Chapter 28: Caring for Clients with Heart Failure

A client with heart failure is placed on a low-sodium diet. Which statement by the client indicates that the nurse's nutritional teaching plan has been effective?

"I will have a baked potato with broiled chicken for dinner."

A patient has been newly diagnosed with heart failure (HF) and has come to the meet with the nurse at the clinic for health education. What lifestyle recommendation should the nurse provide to this patient when discussing dietary modifications?

"It's in your best interests to avoid excessive fluids and sodium in your diet."

A patient has missed 2 doses of digitalis (Digoxin). What laboratory results would indicate to the nurse that the patient is within therapeutic range?

2.0 mg/mL

A client in the cardiac unit has been diagnosed with pulmonary congestion secondary to left ventricular dysfunction. The physician orders supplemental oxygen therapy. At what minimum level should the client's SpO2 be maintained?

90

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?

A weight gain of 2½ pounds in a day

The diagnosis of heart failure is usually confirmed by which of the following?

Echocardiogram

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?

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

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?

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

he 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 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.

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?

An echocardiogram

A 70-year-old man has been living with a diagnosis of heart failure (HF) for several years and has been vigilant about monitoring the trajectory of disease and adhering to his prescribed treatment regimen. The man has scheduled an appointment with his primary care provider because he has noted a weight gain of 6 pounds over the past week. The nurse should anticipate that this patient may benefit from which of the following treatment measures?

An increase in the dose of his prescribed diuretic

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

A client who is at high risk for developing intracardiac thrombi has been placed on long-term anticoagulation. What aspect of the clent's health history creates a heightened risk of intracardiac thrombi?

Atrial fibrillation

Which of the following is a key diagnostic laboratory test for heart failure?

B-type natriuretic peptide

The nurse is caring for an older adult client who has just returned from the OR after inguinal hernia repair. The OR report indicates that the client received large volumes of IV fluids during surgery and the nurse recognizes that the client is at risk for left-sided heart failure. What signs and symptoms would indicate left-sided heart failure?

Bibasilar fine crackles

A client with heart failure has met with his primary provider and begun treatment with an angiotensin-converting enzyme (ACE) inhibitor. When the client begins treatment, the nurse should prioritize what assessment?

Blood pressure

Which is a key diagnostic indicator of heart failure?

Brain natriuretic peptide (BNP)

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.

The nurse has completed a head-to-toe assessment of a patient who was admitted for the treatment of heart failure (HF). Which of the following assessment findings should signal to the nurse a possible exacerbation of the patient's condition?

Crackles are audible on chest auscultation.

What is the primary underlying disorder of pulmonary edema?

Decreased left ventricular pumping

Which of the following body system responses correlates with systolic heart failure (HF)?

Decrease in renal perfusion

Which is a cerebrovascular manifestation of heart failure?

Dizziness

Which of the following symptoms should the nurse expect to find as an early symptom of chronic heart failure?

Fatigue

Which medication is categorized as a loop diuretic?

Furosemide

The nurse is performing an initial assessment of a client diagnosed with heart failure. The nurse also assesses the client's sensorium and LOC. Why is the assessment of the client's sensorium and LOC important in clients with heart failure?

HF ultimately affects oxygen transportation to the brain.

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.

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

IV

A client admitted to the medical unit with heart failure is exhibiting signs and symptoms of pulmonary edema. How should the nurse best position the client?

In a high Fowler position

A nurse is assessing a client with congestive heart failure for jugular vein distension (JVD). Which observation is important to report to the physician?

JVD is noted 4 cm above the sternal angle.

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

Persistent cough

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 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

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

Preload

A client is admitted to the hospital with systolic left-sided heart failure. The nurse knows to look for which of the following assessment findings for this client?

Pulmonary congestion

An older adult client with heart failure is being discharged home on an ACE inhibitor and a loop diuretic. The client's most recent vital signs prior to discharge include oxygen saturation of 93% on room air, heart rate of 81 beats per minute, and blood pressure of 94/59 mm Hg. When planning this client's subsequent care, what nursing diagnosis should be identified?

Risk for falls related to hypotension

The nurse is educating an 80-year-old client diagnosed with heart failure about his medication regimen. What should the nurse to teach this client about the use of oral diuretics?

Take the diuretic in the morning to avoid interfering with sleep.

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 inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart.

The nurse overseeing care in the ICU reviews the shift report on four clients. The nurse recognizes which client to be at greatest risk for the development of cardiogenic shock?

The client admitted following an MI

The nurse is conducting a morning assessment of an 80-year-old female patient who has a longstanding diagnosis of heart failure (HF). The nurse notes an elevation in jugular venous pressure (JVP) greater than 4 cm above the woman's sternal angle, a finding that did not exist the day before. What conclusion should the nurse draw from this assessment finding?

The woman may be experiencing an exacerbation of right-sided HF.

A client with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these findings as signs and symptoms of:

acute pulmonary edema.

A client who has developed congestive heart failure must learn to make dietary adaptations. The client should avoid:

canned peas.

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 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

A patient has been prescribed a digitalis preparation for heart failure. What should the nurse closely monitor when caring for this client?

electrolyte and water loss

When a client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating

orthopnea

When the client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating

orthopnea.

A nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, the nurse should:

place the client in high Fowler's position.

Left-sided heart failure results in several symptoms due to reduced cardiac output. Which symptom would NOT contribute to a diagnosis of heart failure?

polydipsia

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

pulmonary embolism.

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

vision changes.

A client with chronic heart failure is receiving digoxin (Lanoxin), 0.25 mg by mouth daily, and furosemide (Lasix), 20 mg by mouth twice daily. The nurse instructs the client to notify the physician if nausea, vomiting, diarrhea, or abdominal cramps occur because these signs and symptoms may signal digoxin toxicity. Digoxin toxicity may also cause:

visual disturbances.