Med Surg : Chapter 34 -2

The nurse recognizes that which condition is an absolute contraindication for cardiac transplantation?

Advanced cerebral or peripheral vascular disease not amenable to correction

A stable patient with acute decompensated heart failure (ADHF) experiences mild dyspnea. The nurse plans to place the patient in a high Fowler's position with the feet dangling at the bedside. To ensure safety, before positioning the patient's feet, what should the nurse assess?

Blood pressure

The nurse is caring for a patient with acute decompensated heart failure (ADHF) who is experiencing volume overload. The nurse anticipates a prescription for what type of drug?

Diuretic

The nurse recognizes the need for more frequent monitoring of electrolytes when a patient that takes digitalis receives a prescription for what type of medication?

Diuretic

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?

Infection

A patient with chronic heart failure asks the nurse why ivabradine has been prescribed. What explanation should the nurse provide?

It inhibits the sinus node and reduces heart rate (HR)

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?

Metoprolol

The nurse provides education about a 2-gram sodium diet to a patient with heart failure. Which statement made by the patient indicates the need for further teaching?

"Bread is a good food choice because it has a very low salt content."

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.

-ABO blood type -Body size and heart size -Human leukocyte antigen typing -Panel of reactive antibody (PRA) level

The nurse is preparing a discharge plan for a patient with heart failure (HF). The patient does not drive and does not have family members or friends to assist with transportation. What actions should the nurse take related to post-discharge care? Select all that apply.

-Arranging for home health care -Providing printed medication instructions -Arranging for transportation for follow-up appointments -Coordinating equipment for at-home monitoring, including an electronic scale, a blood pressure cuff, and a pulse oximeter

A patient receives immunosuppressive therapy after cardiac transplantation. The nurse identifies that the patient is at risk for what? Select all that apply.

-Cancer -Cytomegalovirus (CMV) infection -Epstein-Barr virus (EBV) infection

The nurse reviews compensatory mechanisms associated with heart failure (HF). The nurse recalls that the sequence of events in the renin-angiotensin-aldosterone system (RAAS) occur in what order?

-Cardiac output falls -Renin is released -Angiotensinogen is activated -Angiotensin I is converted to angiotensin II -Vasoconstriction occurs

The nurse reviews the compensatory mechanisms an overloaded heart uses to try to maintain adequate cardiac output (CO). What is the order of events that occur when the sympathetic nervous system is activated?

-Inadequate cardiac output -Release of catecholamines -Increase in peripheral vasoconstriction -Increase in cardiac output

The nurse is caring for a patient with acute decompensated heart failure (ADHF) who is receiving intravenous (IV) milrinone. The nurse recognizes that this medication is beneficial because of what effects it has on the body? Select all that apply.

-Increased myocardial contractility -Promotion of peripheral vasodilation

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.

-Age over 70 years -Advanced cerebral or vascular disease not amenable to correction

A patient is diagnosed with heart failure, which was caused by thyrotoxicosis. The nurse identifies what other precipitating causes of heart failure? Select all that apply.

-Anemia -Paget's disease -Pulmonary embolism

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 (CO)

A patient has undergone cardiac transplantation. The nurse expects that which treatment will be prescribed?

Immunosuppressive therapy

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?

Tacrolimus

A patient that received a prescription for a diuretic experiences worsening heart failure. During history-taking, the patient tells the nurse, "I quit taking my medication because I was frequently disrupting church services to go to the restroom." What suggestion by the nurse is most likely to increase the patient's compliance with the medication regimen?

"Let's determine if we can adjust your medication schedule, such as taking the diuretic after church services."

A patient is suspected of having heart failure. The nurse recognizes that which diagnostic tests are commonly used to make this diagnosis? Select all that apply.

-Chest x-ray -Echocardiogram -Electrocardiogram (ECG)

A patient with heart failure is hospitalized with a diagnosis of digitalis toxicity. The nurse expects what assessment findings? Select all that apply.

-Depression -Poor appetite -Heart rate (HR) of 52 -Seeing halos around lights

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.

-Distended neck veins -Enlarged cardiac muscle -Engorged or enlarged liver

A patient presents with edema of the legs, dyspnea, and fatigue. The patient is diagnosed with acute decompensated heart failure (ADHF). The nurse expects that which medications will be included in the patient's immediate treatment plan? Select all that apply.

-Dopamine -Furosemide -Morphine sulfate -Sodium nitroprusside

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.

-Hypertension -Cardiomyopathy -Coronary artery disease (CAD)

What events occur as a result of ventricular remodeling? Select all that apply.

-Increased wall tension -Increased ventricular mass -Increased O2 consumption

The nurse is caring for a patient admitted to the intensive care unit with heart failure. The patient is prescribed IV sodium nitroprusside. Which actions should the nurse take when administering the medication? Select all that apply.

-Monitor arterial BP -Ensure a slow rate of administration -Record baseline blood pressure and continuously throughout administration.

What effect does nitroglycerin have on the body that benefits a patient with acute decompensated heart failure (ADHF)? Select all that apply.

-Reduces preload -Dilates the coronary arteries -Increases myocardial oxygen supply

The nurse recognizes what indications for cardiac transplantation? Select all that apply.

-Severe, decompensated, inoperable, valvular disease -End stage heart failure (HF) 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

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

Digoxin

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?

Digoxin

A male patient with a long history of heart failure qualifies for hospice care. The nurse identifies what priority goal?

Providing comfort and relieving suffering

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?

Pulmonary congestion

A patient with a history of acute decompensated heart failure (ADHF) reports blood-tinged sputum, productive frothy cough, and rapid heart rate. The nurse suspects that which condition induced these clinical manifestations?

Pulmonary edema

An echocardiogram for a patient indicates enlarged ventricles of the heart. The nurse caring for the patient understands that this condition has occurred as a result of a chronic condition. What could be the cause of the cardiac dilation?

Elevated pressure in the ventricles

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)

The nurse is caring for a patient developing pulmonary edema. What respiratory rate does the nurse anticipate when assessing this patient?

32 to 36 breaths/minute

What is the most probable cause of death in a patient in the first year after heart transplantation?

Acute rejection

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?

Bilateral edema

A patient with cardiac failure is scheduled to receive sodium nitroprusside. The nurse should monitor what parameter while administering the drug to the patient?

Blood pressure

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?

"I'm not really hungry for lunch. I feel so nauseated and tired."

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

-Stroke volume -Myocardial contractility -Decreased filling of the ventricles

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.

-Systolic failure -Mixed systolic and diastolic failure

A patient presents to the emergency department with acute decompensated heart failure (ADHF) and indications of alveolar edema. The nurse expects what assessment findings? Select all that apply.

-Tachypnea -Lower PaO2 -Increased partial pressure of CO2 in arterial blood (PaCO2)

The nurse provides information to a group pf 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.

-Taking blood pressure medication as prescribed -Initiating lifestyle changes to avoid coronary artery disease (CAD)

A patient that is diagnosed with heart failure experiences fatigue. The nurse suspects that the fatigue is caused by what?

Impaired perfusion to vital organs

Which compensatory mechanisms are initially effective in maintaining adequate cardiac output (CO)? Select all that apply.

-Ventricular dilation -Ventricular hypertrophy -Activation of the sympathetic nervous system (SNS)

The patient with heart failure (HF) receives a prescription for digoxin 0.125 mg by mouth daily. The pharmacy issues 0.5-mg tablets. What should the nurse administer?

0.25 tablet

A patient newly diagnosed with heart failure is being discharged from the hospital. Which health care team member frequently works with protocols set up with the patient's health care provider to identify problems and start interventions?

Home health nurse

A patient's apical heart rate is 45 beats/minute. The nurse should withhold which scheduled medication?

Metoprolol

The nurse is caring for a patient with worsening heart failure (HF) that is hemodynamically unstable. What is likely to be included in the patient's treatment plan to increase coronary blood flow to the heart muscle?

Intraaortic balloon pump (IABP)

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?

Mixed systolic and diastolic failure

The nurse is administering a dose of digoxin. The nurse should suspect digitalis toxicity when the patient reports which symptom?

Nausea

The nurse is caring for a patient with left-sided heart failure and expects what assessment finding?

Pulmonary congestion

Which is considered decisional capacity for informed consent related to treatment decisions?

The patient must be able to communicate his or her decisions

Which device is approved as a bridge to transplantation (BTT) and as destination therapy (DT) for those patients who do not meet criteria for a heart transplant?

Thoratec HeartMate II

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?

"I can add salt to my food and eat what I want."

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?

"I should not use salt at the table."

A patient with atrial fibrillation is due for a first dose of digoxin 125 mcg intravenous (IV) push. The pharmacy issues a vial containing 0.25 mg/mL. How much medication should the nurse withdraw from the vial??

0.5 mL

The nurse is caring for a patient newly diagnosed with heart failure. The patient is scheduled to receive digoxin 0.125 mg intravenous (IV) push. The pharmacy issues a vial containing 0.25 mg/mL. How much medication should the nurse withdraw from the vial? Insert a leading zero if applicable. Fill in the blank using one decimal place. ___mL

0.5 mL

A patient with a history of left-sided heart failure arrives in the emergency department reporting extreme shortness of breath and a persistent cough with pink, frothy sputum. On auscultation of the heart, the nurse notes an S3 gallop. The nurse recognizes those symptoms as being caused by what?

Acute pulmonary edema

A patient with heart failure complains of fatigue. The nurse understands that which causes of fatigue are associated with heart failure?

Anemia

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?

Angioedema

The nurse is preparing to administer digoxin to a patient with heart failure (HF). The nurse should suspect digitalis toxicity if the patient reports which symptom?

Anorexia

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

Assessing the patient's decisional capacity

What is the priority assessment of the nurse caring for a patient receiving intravenous nesiritide to treat heart failure?

Blood pressure

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?

Bradycardia

During history-taking, the nurse notes that a patient consumes foods high in sodium, which contributes to the patient's hypertension. The nurse develops a dietary plan and should educate the patient to avoid which food item?

Canned soups

A patient who underwent cardiac transplantation has a blood pressure of 150/98 mm Hg. The nurse anticipates that which medication will be prescribed to prevent excessive workload on the transplanted heart?

Captopril

The nurse is caring for a patient with chronic heart failure. What is appropriate to be included on the patient's plan of care?

Cardiac resynchronization therapy (CRT)

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

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?

Carvedilol

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?

Conversion of angiotensin I to angiotensin II

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?

Cough

A patient that is suspected to have heart failure reports fatigue. The nurse recalls that what condition related to newly diagnosed heart failure causes fatigue?

Decreased oxygenation of the tissues

A patient is diagnosed with pulmonary edema. The nurse anticipates a prescription for which type of medication?

Diuretic

The nurse recalls that which type of drug therapy is used to treat volume overload in patients with acute decompensated heart failure (ADHF)?

Diuretics

A male patient with a diagnosis of heart failure receives a prescription for a nitrate. The nurse should teach the patient to avoid what?

Drugs used to treat erectile dysfunction

A patient is admitted to the emergency department with pain, dyspnea, and lower extremity edema. The patient is diagnosed with diastolic heart failure. The nurse recognizes that which clinical finding aids in the diagnosis of diastolic heart failure?

Ejection fraction of 55%

A patient is admitted to the hospital with a diagnosis of acute decompensated heart failure (ACHF). The primary health care provider prescribes a continuous intravenous infusion of sodium nitroprusside. What is the priority nursing intervention?

Monitor blood pressure.

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?

Extravascular fluid being reabsorbed from the interstitial spaces back into the circulatory system, resulting in increased perfusion to the kidneys

While assessing a patient with acute decompensated heart failure (ADHF), the nurse auscultates fine crackles bilaterally. The nurse recognizes that crackles are an indicator of what?

Fluid in the alveoli

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?

Frothy, pink-tinged sputum

The nurse develops dietary education for a patient with heart failure (HF) and should include what information?

Guidelines for a low-sodium diet

The nurse recalls that paroxysmal nocturnal dyspnea is a condition indicative of what more serious problem?

Heart failure

A patient with heart failure (HF) takes digoxin. The nurse recognizes that the patient is at risk for digitalis toxicity if what condition exists?

Hypokalemia

A patient with heart failure (HF) often experiences dyspnea and reports feeling very anxious during the dyspneic episodes. The nurse anticipates a prescription for what medication?

Morphine

What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure?

Hypotension and tachycardia

The nurse is educating a patient about diastolic failure and should include what characteristic feature?

Inability of the ventricles to relax and fill

A patient with heart failure (HF) receives a prescription for digoxin. The nurse recognizes that this medication benefits patients with HF because of what positive inotropic effect?

Increased myocardial contractility

A patient is admitted with acute decompensated heart failure. Which part of the treatment plan will increase fatigue in this patient?

Intravenous (IV) furosemide 40 mg every six hours

A nurse is caring for a patient 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 patient?

Left-sided heart failure

The nurse is caring for a patient with manifestations of acute decompensated heart failure (ADHF). What is the priority nursing assessment?

Lung sounds

The nurse recognizes that a primary goal for a patient with chronic heart failure is what?

Maximizing cardiac output

A patient is diagnosed with left-sided heart failure. The nurse expects what assessment finding?

Orthopnea

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?

Potassium

A patient is diagnosed with left ventricular hypertrophy that resulted from untreated hypertension. The nurse should monitor the patient for symptoms of what condition?

Poor contractility

The nurse assesses that a patient with acute decompensated heart failure (ADHF) experiences dyspnea. What is the priority nursing action?

Provide supplemental oxygen

A patient with acute decompensated heart failure (ADHF) experiences severe pulmonary edema. The nurse identifies that what intervention will increase the percentage of O2 in inspired air and is effective in decreasing preload?

Providing bilevel positive airway pressure (BiPAP)

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

Report a weight gain of 3 lb (1.4 kg) in two days, or 3 to 5 lbs (2.3 kg) in a week

A patient in heart failure experiences a neurohormonal response of the renin-angiotensin-aldosterone system (RAAS). What does this response trigger?

Retention of sodium and water

The assessment findings of a patient with myocardial infarction (MI) include jugular venous distention, weight gain, peripheral edema, and a heart rate of 108/minute. The nurse suspects what complication?

Right-sided HF

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?

Sodium nitroprusside

A patient with valvular heart disease has not experienced any symptom of heart failure. How should the nurse classify this patient according to the American College of Cardiology/American Heart Association (ACC/AHA) stages of heart failure (HF)?

Stage B

The nurse reviews the pathophysiology of heart failure. Which compensatory mechanism results in increased heart rate, increased myocardial contractility, and peripheral vasoconstriction?

Sympathetic nervous system (SNS) activation

The nurse recalls that symptoms of right-sided heart failure are caused by what condition?

Systemic venous congestion

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?

The patient reports feeling comfortable at rest but that ordinary physical activity causes fatigue

The nurse encourages the patient diagnosed with chronic heart failure to obtain physical and emotional rest. What is the rationale that is offered by the nurse to the patient?

To decrease the need for additional oxygen

The nurse reviews the assessment findings of a patient with acute decompensated heart failure (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?

Ultrafiltration (UF)