Ch 29

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 nurse is performing a respiratory assessment for a patient in left-sided heart failure. What does the nurse understand is the best determinant of the patient's ventilation and oxygenation status?

ABG

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?

Administration of a vasodilating drug (as ordered by a physician)

A patient is seen in the emergency department (ED) with heart failure secondary to dilated cardiomyopathy. What key diagnostic test does the nurse assess to determine the severity of the patient's heart failure?

BNP

A client with heart failure is having a decrease in cardiac output. What indication does the nurse have that this is occurring?

BP 80/46 mm Hg

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?

Call for a chest x-ray

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

The nurse identifies which symptom as a manifestation of right-sided heart failure (HF)?

Congestion in peripheral tissues

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

Decomponsated heart failure with pulmonary edema

A client is exhibiting digitalis toxicity. Which of the following medications would the nurse expect to be ordered for this client?

Digoxin immune FAB

Which is a cerebrovascular manifestation of heart failure?

Dizziness

A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.)

Dyspnea Cough Crackles

****The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure?

Dyspnea on exertion

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

Which medication is categorized as a loop diuretic?

Furosemide

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. 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 healty care provider

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

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.

Hydralazine

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 3 pillows each night

Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest?

IV

Which of the following is the primary cause of pulmonary or peripheral congestion?

Inadequate cardiac output

A client diagnosed with pulmonary edema has a PaCO2 of 72 mm Hg and an oxygen saturation of 84%. What method of oxygen delivery would best meet the needs of this client?

Intubation and mechanical ventilation

Preload

Is the amount of blood presented to the ventricles just before systole. It increases pressure in the ventricles, which STRETCHES the ventricle wall. Like a piece of elastic, the muscle fibers need to be stretched to produce optimal recoil and forceful ejection of blood.

A new client has been admitted with right-sided heart failure. When assessing this client, the nurse knows to look for which finding?

Jugular venous distention

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?

Left sided heart failure

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

In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure?

Leg Edema

inhibit sodium and chloride reabsorption mainly in the ascending loop of Henle.

Loop diuretics

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:

Peripheral edema

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?

Potassium

A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient?

Potassium levels

Afterload

Refers to the amount of resistance to the ejection of blood from the ventricle. To eject blood, the ventricles much overcome the resistance caused by tension in the aorta, systemic vessels, and pulmonary artery.

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

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 nurse is administering lanoxin, which she knows increases contractility as well as cardiac output. Contractility refers to which of the following?

The force of the contraction related to the status of the myocardium

Which is a classic sign of cardiogenic shock?

Tissue hypoperfusion

A nurse suspects that a client has digoxin toxicity. The nurse should assess for:

Vision changes Such as halos around objects,

Classification of HF Class IV

client is unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.

Cerebrovascular manifestations of HF

dizziness, lightheadedness, confusion, restlessness, and anxiety.

An echocardiogram is usually performed to determine the

ejection fraction, identify anatomic features such as structural abnormalities and valve malfunction, and confirm the diagnosis of HF.

The BNP level is a key diagnostic indicator of HF; high levels are a sign of

high cardiac filling pressure and can aid in both the diagnosis and management of HF

Classification of HF Class II

is when the client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea.

Classification of HF Class III

is when there is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitations, or dyspnea.