Chapter 28: Caring for Clients with Heart Failure

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

Echocardiogram

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? Pulse oximetry Listening to breath sounds End-tidal CO2 Arterial blood gases

Arterial blood gases

A client arrives at the ED with an exacerbation of left-sided heart failure and reports shortness of breath. Which is the priority nursing intervention? Administer angiotensin II receptor blockers Assess oxygen saturation Administer diuretics Administer angiotensin-converting enzyme inhibitors

Assess oxygen saturation

A client who is at high risk for developing intracardiac thrombi has been placed on long-term anticoagulation. What aspect of the client's health history creates a heightened risk of intracardiac thrombi? Atrial fibrillation Infective endocarditis Recurrent pneumonia Recent surgery

Atrial fibrillation

Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole? Afterload Preload Ejection fraction Stroke volume

Preload

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

The nurse notes that a client has developed a cough productive for mucoid sputum, is short of breath, has cyanotic hands, and has noisy, moist-sounding, rapid breathing. These symptoms and signs are suggestive of what health problem? Pericarditis Cardiomyopathy Pulmonary edema Right ventricular hypertrophy

Pulmonary edema

A client has received the diagnosis of right-sided heart failure. During client education, the nurse informs the client that heart failure affects: the body's mechanism to eliminate CO and metabolic wastes. the body's oxygen supply. peripheral circulation. None of the options is correct.

The body's mechanism to eliminate CO and metabolic wastes.

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

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

A client was admitted to the cardiac ICU with full-blown pulmonary edema. After treatment, the nurse discusses the client's symptoms with the client. A typical, subtle symptom that communicates right-sided heart failure is gradual, unexplained: weight gain weight loss cough None of the options is correct.

weight gain

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." What additional assessment information would be important for the CSU nurse to obtain? hypertension high urine output dry mucous membranes pulmonary crackles

pulmonary crackles

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.

A client with chronic heart failure is receiving digoxin 0.25 mg by mouth daily and furosemide 20 mg by mouth twice daily. The nurse should assess the client for what sign of digoxin toxicity? visual disturbances. taste and smell alterations. dry mouth and urine retention. nocturia and sleep disturbances.

visual disturbances

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.

The nurse is performing a physical assessment on a client suspected of having heart failure. The presence of what sound would signal the possibility of impending heart failure? An S3 heart sound Pleural friction rub Faint breath sounds A heart murmur

An S3 heart sound

The nurse is reviewing a newly admitted client's electronic health record, which notes a history of orthopnea. What nursing action is most clearly indicated? Teach the client deep breathing and coughing exercises. Administer supplemental oxygen at all times. Limit the client's activity level. Avoid positioning the client supine.

Avoid positioning the client supine.

The nurse is assessing a client who is known to have right-sided heart failure. What assessment finding is most consistent with this client's diagnosis? Pulmonary edema Distended neck veins Dry cough Orthopnea

Distended neck veins

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

Dizziness

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

Dyspnea on exertion

The nurse is assessing a patient who reports no symptoms of heart failure at rest but is symptomatic with ordinary physical activity. Under what classification does the nurse understand this patient would be categorized? I II III IV

II

A nurse is assessing a client with congestive heart failure for jugular vein distension (JVD). Which observation is important to report to the physician? No JVD is present. JVD is noted at the level of the sternal angle. JVD is noted 2 cm above the sternal angle. JVD is noted 4 cm above the sternal angle.

JVD is noted 4 cm above the sternal angle.

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

Persistent cough

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 ineffective tissue perfusion related to dysrhythmia Risk for fluid volume excess related to medication regimen Risk for ineffective breathing pattern related to hypoxia Risk for falls related to hypotension

Risk for falls related to hypotension

Which nursing intervention should the nurse perform when a client with valvular disorder of the heart has a heart rate less than 60 beats/min before administering beta-blockers? Observe for symptoms of pulmonary edema. Continue the drug and document in the client's chart. Withhold the drug and inform the primary health care provider. Check for signs of toxicity.

Withhold the drug and inform the primary health care provider.

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 ham and cheese sandwich for lunch." "I will have a baked potato with broiled chicken for dinner." "I will have a tossed salad with cheese and croutons for lunch." "I will have chicken noodle soup with crackers and an apple for lunch."

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

The nurse is admitting a client with heart failure. What client statement indicates that fluid overload was occurring at home? "I eat six small meals a day when I am hungry." "I've stopped eating foods with salt, though I miss the taste." "I'm having trouble going up the steps during the day." "My best time of the day is the morning."

"I'm having trouble going up the steps during the day."

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." "Try to replace as many of the complex carbohydrates in your diet with simple sugars." "I'll teach you some good sources of potassium, which you should try to eat regularly." "Many people with HF find that small, frequent meals allow them to manage their diet effectively."

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

A client has had an echocardiogram to measure ejection fraction. 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% 50% 45% 40%

55%

The nurse is reviewing the medication administration record of a client diagnosed with systolic heart failure. What medication should the nurse anticipate administering to this client? A beta-adrenergic blocker An antiplatelet aggregator A calcium channel blocker A nonsteroidal anti-inflammatory drug (NSAID)

A beta-adrenergic blocker

A cardiac client's resistance to left ventricular filling has caused blood to back up into the client's circulatory system. What health problem is likely to result? Acute pulmonary edema Right-sided heart failure Right ventricular hypertrophy Left-sided heart failure

Acute pulmonary edema

A client presents to the ED reporting increasing shortness of breath. The nurse assessing the client notes a history of left-sided heart failure. The client is agitated and occasionally coughing up pink-tinged, foamy sputum. The nurse should recognize the signs and symptoms of what health problem? Right-sided heart failure Acute pulmonary edema Pneumonia Cardiogenic shock

Acute pulmonary edema

The nurse is administering sublingual nitroglycerin to a client with chest pain. What action will the nurse take after administering two sublingual tablets if the client continues with chest pain and has a blood pressure of 120/82 mm Hg? Hold any further treatment until the client's blood pressure increases. Notify the health care provider of the chest pain. Administer the third sublingual nitroglycerin tablet. Wait ten minutes after the second tablet to assess pain.

Administer the third sublingual nitroglycerin tablet.

A client has been experiencing increasing shortness of breath and fatigue. The health care provider has ordered a diagnostic test in order to determine what type of heart failure the client is having. What diagnostic test does the nurse anticipate being ordered? A chest x-ray An echocardiogram An electrocardiogram A ventriculogram

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? A further reduction in his dietary sodium intake An increase in the dose of his prescribed diuretic A decrease in his daily activity level Thoracentesis

An increase in the dose of his prescribed diuretic

The triage nurse in the ED is assessing a client with chronic heart failure who has presented with worsening symptoms. In reviewing the client's medical history, what is a potential primary cause of the client's heart failure? Endocarditis Pleural effusion Atherosclerosis Atrial septal defect

Atherosclerosis

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? Jugular vein distention Right upper quadrant pain Bibasilar fine crackles Dependent edema

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 Level of consciousness (LOC) Assessment for nausea Oxygen saturation

Blood pressure

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 nurse has performed an assessment of a patient and subsequently administered the patient's scheduled dose of ramipril, an angiotensin-converting enzyme (ACE) inhibitor prescribed for the treatment of the patient's longstanding heart failure (HF). The nurse understands that this drug will aid in the treatment of the patient's disease by: Reducing the patient's overall oxygen demand Reducing preload through the excretion of fluid and sodium Increasing the contractility of the heart and increasing ejection fraction Causing vasodilation and decreasing the heart's workload

Causing vasodilation and decreasing the heart's workload

A client has been prescribed furosemide 80 mg twice daily. The asymptomatic client begins to have rare premature ventricular contractions followed by runs of bigeminy with stable signs. What action will the nurse perform next? Notify the health care provider. Check the client's potassium level. Calculate the client's intake and output. Administer potassium.

Check the client's potassium level.

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? Heart failure ultimately affects oxygen transportation to the brain. Clients with heart failure are susceptible to overstimulation of the sympathetic nervous system. Decreased LOC causes an exacerbation of the signs and symptoms of heart failure. The most significant adverse effect of medications used for heart failure treatment is altered LOC.

Heart failure ultimately affects oxygen transportation to the brain.

The nurse is caring for a client with advanced heart failure. What treatment will be considered after all other therapies have failed? heart transplant ventricular access device implantable cardiac defibrillator (ICD) cardiac resynchronization therapy

Heart transplant

Which New York Heart Association classification of heart failure (HF) has a poor prognosis and includes symptoms of cardiac insufficiency at rest? IV I II III

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 On the left side-lying position In a flat, supine position In the Trendelenburg position

In a high Fowler position

Which is a characteristic of right-sided heart failure? Jugular vein distention Dyspnea Pulmonary crackles Cough

Jugular vein distention

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

Which is the hallmark of heart failure? Low ejection fraction (EF) Pulmonary congestion Limited ADLs Basilar crackles

Low ejection fraction (EF)

When a client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating orthopnea. dyspnea upon exertion. hyperpnea. paroxysmal nocturnal dyspnea.

Orthopnea

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 with acute renal failure The client admitted following an MI The client admitted with malignant hypertension The client admitted following a stroke

The client admitted following an MI

The physician writes orders for a patient to receive an angiotensin II receptor blocker for treatment of heart failure. What medication does the nurse administer? Digoxin (Lanoxin) Valsartan (Diovan) Metolazone (Zaroxolyn) Carvedilol (Coreg)

Valsartan (Diovan)

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

The nurse is assigned to care for a client with heart failure. What medication does the nurse anticipate administering that will improve client symptoms as well as increase survival? lisinopril diltiazem bumetanide cholestyramine

lisinopril

A client asks the nurse if systolic heart failure will affect any other body function. What body system response 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 patient has been admitted to the hospital with exacerbation of heart failure (HF) that has resulted in pulmonary and peripheral edema. The nurse has been carefully monitoring the trajectory of the patient's signs and symptoms of HF. How can the nurse best monitor the patient's fluid balance? By monitoring the patient's blood urea nitrogen (BUN) and creatinine levels By measuring and recording the patient's oral fluid intake By performing daily weights at the same time each day By assessing the patient's skin turgor at several different sites

By performing daily weights at the same time each day

The nurse is caring for a client with systolic heart failure whose previous adverse reactions rule out the safe use of ACE inhibitors. The nurse should anticipate that the prescriber may choose what combination of drugs? Loop diuretic and antiplatelet aggregator Loop diuretic and calcium channel blocker Combination of hydralazine and isosorbide dinitrate Combination of digoxin and normal saline

Combination of hydralazine and isosorbide dinitrate

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. The patient's blood pressure (BP) is 144/99. The patient has put out 600 mL of dilute urine over the past 8 hours. Blood glucose testing reveals a glucose level of 158 mg/dL.

Crackles are audible on chest auscultation

Which particular area(s) should be examined to assess peripheral edema? Upper arms Under the sacrum Lips, earlobes Feet, ankles

Feet, ankles

A client has been admitted to the cardiac step-down unit with acute pulmonary edema. Which symptoms would the nurse expect to find during assessment? moist, gurgling respirations drowsiness, numbness increased cardiac output hypertension

moist, gurgling respirations