PrepU Chapter 29: Heart Disease (Exam 1)

A total artificial heart (TAH) is an electrically powered pump that circulates blood into the pulmonary artery and the aorta, thus replacing the functions of both the right and left ventricles. What makes it different from an LVAD? -An LVAD only supports a failing left ventricle. -It is specifically designed for long-term use. -It never needs batteries. -It is designed for extremely active patients.

-An LVAD only supports a failing left ventricle. A TAH is considered an extension of LVADs, which only support a failing left ventricle. TAHs are targeted for clients who are unlikely to live more than a month without further interventions.

A patient in severe pulmonary edema is being intubated by the respiratory therapist. What priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea? -Observe for mist in the endotracheal tube. -Listen for breath sounds over the epigastrium. -Call for a chest x-ray. -Attach a pulse oximeter probe and obtain values.

-Call for a chest x-ray. A chest x-ray is always obtained after ET tube placement to confirm that the tube is in the proper position within the trachea.

A client has been prescribed furosemide (Lasix) 80 mg twice daily. The cardiac monitor technician informs the nurse that the client has started having rare premature ventricular contractions followed by runs of bigeminy lasting 2 minutes. During the assessment, the nurse determines that the client is asymptomatic and has stable vital signs. Which of the following actions should the nurse perform next? -Call the physician. -Check the client's potassium level. -Summon the nurse-manager. -Administer potassium.

-Check the client's potassium level. The client is asymptomatic but has had a change in heart rhythm. More information is needed before calling the physician. Because the client is taking furosemide (Lasix), a potassium-wasting diuretic, the next action would be to check the client's potassium level. The nurse would then call the physician with a more complete database. The physician will need to be notified after the nurse checks the latest potassium level. Calling the nurse-manager is not indicated at this time. Administering potassium requires a physician's order.

The nurse identifies which symptom as a manifestation of right-sided heart failure (HF)? -Accumulation of blood in the lungs -Congestion in the peripheral tissues -Reduction in forward flow -Reduction in cardiac output

-Congestion in the peripheral tissues Right-sided HF, failure of the right ventricle, results in congestion in the peripheral tissues and the viscera and causes systemic venous congestion and a reduction in forward flow. Left-sided HF refers to failure of the left ventricle; it results in pulmonary congestion and causes an accumulation of blood in the lungs and a reduction in forward flow or cardiac output that results in inadequate arterial blood flow to the tissues.

What is the primary underlying disorder of pulmonary edema? -Decreased left ventricular pumping -Decreased right ventricular elasticity -Increased left atrial contractility -Increased right atrial resistance

-Decreased left ventricular pumping Pulmonary edema is an acute event that results from heart failure. Myocardial scarring, resulting from ischemia, limits the distensibility of the ventricle, making it vulnerable to demands for increased workload. When the demand on the heart increases, there is resistance to left ventricular filling and blood backs up into the pulmonary circulation. Pulmonary edema quickly develops.

A client is exhibiting digitalis toxicity. Which of the following medications would the nurse expect to be ordered for this client? -Digoxin immune FAB -Ibuprofen -Warfarin -Amlodipine

-Digoxin immune FAB Digibind binds with digoxin and makes it unavailable for use. The digibind dosage is based on the digoxin level and the patient's weight. Ibuprofen, warfarin, and amlodipine are not used to reverse the effects of digoxin.

Which medication reverses digitalis toxicity? -Ibuprofen -Warfarin -Amlodipine -Digoxin immune FAB

-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. Ibuprofen, warfarin, and amlodipine are not used to reverse the effects of digoxin.

Which is a cerebrovascular manifestation of heart failure? -Tachycardia -Ascites -Nocturia -Dizziness

-Dizziness Cerebrovascular manifestations of heart failure include dizziness, lightheadedness, confusion, restlessness, and anxiety. Tachycardia is a cardiovascular manifestation. Ascites is a gastrointestinal manifestation. Nocturia is a renal manifestation.

Which drug is most commonly used to treat cardiogenic shock? -Dopamine (Intropin) -Enalapril (Vasotec) -Furosemide (Lasix) -Metoprolol (Lopressor)

-Dopamine (Intropin) Dopamine, a sympathomimetic drug, is used to treat cardiogenic shock. It increases perfusion pressure to improve myocardial contractility and blood flow through vital organs. Enalapril is an angiotensin-converting enzyme inhibitor that directly lowers blood pressure. Furosemide is a diuretic and doesn't have a direct effect on contractility or tissue perfusion. Metoprolol is a beta-adrenergic blocker that slows heart rate and lowers blood pressure, undesirable effects when treating cardiogenic shock.

The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure? -Decreased urinary output -Dyspnea on exertion -Hypotension -Tachycardia

-Dyspnea on exertion Left-sided heart failure produces hypoxemia as a result of reduced cardiac output of arterial blood and respiratory symptoms. Many clients notice unusual fatigue with activity. Some find exertional dyspnea to be the first symptom. An increase in urinary output may be seen later as fluid accumulates. Hypotension would be a later sign of decompensating heart failure as well as tachycardia.

The diagnosis of heart failure is usually confirmed by which of the following? -Chest x-ray -Echocardiogram -Electrocardiogram (12-lead) -Ventriculogram

-Echocardiogram Although the chest X-ray can indicate cardiomegaly and the ECG can indicate a left ventricular abnormality, it is the echocardiogram that is diagnostic. This test measures ejection fraction (EF) which, if greater than 40% and accompanied with signs and symptoms of heart failure, indicates diastolic dysfunction and impaired ventricular relaxation.

The nurse is caring for a client with heart failure. What procedure should the nurse prepare the client for in order to determine the ejection fraction to measure the efficiency of the heart as a pump? -Echocardiogram -A pulmonary arteriography -A chest radiograph -Electrocardiogram

-Echocardiogram The heart?'s ejection fraction is measured using an echocardiogram or multiple gated acquisition scan. A pulmonary arteriography is used to confirm corpulmonale. A chest radiograph can reveal the enlargement of the heart. An electrocardiogram is used to determine the activity of the heart?s conduction system.

A client is already being treated for hypertension. The doctor is concerned about the potential for heart failure, and has the client return for regular check-ups. What does hypertension have to do with heart failure? -Hypertension causes the heart's chambers to enlarge and weaken. -Hypertension causes the heart's chambers to shrink. -Heart failure occurs when blood pressures drops. -Hypertension in older males regularly leads to heart failure.

-Hypertension causes the heart's chambers to enlarge and weaken. Hypertension causes the heart's chambers to enlarge and weaken, making it impossible for the ventricles to eject all the blood they receive.

Which of the following is the primary cause of pulmonary or peripheral congestion? -Ascites -Hepatomegaly -Inadequate cardiac output -Nocturia

-Inadequate cardiac output Pulmonary congestion occurs and tissue perfusion is compromised and diminished when the heart, primarily the left ventricle, cannot pump blood out of the ventricle effectively into the aorta and the systemic circulation.

Which is a potassium-sparing diuretic used in the treatment of heart failure (HF)? -Spironolactone -Bumetanide -Chlorothiazide -Ethacrynic acid

-Spironolactone Spironolactone is a potassium-sparing diuretic. Chlorothiazide is a thiazide diuretic is Diuril. Bumetanide and ethacrynic acid are loop diuretics.

Which is a manifestation of right-sided heart failure? -Accumulation of blood in the lungs -Systemic venous congestion -Reduction in forward flow -Reduction in cardiac output

-Systemic venous congestion Right-sided heart failure causes systemic venous congestion and a reduction in forward flow. Left-sided heart failure causes an accumulation of blood in the lungs and a reduction in forward flow or cardiac output that results in inadequate arterial blood flow to the tissues.

A new client has been admitted with right-sided heart failure. When assessing this client, the nurse knows to look for which finding? -Pulmonary congestion -Cough -Dyspnea -Jugular venous distention

-Jugular venous distention When the right ventricle cannot effectively pump blood from the ventricle into the pulmonary artery, the blood backs up into the venous system and causes jugular venous distention and congestion in the peripheral tissues and viscera. All the other choices are symptoms of left-sided heart failure.

The nurse is discussing cardiac hemodynamics with a nursing student. The nurse explains preload to the student and then asks the student what nursing interventions might cause decreased preload. The student correctly answers which of the following? -Application of antiembolytic stockings -Ambulation -Administration of a vasodilating drug (as ordered by a physician) -Maintaining the client's legs elevated

-Administration of a vasodilating drug (as ordered by a physician) Preload is the amount of blood presented to the ventricles just before systole. Anything that decreases the amount of blood returning to the heart will decrease preload, such as vasodilation or blood pooling in the extremities. Anything that assists in returning blood to the heart (antiembolytic stockings) or preventing blood from pooling in the extremities will increase preload.

The Cardiac Nurse Clinician is teaching a group of clients with heart failure about self-management of their disease. What dietary advice should the Nurse Clinician give to clients with severe heart failure until edema resolves? -Avoid the intake of processed and commercially prepared foods. -Avoid the intake of canned fruit and fruit juices. -Encourage increased intake of vegetables with natural sodium. -Encourage increased intake of red meat.

-Avoid the intake of processed and commercially prepared foods. Until edema resolves, a client with severe heart failure requires restriction of sodium to 500 to 1,000 mg/day. Therefore, processed and commercially prepared foods are eliminated. Vegetables with natural sodium, for example, beets, carrots, and "greens," should be avoided. Fresh, frozen, and canned fruit and fruit juices are not restricted. Increased intake of red meat should not be encouraged; it should be restricted to 6 oz per day.

Which of the following is a key diagnostic laboratory test for heart failure? -Complete blood count -Blood urea nitrogen -B-type natriuretic peptide -Leukocyte analysis

-B-type natriuretic peptide Although the other tests are important, the B-type natriuretic peptide (BNP) is important because high levels (>100 pg/mL) indicate abnormal ventricular function or symptomatic heart failure.

A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client? -Intubation of the airway -BP and pulse measurements every 15 to 30 minutes -Insertion of a central venous catheter -Hourly administration of a fluid bolus

-BP and pulse measurements every 15 to 30 minutes Bedside ECG monitoring is standard, as are continuous pulse oximetry, automatic BP, and pulse measurements approximately every 15 to 30 minutes.

A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure? -Jugular vein distention -Right upper quadrant pain -Bibasilar crackles -Dependent edema

-Bibasilar crackles Bibasilar crackles are a sign of alveolar fluid, a sequelae of left ventricular fluid, or pressure overload and indicate left-sided heart failure. Jugular vein distention, right upper quadrant pain (hepatomegaly), and dependent edema are caused by right-sided heart failure, usually a chronic condition.

A patient is undergoing a pericardiocentesis. Following withdrawal of pericardial fluid, which of the following indicates that cardiac tamponade has been relieved? -Decrease in central venous pressure (CVP) -Increase in CVP -Decrease in blood pressure -Absence of cough

-Decrease in central venous pressure (CVP) A resulting decrease in CVP and an associated increase in blood pressure after withdrawal of pericardial fluid indicate that the cardiac tamponade has been relieved. An absence of cough would not indicate the absence of cardiac tamponade.

Which of the following body system responses correlates with systolic heart failure (HF)? -Decrease in renal perfusion -Increased blood volume ejected from ventricle -Vasodilation of skin -Dehydration

-Decrease in renal perfusion A decrease in renal perfusion due to low cardiac output (CO) and vasoconstriction causes the release of renin by the kidney. Systolic HF results in decreased blood volume being ejected from the ventricle. Sympathetic stimulation causes vasoconstriction of the skin, gastrointestinal tract, and kidneys. Dehydration does not correlate with systolic heart failure.

The nurse assessing a client with an exacerbation of heart failure identifies which symptom as a cerebrovascular manifestation of heart failure (HF)? -Tachycardia -Ascites -Nocturia -Dizziness

-Dizziness Cerebrovascular manifestations of heart failure stemming from decreased brain perfusion include dizziness, lightheadedness, confusion, restlessness, and anxiety due to decreased oxygenation and blood flow.

Which diagnostic study is usually performed to confirm the diagnosis of heart failure? -Electrocardiogram (ECG) -Echocardiogram -Serum electrolytes -Blood urea nitrogen (BUN)

-Echocardiogram An echocardiogram is usually performed to confirm the diagnosis of heart failure. ECG, serum electrolytes, and a BUN are usually completed during the initial workup.

A patient is admitted to the hospital and is being evaluated for heart failure. Which diagnostic study is usually performed to confirm the diagnosis of heart failure? -Echocardiogram -Electrocardiogram (ECG) -Serum electrolytes -Blood urea nitrogen (BUN)

-Echocardiogram An echocardiogram is usually performed to confirm the diagnosis of heart failure. ECG, serum electrolytes, and a BUN are usually completed in the initial workup.

A client has a significant history of congestive heart failure. What should the nurse specifically assess during the client's semiannual cardiology examination? Select all that apply. -Examine the client's neck for distended veins. -Monitor the client for signs of lethargy or confusion. -Examine the client's joints for crepitus. -Examine the client's eyes for excess tears.

-Examine the client's neck for distended veins. -Monitor the client for signs of lethargy or confusion. During a head-to-toe assessment of a client with congestive heart failure, the nurse checks for dyspnea, auscultates apical heart rate and counts radial heart rate, measures BP, and documents any signs of peripheral edema, lethargy, or confusion. Excess tears are not part of the checklist.

A client with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, bradycardia, and muffled heart sounds. The nurse recognizes these as symptoms of what occurrence? -The pericardial space is eliminated with scar tissue and thickened pericardium. -Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. -The parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction. -Fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction.

-Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. The cardinal signs of cardiac tamponade are falling systolic blood pressure, narrowing pulse pressure, rising venous pressure (increased JVD), and distant (muffled) heart sounds. Increased pericardial pressure, reduced venous return to the heart, and decreased carbon dioxide result in cardiac tamponade (e.g., compression of the heart).

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 30 degrees and legs elevated on pillows -Head of the bed elevated 45 degrees and lower arms supported by pillows -Supine with arms elevated on pillows above the level of the heart -Prone with legs elevated on pillows

-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.

A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect? -Pulmonary embolism -Heart failure -Cardiac tamponade -Tension pneumothorax

-Heart failure A client with heart failure has decreased cardiac output caused by the heart's decreased pumping ability. A buildup of fluid occurs, causing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. A client with pulmonary embolism experiences acute shortness of breath, pleuritic chest pain, hemoptysis, and fever. A client with cardiac tamponade experiences muffled heart sounds, hypotension, and elevated central venous pressure. A client with tension pneumothorax has a deviated trachea and absent breath sounds on the affected side as well as dyspnea and jugular vein distention.

The nurse is preparing to administer hydralazine and isosorbide dinitrate. 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 health care provider. -Administer the medication and check the blood pressure in 30 minutes. -Administer a saline bolus of 250 mL and then administer the medication. -Administer the hydralazine and hold the dinitrate.

-Hold the medication and call the health care provider. A combination of hydralazine and isosorbide dinitrate may be another alternative for patients who cannot take ACE inhibitors (ICSI, 2011). Nitrates (e.g., isosorbide dinitrate) cause venous dilation, which reduces the amount of blood return to the heart and lowers preload. 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 health care provider.

A patient in the emergency room is in cardiac arrest and exhibiting pulseless electrical activity (PEA) on the telemetry monitor. Which of the following is a potential cause of PEA? -Hyperkalemia -Hypokalemia -Small pulmonary embolism -Hypervolemia

-Hyperkalemia PEA can be caused by hypovolemia, hypoxia, hypothermia, hyperkalemia, massive pulmonary embolism, myocardial infarction, and medication overdose (beta blockers, calcium channel blockers).

A client in the hospital informs the nurse he "feels like his heart is racing and can't catch his breath." What does the nurse understand occurs as a result of a tachydysrhythmia? -It causes a loss of elasticity in the myocardium. -It reduces ventricular ejection volume. -It increases afterload. -It increases preload.

-It reduces ventricular ejection volume. Reducing ventricular ejection volume because diastole, during which the ventricle fills withblood (preload), is shortened as a result of a tachydsrhythmia. Causing a loss of elasticity in the muscle is a result of cardiomyopathy. Afterload is decreased not increased.

The clinical manifestations of cardiogenic shock reflect the pathophysiology of heart failure (HF). By applying this correlation, the nurse notes that the degree of shock is proportional to which of the following? -Left ventricular function -Right ventricular function -Left atrial function -Right atrial function

-Left ventricular function The signs and symptoms of cardiogenic shock reflect the circular nature of the pathophysiology of HF. The degree of shock is proportional to the extent of left ventricular dysfunction.

In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure? -Cyanosis of the lips -Bilateral crackles -Productive cough -Leg edema

-Leg edema Right-sided heart failure is characterized by signs of circulatory congestion, such as leg edema, jugular vein distention, and hepatomegaly. Left-sided heart failure is characterized by circumoral cyanosis, crackles, and a productive cough.

The nurse is preparing a client for a multiple gated acquisition (MUGA) scan. What would be an important instruction for the nurse to give a client who is to undergo a MUGA scan? -Avoid any activity at least 2 hours before the test. -Drink plenty of fluids during the test. -Avoid dairy products a day before and a day after the test. -Lie very still at intermittent times during the test.

-Lie very still at intermittent times during the test. The nurse should instruct the client, who is to undergo a MUGA scan, to lie very still at intermittent times during the 45-minute test. The client need not drink plenty of fluids, avoid activities before/after the test, or avoid dairy products during the test.

Which feature is the hallmark of systolic heart failure? -Low ejection fraction (EF) -Pulmonary congestion -Limited activities of daily living (ADLs) -Basilar crackles

-Low ejection fraction (EF) A low EF is a hallmark of systolic heart failure (HF); the severity of HF is frequently classified according to the client's symptoms.

Which action will the nurse include in the plan of care for a client admitted with acute decompensated heart failure (ADHF) who is receiving milrinone? -Monitor blood pressure frequently -Encourage the client to ambulate in room -Titrate milrinone rate slowly before discontinuing -Teach the client about safe home use of the medication

-Monitor blood pressure frequently Milrinone is a phosphodiesterase inhibitor that delays the release of calcium from intracellular reservoirs and prevents the uptake of extracellular calcium by the cells. This promotes vasodilation, resulting in decreased preload and afterload and reduced cardiac workload. Milrinone is administered intravenously to clients with severe HF, including those who are waiting for a heart transplant. Because the drug causes vasodilation, the client's blood pressure is monitored before administration because if the client is hypovolemic the blood pressure could drop quickly. The major side effects are hypotension and increased ventricular dysrhythmias. Blood pressure and the electrocardiogram (ECG) are monitored closely during and after infusions of milrinone.

Which of the following medications is a human brain natriuretic peptide (BNP) preparation? -Natrecor -Metoprolol -Captopril -Enalapril

-Natrecor Nesiritide (Natrecor) is a preparation of human BNP that mimics the action of endogenous BNP, causing dieresis and vasodilation, reducing blood pressure, and improving cardiac output. It is a preload and afterload reducer. Metoprolol is a beta-blocker. Captopril and enalapril are angiotensin-converting enzyme (ACE) inhibitors.

The client with cardiac failure is taught to report which symptom to the physician or clinic immediately? -Increased appetite -Persistent cough -Weight loss -Ability to sleep through the night

-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 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 -Oliguria -S3 ventricular gallop sign -Decreased O2 saturation levels

-Pitting edema The presence of pitting edema is a significant sign of right-sided heart failure because it indicates fluid retention of about 10 lbs. Sodium and water are retained because reduced cardiac output causes a compensatory neurohormonal response.

A nurse in the emergency department is caring for a client with acute heart failure. Which laboratory value is most important for the nurse to check before administering medications to treat heart failure? -Platelet count -Potassium -Calcium -White blood cell (WBC) count

-Potassium Diuretics, such as furosemide (Lasix), are commonly used to treat acute heart failure. Most diuretics increase the renal excretion of potassium. The nurse should check the client's potassium level before administering diuretics, and obtain an order to replace potassium if the level is low. Other medications commonly used to treat heart failure include angiotensin-converting enzyme inhibitors, digoxin (Lanoxin), and beta-adrenergic blockers. Although checking the platelet count, calcium level, and WBC count are important, these values don't affect medication administration for acute heart failure.

A physician orders digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity? -Magnesium level of 2.5 mg/dl -Calcium level of 7.5 mg/dl -Sodium level of 152 mEq/L -Potassium level of 2.8 mEq/L

-Potassium level of 2.8 mEq/L Conditions that may predispose a client to digoxin toxicity include hypokalemia (evidenced by a potassium level less than 3.5 mEq/L), hypomagnesemia (evidenced by a magnesium level less than 1.5 mEq/L), hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia (evidenced by a magnesium level greater than 2.5 mEq/L), hypercalcemia (evidenced by an ionized calcium level greater than 5.3 mg/dl), and hypernatremia (evidenced by a sodium level greater than 145 mEq/L) aren't associated with a risk of digoxin toxicity.

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? -BNP of 100 -Sodium level of 135 -Hemoglobin of 12 -Potassium level of 3.1

-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 BNP does not demonstrate a severe heart failure. Sodium level of 135 is within normal range, as is the hemoglobin level.

A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient? -Vasculitis -Potassium levels -Flexion contractures -Enlargement of joints

-Potassium levels A key concern associated with digoxin therapy is digitalis toxicity. Clinical manifestations of toxicity include anorexia, nausea, visual disturbances, confusion, and bradycardia. The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur.

A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which assessment finding for this client? -Pulmonary congestion -Pedal edema -Nausea -Jugular venous distention

-Pulmonary congestion When the left ventricle cannot effectively pump blood out of the ventricle into the aorta, the blood backs up into the pulmonary system and causes congestion, dyspnea, and shortness of breath. All the other choices are symptoms of right-sided heart failure. They are all symptoms of systolic failure.

Which of the following would be inconsistent as a lifestyle change directive for the patient diagnosed with heart failure? -Push fluids -Restrict dietary sodium -Avoid excess alcohol -Abstinence from smoking

-Push fluids Lifestyle recommendations include restriction of dietary sodium; avoidance of excessive fluid intake, alcohol, and smoking; weight reduction when indicated; and regular exercise.

A client with heart failure reports a sudden change in the ability to perceive colors. The client reports nausea, and assessment reveals an irregular pulse of 39 beats per minute. What is the nurse's best action? -Report the possibility of digitalis toxicity to the care provider promptly -Withhold the client's next scheduled dose of furosemide and report to the care provider -Monitor the client's vital signs every 30 minutes -Facilitate an ophthalmology referral promptly

-Report the possibility of digitalis toxicity to the care provider promptly

The nurse recognizes which symptom as a classic sign of cardiogenic shock? -Restlessness and confusion -Hyperactive bowel sounds -High blood pressure -Increased urinary output

-Restlessness and confusion Cardiogenic shock occurs when decreased cardiac output leads to inadequate tissue perfusion and initiation of the shock syndrome. Inadequate tissue perfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation).

A patient has been diagnosed with systolic heart failure. The nurse would expect the patient's ejection fraction to be at which level? -Severely reduced -High -Normal -Slightly reduced

-Severely reduced The ejection fraction is normal in diastolic heart failure, but severely reduced in systolic heart failure.

A patient in cardiogenic shock after a myocardial infarction is placed on an intra-aortic balloon pump (IABP). What does the nurse understand is the mechanism of action of the balloon pump? -The balloon keeps the vessels open so that blood will adequately deliver to the myocardium. -The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart. -The balloon delivers an electrical impulse to correct dysrhythmias the patient experiences. -The balloon will inflate at the beginning of systole and deflate before diastole to provide a long-term solution to a failing myocardium.

-The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart. The IABP uses internal counterpulsation through the regular inflation and deflation of the balloon to augment the pumping action of the heart. It inflates during diastole, increasing the pressure in the aorta during diastole and therefore increasing blood flow through the coronary and peripheral arteries. It deflates just before systole, lessening the pressure within the aorta before left ventricular contraction, decreasing the amount of resistance the heart has to overcome to eject blood and therefore decreasing left ventricular workload.

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 chronic obstructive pulmonary disease (COPD) -The development of left-sided heart failure -The development of right-sided heart failure -The development of corpulmonale

-The development of left-sided heart failure When the left ventricle fails, the heart muscle cannot contract forcefully enough to expel blood into the systemic circulation. Blood subsequently becomes congested in the left ventricle, left atrium, and finally the pulmonary vasculature. Symptoms of left-sided failure include fatigue; paroxysmal nocturnal dyspnea; orthopnea; hypoxia; crackles; cyanosis; S3 heart sound; cough with pink, frothy sputum; and elevated pulmonary capillary wedge pressure. COPD develops over many years and does not develop after a myocardial infarction. The development of right-sided heart failure would generally occur after a right ventricle myocardial infarction or after the development of left-sided heart failure. Corpulmonale is a condition in which the heart is affected secondarily by lung damage.

Which is a classic sign of cardiogenic shock? -Tissue hypoperfusion -Hyperactive bowel sounds -High blood pressure -Increased urinary output

-Tissue hypoperfusion Tissue hypoperfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation). Low blood pressure is a classic sign of cardiogenic shock. Hypoactive bowel sounds are classic signs of cardiogenic shock. Decreased urinary output is a classic sign of cardiogenic shock.

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). How should the nurse document this sound? -a first heart sound (S1). -a third heart sound (S3). -a fourth heart sound (S4). -a murmur.

-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. An S1 is a normal heart sound made by the closing of the mitral and tricuspid valves. An S4 is heard before an S1 and is caused by resistance to ventricular filling. A murmur is heard when there is turbulent blood flow across the valves.

Frequently, what is the earliest symptom of left-sided heart failure? -dyspnea on exertion -anxiety -confusion -chest pain

-dyspnea on exertion Dyspnea on exertion is often the earliest symptom of left-sided heart failure.

A client has been having cardiac symptoms for several months and is seeing a cardiologist for diagnostics to determine the cause. How will the client's ejection fraction be measured? -echocardiogram -electrocardiogram -cardiac catheterization -cardiac ultrasound

-echocardiogram The heart's ejection fraction is measured using an echocardiogram or multiple gated acquisition scan, not an electrocardiogram or cardiac ultrasound. Cardiac catheterization is not the diagnostic tool for this measurement.

A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client? -Vasculitis -nausea and vomiting -Flexion contractures -Enlargement of joints

-nausea and vomiting Digitalis medications are potent and may cause various toxic effects. The nurse should monitor the client for signs of digitalis toxicity, not just during the initial period of therapy, but throughout care management. The most common signs and symptoms include nausea and vomiting which can lead to dehydration and electrolyte imbalance. Symptoms of toxicity do not include vasculitis, flexion contractures, or enlargement of joints.

A client is receiving captopril (Capoten) for heart failure. The nurse should notify the physician that the medication therapy is ineffective if an assessment reveals: -skin rash. -peripheral edema. -dry cough. -postural hypotension.

-peripheral edema. Peripheral edema is a sign of fluid volume excess and worsening heart failure. A skin rash, dry cough, and postural hypotension are adverse reactions to captopril, but they don't indicate that therapy is ineffective.

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: -hypertension. -high urine output. -dry mucous membranes. -pulmonary crackles.

-pulmonary crackles. High pulmonary artery wedge pressures are diagnostic for left-sided heart failure. With left-sided heart failure, pulmonary edema can develop causing pulmonary crackles. In left-sided heart failure, hypotension may result and urine output will decline. Dry mucous membranes aren't directly associated with elevated pulmonary artery wedge pressures.

A client who was admitted to the hospital with a diagnosis of thrombophlebitis 1 day ago suddenly reports chest pain and shortness of breath and is visibly anxious. The nurse immediately assesses the client for other signs and symptoms of -myocardial infarction. -pulmonary embolism. -pneumonia. -pulmonary edema.

-pulmonary embolism. Pulmonary embolism is a potentially life-threatening disorder typically caused by blood clots in the lungs. This disorder poses a particular threat to people with cardiovascular disease. Blood clots that form in the deep veins of the legs and embolize to the lungs can cause a pulmonary infarction, whereby emboli mechanically obstruct the pulmonary vessels, cutting off the blood supply to sections of the lung. Clinical indicators of pulmonary embolism can vary but typically include dyspnea, pleuritic chest pain, and tachypnea.

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?" -"How far can you walk without becoming short of breath?" -"Are you coughing up blood at night?" -"Are you urinating excessively at night?"

-"Are you only able to breathe when you are sitting upright?" To determine if a client is having orthopnea, the nurse needs to ask about the inability to breathe unless sitting upright. Determining how far the client can walk without becoming short of breath would indicate exertional dyspnea. Coughing up blood would indicate hemoptysis. Urinating excessively at night can be indicative of different factors such as taking a diuretic late in the evening causing the client to urinate often at night. This question would be vague.

A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when the client makes which statement? -"I sleep on three pillows each night." -"My feet are bigger than normal." -"My pants don't fit around my waist." -"I don't have the same appetite I used to."

-"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. Swollen feet, ascites, and anorexia are signs of right-sided heart failure.

A patient has missed 2 doses of digitalis (Digoxin). What laboratory results would indicate to the nurse that the patient is within therapeutic range? -0.25 mg/mL -4.0 mg/mL -2.0 mg/mL -3.2 mg/mL

-2.0 mg/mL For many years, digitalis (digoxin) was considered an essential agent for the treatment of HF, but with the advent of new medications, it is not prescribed as often. Digoxin increases the force of myocardial contraction and slows conduction through the atrioventricular node. It improves contractility, increasing left ventricular output.

Cardiogenic shock is pump failure that primarily occurs because of which of the following? -Coronary artery stenosis -Inadequate tissue perfusion -Myocardial ischemia -Right atrial flutter

-Inadequate tissue perfusion The classic signs of cardiogenic shock are related to tissue hypoperfusion and an overall state of shock that is proportional to the extent of left ventricular damage. Reduced cardiac output and stroke volume reduces arterial blood pressure and tissue perfusion.

Which is a potassium-sparing diuretic used in the treatment of heart failure? -Spironolactone -Bumetanide -Chlorothiazide -Ethacrynic acid

-Spironolactone Spironolactone is a potassium-sparing diuretic. Chlorothiazide is a thiazide diuretic. Bumetanide and ethacrynic acid are loop diuretics.

The nurse is discussing cardiac hemodynamics with a nursing student. The nurse explains afterload to the student and then asks the student what nursing interventions might cause decreased afterload. The student correctly answers which of the following? -Application of antiembolytic stockings -Fluid restriction -Administration of a vasodilating drug (as ordered by a physician) -Maintenance of the client's legs elevated above the heart

-Administration of a vasodilating drug (as ordered by a physician) Afterload is the amount of resistance to the ejection of blood from the ventricles. Anything that decreases this resistance will decrease afterload. Vasodilation will decrease systemic resistance. Antiembolytic stockings and keeping the client's legs elevated will increase resistance.

A nurse suspects that a client has digoxin toxicity. The nurse should assess for: -hearing loss. -vision changes. -decreased urine output. -gait instability.

-vision changes. Vision changes, such as halos around objects, are signs of digoxin toxicity. Hearing loss can be detected through hearing assessment; however, it isn't a common sign of digoxin toxicity. Intake and output aren't affected unless there is nephrotoxicity, which is uncommon. Gait changes are also uncommon.