NUR 332: cardio coursepoint pt. 2

The nurse is gathering data from a client recently admitted to the hospital. The nurse asks the client about experiencing orthopnea. What question would the nurse ask to obtain this information?

"Are you only able to breathe when you are sitting upright?"

A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when he makes which statement?

"I sleep on three pillows each night."-- Orthopnea is a classic sign of left-sided heart failure. The client commonly sleeps on several pillows at night to help facilitate breathing

The nurse does an assessment on a patient who is admitted with a diagnosis of right-sided heart failure. The nurse knows that a significant sign is which of the following?

Pitting edema

A client has had an echocardiogram to measure ejection fracton. The nurse explains that ejection fraction is the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects?

55%

The nursing instructor is discussing heart failure with their clinical group. The instructor talks about heart failure in terms of a decreasing ejection fraction of the heart. What diagnostic test is used to measure the ejection fraction of the heart?

Echocardiogram

Which diagnostic study is usually performed to confirm the diagnosis of heart failure?

Echocardiogram

The nurse is caring for a client with suspected right-sided heart failure. What would the nurse know that clients with suspected right-sided heart failure may experience?

Gradual unexplained weight gain

Which of the following therapies are for patient who have advanced heart failure (HF) after all other therapies have failed?

Heart transplant

The nurse is preparing to administer hydralazine and isosorbide dinitrate (Dilatrate). When obtaining vital signs, the nurse notes that the blood pressure is 90/60. What is the priority action by the nurse?

Hold the medication and call the physician-- Hydralazine lowers systemic vascular resistance and left ventricular afterload. If these medications lead to severe hypotension, the nurse should hold the medication and call the physician.

Which is a characteristic of right-sided heart failure?

Jugular vein distention

The nurse is providing discharge instructions to a client with heart failure preparing to leave the following day. What type of diet should the nurse request the dietitian to discuss with the client?

Low-sodium diet

The client with cardiac failure is taught to report which symptom to the physician or clinic immediately?

Persistent cough-- Persistent cough may indicate an onset of left-sided heart failure. Loss of appetite, weight gain, interrupted sleep, unusual shortness of breath, and increased swelling should also be reported immediately.

The nurse is preparing to administer furosemide to a client with severe heart failure. What lab study should be of most concern for this client while taking furosemide?

Potassium level of 3.1-- Severe heart failure usually requires a loop diuretic such as furosemide (Lasix). These drugs increase sodium and therefore water excretion, but they also increase potassium excretion. If a client becomes hypokalemic, digitalis toxicity is more likely.

The nurse is administering nitroglycerin, which he knows decreases preload as well as afterload. Preload refers to which of the following?

The amount of blood presented to the ventricles just before systole

A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client?

The development of left-sided heart failure

A nurse caring for a client recently admitted to the ICU observes the client coughing up large amounts of pink, frothy sputum. Lung auscultation reveals course crackles to lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing

decompensated heart failure with pulmonary edema.

A client with a history of an anterior wall myocardial infarction is being transferred from the coronary care unit (CCU) to the cardiac step-down unit (CSU). While giving a report to the CSU nurse, the CCU nurse says, "His pulmonary artery wedge pressures have been in the high normal range." The CSU nurse should be especially observant for:

pulmonary crackles.

Which of the following is a key diagnostic indicator of heart failure (HF)?

Brain natriuretic peptide (BNP)-- High levels of BNP are a sign of high cardiac filling pressure and can aid in the diagnosis of HF.

Which medication reverses digitalis toxicity?

Digoxin immune FAB-- Digoxin immune FAB binds with digoxin and makes it unavailable for use. The dosage is based on the digoxin concentration and the client's weight

You are caring for a client with left-sided heart failure. When you go in to do your shift assessment, you find your client is wheezing, restless, tachycardic, and has severe apprehension. You know that these are symptoms of what?

Acute pulmonary edema

A client with chronic heart failure is able to continue with his regular physical activity and does not have any limitations as to what he can do. According to the New York Heart Association (NYHA), what classification of chronic heart failure does this client have?

Class I (Mild)

A patient has been experiencing increasing shortness of breath and fatigue. The physician has ordered a diagnostic test in order to determine what type of heart failure the patient is having. What diagnostic test does the nurse anticipate being ordered?

Echocardiogram

A client with congestive heart failure is admitted to the hospital after reporting shortness of breath. How should the nurse position the client in order to decrease preload?

Head of the bed elevated 45 degrees and lower arms supported by pillows-- Preload refers to the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole. The client is positioned or taught how to assume a position that facilitates breathing. The number of pillows may be increased, the head of the bed may be elevated, or the client may sit in a recliner. In these positions, the venous return to the heart (preload) is reduced, pulmonary congestion is alleviated, and pressure on the diaphragm is minimized. The lower arms are supported with pillows to eliminate the fatigue caused by the pull of the client's weight on the shoulder muscles.

Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole?

Preload

Which is a potassium-sparing diuretic used in the treatment of heart failure?

Spironolactone

The nurse is discussing cardiac hemodynamics with a nursing student, who understands the following formula: CO = HR X SV (cardiac output equals heart rate times stroke volume). The student asks what determines stroke volume. The correct response by the nurse is which of the following?

Stroke volume depends on three factors: preload, afterload, and contractility.

While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). The nurse should document this as:

a third heart sound (s3)-- An S3 is heard following an S2, which commonly occurs in clients experiencing heart failure and results from increased filling pressures.