response to maximal interventions may prove to be fatal angina pectoris is a transient blockage of coronary blood vessels and may not be severe enough to require a cardiac transplantation myocardial ischemia is an inadequate oxygen supply to the myocardial tissue and also may not be severe enough to require a cardiac transplantation)

a pt 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? 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 pt with chronic HF develops enlarged breasts. The nurse reviews the pt's medication profile and suspects that which medication is the cause of the patient's condition? digoxin captopril carvedilol spironolactone

spironolactone (spironolactone (diuretics) if used for a prolonged period, may cause breast enlargement or gynecomastia in males digoxin may cause bradycardia and AV block captopril may cause conditions such as hypotension and hyperkalemia carvedilol may cause side effects of profound bradycardia, hypotension, and bronchospasm )

a pt is diagnosed with HF. The nurse identifies that which factors may influence the pt's cardiac output? stroke volume portal pressure respiratory rate myocardial contractility decreased filling of the ventricles

stroke volume, myocardial contractility, decreased filling of the ventricles (CO depends on stroke volume, decreased filling of the ventricles, and myocardial contractility. decreased filling of the ventricles decreases CO. Impaired myocardial contractility decreases CO)

diagnostic results of a pt reveal an EF of 32%. The nurse recognizes that the finding may be indicative of what conditions?

systolic failure, mixed systolic and diastolic failure (EF is defined as the amount of blood ejected from the left ventricle after each contraction. normal EF is 55-60% hallmark of systolic failure is a DECREASE in EF (less than 45%) mixed systolic and diastolic failure (less than 35%) diastolic failure EF is normal)

a pt presents to the ER with acute decompensated HF (ADHF) and indications of alveolar edema. The nurse expects what assessment findings? tachypnea lower PaO2 increased glucose levels changes in metabolic status increased partial pressure of CO2 in arterial blood (PaCO2)

tachypnea, lower PaO2, increased partial pressure of CO2 in arterial blood (PaCO2) (when the pulmonary venous pressure increases, the alveoli lining cells are disrupted and a fluid containing RBC moves into the alveoli (alveolar edema). As the disruption becomes worse from further increases in the pulmonary venous pressure, the alveoli and airways are flooded with fluid. This is accompanied by a worsening of arterial blood gases (lower PaO2 and possible increased partial pressure of CO2 in arterial blood and progressive respiratory alkalosis). Abnormalities in the glucose levels and metabolic status of the pt do not indicate alveolar edema)

the nurse provides information to a group of nursing students about primary causes of HF. The nurse should include what interventions that are associated with primary causes and that are aimed at reducing the RISK of pts developing HF? blood transfusions for anemia taking BP medications as prescribed decreasing dysrhythmias by reducing caffeine intake initiating lifestyle changes to avoid CAD taking aspirin every day to reduce the incidence of PE

taking BP medication prescribed, initiating lifestyle changes to avoid CAD (HTN and CAD are considered PRIMARY causes of HF. anemia, dysrhythmias, and PE are precipitating causes of HF)

the nurse is providing discharge education for a pt with moderate HF. What physical activity is recommended and should be included in the POC?

taking frequent rest breaks during activities (pt with moderate HF 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 pts with moderate HF walking briskly is too strenuous for this pt activity is standardized for pts with heart failure and is included in the POC)

a pt is admitted to the hospital with HF. following an assessment, the HCP classifies the pt as NYHA II. What is the most likely reason for this classification?

the pt reports feeling comfortable at rest, but ordinary physical activity causes fatigue (class II: no symptoms at rest)

a nurse reviews the assessment findings of a pt with acute decompensated HF (ADHF) and notes a pulmonary artery wedge pressure (PAWP) of 28 mm Hg, an intake of 1000 mL more than the output in 24 hours, and resistance to diuretics. The nurse anticipates a prescription for which clinical intervention? oxygen therapy ultrafiltration (UF) biventricular pacing cardiac transplantation

ultrafiltration (UF) (in a patient with ADHF, the pulmonary artery wedge pressure (PAWP) can be as high as 30 mm Hg. a NORMAL PAWP is between 18 and 22 mm Hg ideal pts for UF are those with major pulmonary or systemic overload who have shown RESISTANCE to diuretics and are hemodynamically stable. UF helps decrease the fluid overload in the lungs and, therefore, decreases the PAWP. O2 therapy may improve perfusion, but it does not cause a decrease in PAWP. Biventricular pacing and cardiac transplantation are preferred in cases of CHRONIC HF but are not the best options fo ADHF)