Chapter 34 Heart Failure medsurg
The nurse recognizes that a primary goal for a patient with chronic heart failure is what? 1 Maximizing cardiac output 2 Maintaining an ideal body weight 3 Performing daily aerobic exercises 4 Maintaining a steady pulse oximetry reading
1 An increase in cardiac output helps overcome chronic heart failure, thereby maintaining the blood flow to meet the body's demand. Being overweight is just one risk factor for chronic heart failure; maintaining ideal body weight may not be a goal for some patients. Performing daily aerobic exercises may be too strenuous on the heart. There are many risk factors to consider when determining treatment goals. Pulse oximetry is used to monitor the effectiveness of oxygen therapy, and achievement of a steady reading is not a practical or primary goal.
A patient with heart failure complains of fatigue. The nurse understands that which causes of fatigue are associated with heart failure? 1 Anemia 2 Increased cardiac output 3 Increased oxygen to tissues 4 Increased perfusion to organs
1 Anemia related to heart failure is caused by poor nutrition, renal disease, and angiotensin-converting enzyme. This leads to fatigue. Cardiac output is reduced, which in turn reduces perfusion to tissues and decreases oxygen delivery to tissues, leading to fatigue.
The nurse is preparing to administer digoxin to a patient with heart failure (HF). The nurse should suspect digitalis toxicity if the patient reports which symptom? 1 Anorexia 2 Constipation 3 Restlessness 4 Muscle aches
1 Anorexia, nausea and vomiting, fatigue, headache, depression, and visual changes are early signs of toxicity. The nurse should become concerned and notify the health care provider if the patient exhibits any of these symptoms. Muscle aches, constipation, and restlessness are not signs of digitalis toxicity.
The nurse recalls that which type of drug therapy is used to treat volume overload in patients with acute decompensated heart failure (ADHF)? 1 Diuretics 2 Narcotics 3 Vasodilators 4 Positive inotropes
1 Diuretics are used in patients with fluid overload, which helps them to decrease the sodium reabsorption at various sites within the nephrons. This helps with flushing out the sodium from the body and promotes water loss. Vasodilators improve coronary artery circulation by dilating the coronary artery. Narcotics, such as morphine sulfate, dilate both pulmonary and systematic blood vessels but may not help in fluid overload. Positive inotropes increase myocardial contractility and help in dilating renal blood vessels, enhancing renal output.
A patient is diagnosed with pulmonary edema. The nurse anticipates a prescription for which type of medication? 1 Diuretic 2 Vasodilator 3 β-adrenergic blocker 4 Angiotensin-converting enzyme (ACE) inhibitor
1 Diuretics are used to treat pulmonary edema because they act on the ascending loop of Henle to promote sodium, chloride, and water excretion. Vasodilators cause dilation of the blood vessel wall. β-adrenergic blockers help counteract the negative effect of the sympathetic nervous system. Angiotensin-converting enzyme inhibitors block the enzyme that can cause angiotensin I to form angiotensin II, which is a potent vasoconstrictor.
The nurse reviews the laboratory results of a patient with heart failure (HF) and notes an increased calcium level and decreased magnesium level. The nurse should notify the health care provider of the findings and withhold which scheduled medication? 1 Digoxin 2 Metoprolol 3 Spironolactone 4 Morphine sulfate
1 Hypercalcemia and hypomagnesemia can trigger digitalis toxicity. The dose should be held, and the health care provider should be notified. The lab findings are not indications to withhold morphine sulfate, metoprolol, or spironolactone.
The nurse reviews the laboratory results of a patient with heart failure (HF) who receives a prescription for digoxin. The nurse decides to withhold the medication based on abnormal findings of what blood study? 1 Potassium 2 Thyroid function tests 3 White blood cells (WBCs) 4 Blood urea nitrogen (B.U.N.)
1 Low serum potassium enhances the actions of digitalis, causing a therapeutic dose to reach toxic levels. Similarly, hyperkalemia inhibits the actions of digitalis, resulting in subtherapeutic dose. Monitor serum potassium levels of all patients taking digitalis. The results of a B.U.N., WBCs, or thyroid function tests do not affect the nurse's decision to administer or to withhold digoxin.
The nurse educates a patient with heart failure (HF) about lifestyle changes to avoid complications. Which statement made by the patient indicates that further teaching is needed? 1 "I can add salt to my food and eat what I want." 2 "I can eat hard candy or ice pops to avoid thirst." 3 "I shouldn't exercise or do anything to strain my heart." 4 "I will take all of my medications at the prescribed times."
1 Not following a low-sodium diet may lead to complications such as hypertension, edema, and other conditions. Fluid restriction is not usually prescribed for the patient with mild to moderate HF. However, in chronic HF, fluids are limited to 2 L/day. Use of ice pops and hard candy helps avoid thirst, which is a side effect of the HF medications. Lack of exercise does not increase a patient's sodium level. Taking medication at the prescribed times is correct and does not need further teaching.
A nurse provides discharge instructions to a patient with chronic heart failure related to dietary restrictions. Which statement made by the patient indicates understanding of the teaching? 1 "I should not use salt at the table." 2 "I should increase the intake of milk." 3 "I should avoid use of lemon juice and spices." 4 "I can eat bread, processed meat, and cheese."
1 Patients with heart failure should avoid salt because it contains sodium. Sodium tends to absorb water and increase edema, which may worsen heart failure. Bread, processed meat, and cheese contain high levels of sodium and should be avoided. Intake of milk should be restricted to only two cups daily because it is rich in fat. Lemon juice and spices can be used instead of salt to flavor food.
A patient with cardiac failure is scheduled to receive sodium nitroprusside. The nurse should monitor what parameter while administering the drug to the patient? 1 Blood pressure 2 Body temperature 3 Heart rate and pulse rate 4 Central venous pressure
1 Symptomatic hypotension is a major adverse effect of sodium nitroprusside; therefore, blood pressure is continuously monitored in patients taking sodium nitroprusside. Body temperature, heart rate, and central venous pressure are not altered due to administration of this drug.
A male patient with a long history of heart failure qualifies for hospice care. The nurse identifies what priority goal? 1 Providing comfort and relieving suffering 2 Decreasing the patient's medication dosages 3 Providing education to the patient and family 4 Pursuing experimental therapies and considering surgical options
1 The central focus of hospice care is the promotion of comfort and the prevention of suffering. Medications should be continued unless they are not tolerated. Patient education should continue, but providing comfort is paramount. Experimental therapies and surgeries are not commonly used in the care of hospice patients.
The nurse is caring for a patient with manifestations of acute decompensated heart failure (ADHF). What is the priority nursing assessment? 1 Lung sounds 2 Facial swelling 3 Level of anxiety 4 Intake and output
1 The priority nursing assessment is auscultation of lung sounds. Excess fluid volume often leads to pulmonary congestion. ADHF can manifest as pulmonary edema. Facial swelling is a possible side effect with prescribed renin-angiotensin-aldosterone inhibitors for heart failure. It is important to assess the patient's anxiety, but it is not the priority. Assessing intake and output is important for right-sided heart failure.
A patient with atrial fibrillation is due for a first dose of digoxin 125 mcg intravenous (IV) push. The pharmacy issues a vial containing 0.25 mg/mL. How much medication should the nurse withdraw from the vial?? 1 0.5 mL 2 0.6 mL 3 1.0 mL 4 1.25 mL
1 The vial contains 250 mcg/mL, since 0.25 mg = 250 mcg. The dose is in mcg. Multiply 125 by x and multiply 0.25 × 1 to yield 125x = 0.25. Divide 0.25 by 125 to yield 0.5 mL.
A patient is admitted to the hospital with heart failure (HF). The nurse should monitor the patient for what complications? Select all that apply. 1 Pleural effusion 2 Dysrhythmias 3 Hepatomegaly 4 Renal failure 5 Thyrotoxicosi
1,2,3,4 A pleural effusion occurs when excess fluid builds up in the pleural cavity of the lungs secondary to increasing pressure in the pleural capillaries. Fluid then moves from these capillaries into the pleural space. Chronic HF causes enlargement of the chambers of the heart. This enlargement can cause changes in the normal electrical pathways. HF can lead to severe hepatomegaly. The liver becomes congested with venous blood. The decreased cardiac output (CO) that accompanies chronic HF results in decreased perfusion to the kidneys and can lead to renal insufficiency or failure.
A patient with heart failure is hospitalized with a diagnosis of digitalis toxicity. The nurse expects what assessment findings? Select all that apply. 1 Depression 2 Poor appetite 3 Heart rate (HR) of 52 4 Distant heart sounds 5 Seeing halos around lights 6 Weight gain of 3 pounds in the past two days
1,2,3,5 Poor appetite (e.g., anorexia), decreased heart rate (due to digitalis preparations causing a decrease in HR), depression, and visual changes (e.g., seeing halos around lights) are all symptoms of digitalis toxicity. "Distant heart sounds" is not a correct answer; they are a symptom of pericarditis. Weight gain of 3 pounds in the past two days is not correct; it is a symptom of possible exacerbation of heart failure and fluid retention.
What is the most probable cause of death in a patient in the first year after heart transplantation? 1 Lymphoma 2 Acute rejection 3 Cardiac vasculopathy 4 Sudden cardiac death
2 Acute rejection of the graft could be the most probable cause of death within a year of cardiac transplantation. Other long-term causes may include lymphoma, sudden cardiac death, and cardiac vasculopathy.
The assessment findings of a patient with myocardial infarction (MI) include jugular venous distention, weight gain, peripheral edema, and a heart rate of 108/minute. The nurse suspects what complication? 1 Left-sided HF 2 Right-sided HF 3 Chronic heart failure (HF) 4 Acute decompensated heart failure (ADHF)
2 An MI is a primary cause of heart failure. Jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure, not left-sided HF, ADHF, or chronic HF.
The nurse provides medication education to a patient with heart failure. The nurse explains that the drug's mechanism of action is to reverse ventricular remodeling and to decrease cardiac workload by inhibiting catecholamines. Which drug is the nurse referring to? 1 Digitalis 2 Carvedilol 3 Dopamine 4 Furosemide
2 Carvedilol is a β-adrenergic blocker that inhibits the sympathetic nervous system, preventing the release of catecholamines. (Catecholamines increase heart rate and myocardial contractility, which increases the workload of the heart.) Carvedilol also promotes reverse remodeling and decreases afterload. Furosemide is a diuretic and does not have those sympathetic nervous system (SNS)-blocking effects. Digitalis and dopamine are inotropic drugs that serve to increase contractility and do not block SNS stimulation.
A patient is admitted to the emergency department with pain, dyspnea, and lower extremity edema. The patient is diagnosed with diastolic heart failure. The nurse recognizes that which clinical finding aids in the diagnosis of diastolic heart failure? 1 Low filling pressures 2 Ejection fraction of 55% 3 Impaired contractile function 4 Ejection fraction less than 45%
2 Diastolic failure is also known as heart failure with preserved EF (HFpEF), thus eluding to the finding of a normal ejection fraction (EF). A normal ejection fraction is 55-60%. In systolic heart failure, the ejection fraction is generally less than 45%. Diastolic failure is characterized by high filling pressures because of stiff ventricles. Systolic failure results from an inability of the heart to pump blood effectively, caused by impaired contractile functio
The nurse recognizes the need for more frequent monitoring of electrolytes when a patient that takes digitalis receives a prescription for what type of medication? 1 Nitrate 2 Diuretic 3 β-adrenergic blocker 4 Angiotensin-converting enzyme (ACE) inhibitor
2 Diuretics can either waste or spare potassium, causing hypokalemia or hyperkalemia, both of which can cause issues when occurring in the patient on digitalis. Nitroglycerin and ACE inhibitors are not correct answers; they do not impact the levels of electrolytes. The combination of a β-adrenergic blocker and digitalis can cause a decrease in heart rate but not an electrolyte imbalance.
A patient that is suspected to have heart failure reports fatigue. The nurse recalls that what condition related to newly diagnosed heart failure causes fatigue? 1 Impaired renal perfusion 2 Decreased oxygenation of the tissues 3 Reabsorption of fluid from dependent body areas 4 An increased pulmonary pressure secondary to interstitial and alveolar edema
2 Fatigue is caused by decreased oxygenation of the tissues. Impaired renal perfusion resulting in decreased urine output during the day is a cause of nocturia, not fatigue. Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluids from the dependent body areas when the patient is lying flat. Dyspnea, not fatigue, is caused by an increased pulmonary pressure secondary to interstitial and alveolar edema.
While assessing a patient with acute decompensated heart failure (ADHF), the nurse auscultates fine crackles bilaterally. The nurse recognizes that crackles are an indicator of what? 1 Atelectasis 2 Fluid in the alveoli 3 Mucus in the alveoli 4 Bronchoconstriction
2 Fluid in the alveoli is the correct answer because crackles are made by the sound of air moving through fluid-filled alveoli. Atelectasis is the collapsing of alveoli and would not produce sound. Mucus in the airways sounds like rhonchi or would cause diminished lung sounds if there were consolidation. Bronchoconstriction results in wheezing.
A patient with heart failure (HF) often experiences dyspnea and reports feeling very anxious during the dyspneic episodes. The nurse anticipates a prescription for what medication? 1 Digoxin 2 Morphine 3 Dopamine
2 Morphine is an opioid analgesic used to both reduce anxiety and treat heart failure. Digoxin is a cardiac glycoside, which is used to increase cardiac contractility. Dopamine is a positive inotrope that is used to treat heart failure. Metolazone is a thiazide-like diuretic that is used to treat heart failure.
A patient with heart failure (HF) often experiences dyspnea and reports feeling very anxious during the dyspneic episodes. The nurse anticipates a prescription for what medication? 1 Digoxin 2 Morphine 3 Dopamine 4 Metolazone
2 Morphine is an opioid analgesic used to both reduce anxiety and treat heart failure. Digoxin is a cardiac glycoside, which is used to increase cardiac contractility. Dopamine is a positive inotrope that is used to treat heart failure. Metolazone is a thiazide-like diuretic that is used to treat heart failure.
The nurse assesses that a patient with acute decompensated heart failure (ADHF) experiences dyspnea. What is the priority nursing action? 1 Perform ultrafiltration 2 Provide supplemental oxygen 3 Provide mechanical ventilation 4 Obtain arterial blood gases (ABGs)
2 Supplemental oxygen helps increase the percentage of oxygen in inspired air. Ultrafiltration is a process used to remove excess salt and water from the blood in case of volume overload. Mechanical ventilation is used in cases of pulmonary edema, to help decrease the preload. An ABG test will provide information about the amount of oxygen and carbon dioxide is in the blood, but it is not a priority.
The nurse develops dietary education for a patient with heart failure (HF) and should include what information? 1 A list of foods high in thiamine 2 Guidelines for a low-sodium diet 3 Guidelines for a high-protein diet 4 Instructions for fluid restriction of less than 500 mL per day
2 A low-sodium diet is advised for heart failure patients. Protein levels should not be increased for heart failure patients. High levels of thiamine are not part of the dietary plan for heart failure patients. Fluid restrictions are not necessary for all patients and would not be as low as 500
A patient presents with edema of the legs, dyspnea, and fatigue. The patient is diagnosed with acute decompensated heart failure (ADHF). The nurse expects that which medications will be included in the patient's immediate treatment plan? Select all that apply. 1 Digitalis 2 Dopamine 3 Furosemide 4 Morphine sulfate 5 Sodium nitroprusside
2,3,4,5 ADHF should be treated immediately to prevent complications. Furosemide is a loop diuretic used to promote sodium and water loss. Water loss decreases the preload and enhances the cardiac contractility. Sodium nitroprusside is a potent vasodilator and reduces both the preload and afterload. This results in improved cardiac contractility. Dopamine is a beta-adrenergic agonist and is used to dilate the renal vessels and promote water loss. Morphine sulfate reduces preload and afterload; it is frequently used in the treatment of HF and acute coronary syndrome. It dilates pulmonary and systemic blood vessels, resulting in decreased pulmonary pressure and increased gas exchange. Digitalis is a positive inotrope that improves the myocardial contractility. Because it requires a loading dose and time to work, it is not recommended for the initial treatment of ADHF.
The nurse provides information to a group pf nursing students about primary causes of heart failure (HF). The nurse should include what interventions that are associated with the primary causes and that are aimed at reducing the risk of patients developing HF?? Select all that apply. 1 Blood transfusions for anemia 2 Taking blood pressure medication as prescribed 3 Decreasing dysrhythmias by reducing caffeine intake 4 Initiating lifestyle changes to avoid coronary artery disease (CAD) 5 Taking aspirin every day to reduce the incidence of pulmonary embolism 00:00:02 Question Answer Confidence Buttons
2,4 Hypertension and coronary artery disease (CAD) are considered primary causes of heart failure (HF). Anemia, dysrhythmias, and pulmonary embolism are precipitating causes of heart failure.
The nurse reviews a patient's medical history and identifies what risk factors for heart failure (HF)? Select all that apply. 1 Cirrhosis 2 Hypertension 3 Multiple sclerosis 4 Marfan's syndrome 5 Metabolic syndrome
2,5, Hypertension and coronary artery disease (CAD are the primary risk factors for HF. Other co-morbidities, such as diabetes, metabolic syndrome, advanced age, tobacco use, and vascular disease, also contribute to the development of HF. Cirrhosis, multiple sclerosis, and Marfan's syndrome are not precipitating causes of HF.
A patient is diagnosed with early left ventricular heart failure (HF). The nurse recalls that the changes involved in the development of dyspnea associated with the failure occur in what order? 1. Inadequate alveolar gas exchange 2. Ineffective ventricular contractility 3. Elevated pressure in the left atrium 4. Fluid leaking into interstitial spaces
2. Ineffective ventricular contractility 3. Elevated pressure in the left atrium 1. Inadequate alveolar gas exchange 4. Fluid leaking into interstitial spaces In left ventricular HF, ineffective ventricular contractions impair the normal forward flow of blood to the body. As a result, fluid returning to the heart from the lungs backs up in the heart and increases the pressure in the left atrium. If contractility continues to falter, the blood continues to back up into the pulmonary vasculature and eventually can result in fluid leaking into the interstitial spaces and alveoli of the lungs. This abnormal fluid in the parenchyma and alveoli impairs gas exchange, which causes dyspnea.
During history-taking, the nurse notes that a patient consumes foods high in sodium, which contributes to the patient's hypertension. The nurse develops a dietary plan and should educate the patient to avoid which food item? 1 Shrimp 2 Spinach salad 3 Canned soups 4 Skinless chicken breasts
3 Canned soups are high in sodium and should be avoided by patients with hypertension. Skinless chick breasts, spinach salad, fish, and shellfish are low in sodium and may be consumed on a low-sodium diet.
A patient that is diagnosed with heart failure experiences fatigue. The nurse suspects that the fatigue is caused by what? 1 Increased cardiac output 2 Increased hemoglobin levels 3 Impaired perfusion to vital organs 4 Increased oxygenation of the tissu
3 Fatigue is one of the early signs of heart failure. Due to heart failure, there is inadequate blood circulation, leading to decreased perfusion to the vital organs. An impaired functioning of the vital organs may lead to fatigue. Cardiac output decreases in heart failure, depriving the body tissues of oxygen and nutrients, leading to fatigue. Inadequate blood supply results in inadequate oxygenation of the tissue and causes fatigue when the oxygen demands are not met. Hemoglobin levels are low in heart failure, leading to anemia. A decreased oxygen-carrying capacity of the blood also results in fatigue.
A patient who underwent cardiac transplantation exhibits signs of acute rejection. The nurse recognizes that which medication is often used as posttransplantation therapy to prevent this type of response? 1 Ibuprofen 2 Metoprolol 3 Tacrolimus 4 Acetaminophen
3 Tacrolimus is a calcineurin that is included in most immunosuppressive regimens. Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) used to treat pain. Metoprolol is a beta-blocker that is used to treat hypertension. Acetaminophen is a nonsteroidal antiinflammatory drug (NSAID) that is used to treat pain and fever.
The nurse identifies that which intervention is the most suitable for a patient with worsening acute decompensated heart failure (ADHF) that is hemodynamically unstable? 1 Ultrafiltration (UF) 2 Endotracheal intubation 3 Intraaortic balloon pump (IABP) 4 Bilevel positive airway pressure (BiPAP)
3 The IABP uses a process called counterpulsation to increase coronary blood flow and decrease the heart's workload. Ultrafiltration is a process to remove excess salt and water from the blood. Endotracheal intubation and BiPAP (bilevel positive airway pressure) help maintain an open airway.
The nurse is caring for a patient with acute decompensated heart failure (ADHF) who is receiving intravenous (IV) milrinone. The nurse recognizes that this medication is beneficial because of what effects it has on the body? Select all that apply. 1 Increased diuresis 2 Dilation of renal blood vessels 3 Increased myocardial contractility 4 Promotion of peripheral vasodilation 5 Increased systemic vascular resistance 00:00:07 Question Answer Confidence Buttons
3,4 Milrinone is a phosphodiesterase inhibitor (also known as an inodilator). It increases myocardial contractility (inotropic effect) and promotes peripheral vasodilation. Milrinone does not dilate renal blood vessels and promote diuresis, nor does it increase systemic vascular resistance.
The nurse is caring for a patient developing pulmonary edema. What respiratory rate does the nurse anticipate when assessing this patient? 1 10 to 14 breaths/minute 2 16 to 20 breaths/minute 3 22 to 28 breaths/minute 4 32 to 36 breaths/minute
4 A respiratory rate higher than 30 breaths/minute is often found in patients with pulmonary edema. A patient experiences dyspnea and orthopnea due to the accumulation of edematous fluid in the lung tissues, which affects the patient's respiratory rate. The respiratory rates in the ranges of 12 to 16, 16 to 20, and 20 to 24 breaths/minute indicate normal respiration.
The nurse recognizes what indications for cardiac transplantation? Select all that apply. 1 Angina pectoris 2 Myocardial ischemia 3 Severe, decompensated, inoperable, valvular disease 4 End stage heart failure (HF) refractory to medical care 5 Cardiac abnormality that has a mortality rate of more than 50% within two years 6 Recurrent life-threatening dysrhythmias not responsive to maximal interventions
3,4,5,6 Severe valvular disease may compromise the vital functions of the heart. End-stage heart failure refractory to medical care may prove to be fatal if the heart is not transplanted. Cardiac transplantation would be the only option left for a cardiac abnormality that has a mortality rate of more than 50% within two years. Recurrent life-threatening dysrhythmias not responsive to maximal interventions may prove to be fatal. Angina pectoris is a transient blockage of coronary blood vessels and may not be severe enough to require a cardiac transplantation. Myocardial ischemia is an inadequate oxygen supply to the myocardial tissue and also may not be severe enough to require a cardiac transplantation.
The nurse presents information to a group of nursing students about heart transplantation. When listing major causes of death after the first year posttransplantation, what should the nurse include? 1 Infection 2 Acute rejection 3 Immunosuppression 4 Cardiac vasculopathy
4 Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated coronary artery disease [CAD]) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increase the patient's risk of an infection.
A patient with heart failure is being discharged from the hospital. Which instructions should the nurse include in the patient's teaching plan? 1 Limit activity, including daily exercise. 2 Restrict fluid intake to less than 2 L per day. 3 Take one extra dose of diuretic medication for swelling of the feet. 4 Report a weight gain of 3 lb (1.4 kg) in two days, or 3 to 5 lbs (2.3 kg) in a week.
4 Daily weight is the best indicator of changes in fluid status. An activity such as daily exercise is encouraged because exercise improves the patient's sense of well-being. A fluid restriction may be recommended for advanced heart failure but is not a method of monitoring fluid status. The patient should never adjust medications without consulting with the primary health care provider.
A patient with chronic heart failure (HF) reports disturbed sleep due to the urge to urinate frequently. The nurse suspects that what condition that is associated with HF is most likely causing the patient's nocturia? 1 Diabetes 2 An enlarged prostate 3 Increased caffeine intake during the day, resulting in diuresis at night 4 Extravascular fluid being reabsorbed from the interstitial spaces back into the circulatory system, resulting in increased perfusion to the kidneys
4 In a patient with chronic heart failure, there is decreased renal perfusion and urine production during the day, because most fluid gets accumulated in the peripheral tissues. However, while lying down at night in a recumbent position, the fluid from the peripheral interstitial tissues enters the central circulation. This leads to an increase in renal function, causing nocturia. Diabetes, an enlarged prostate, and caffeine intake before going to bed also cause nocturia but are less likely in this case.
The nurse compares the signs and symptoms of right-sided heart failure and left-sided heart failure. Which symptom is unique to right-sided heart failure? 1 Fatigue 2 Anxiety 3 Depression 4 Bilateral edema
4 Right-sided heart failure is manifested as bilateral edema in the patient. Fatigue, anxiety, and depression are symptoms of both right-sided and left-sided heart failure.
A patient is diagnosed with left-sided heart failure. The nurse should carefully monitor the patient for what complication? 1 Hepatomegaly 2 Splenomegaly 3 Vascular congestion 4 Pulmonary congestion
4 The most common form of heart failure is left-sided heart failure. It results from left ventricular dysfunction. This prevents normal, forward blood flow and causes blood to back up into the left atrium and pulmonary veins. There would be fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli; this manifests as pulmonary congestion and edema. Right-sided heart failure occurs when the right ventricle fails to contract effectively.
A patient is diagnosed with heart failure, which was caused by thyrotoxicosis. The nurse identifies what other precipitating causes of heart failure? Select all that apply. 1 Anemia 2 Myocarditis 3 Paget's disease 4 Pulmonary embolism 5 Coronary artery disease
1,3,4 The precipitating causes of heart failure include anemia, in which the oxygen-carrying capacity of the blood is reduced. Hypoxemia leads to an increase in cardiac output, which then increases the workload on the heart. In Paget's disease, there is an increase in the vascular bed in the skeletal muscles, which causes an increase in the cardiac workload. In pulmonary embolism, an increase in pulmonary pressure decreases cardiac output. Myocarditis and coronary artery disease are the primary causes of heart failure but are unlikely in this patient.
The nurse assesses a patient with a family history of heart failure. Which primary causes of heart failure are linked to specific genes and gene mutations? Select all that apply. 1 Hypertension 2 Hyperthyroidism 3 Cardiomyopathy 4 Rheumatic heart disease 5 Coronary artery disease (CAD)
1,3,5 Primary causes of heart failure linked to specific genes and gene mutations include coronary artery disease, cardiomyopathy, and hypertension. Hyperthyroidism and rheumatic heart disease are primary causes of heart failure that are not linked to specific genes and gene mutation. Some of the precipitating causes of heart failure include anemia, hypothyroidism, and infection.
A patient is admitted to the hospital with a diagnosis of acute decompensated heart failure (ACHF). The primary health care provider prescribes a continuous intravenous infusion of sodium nitroprusside. What is the priority nursing intervention? 1 Monitor urinary output. 2 Monitor blood pressure. 3 Check serum potassium level. 4 Assess the skin surrounding the intravenous (IV) site.
2 The priority nursing intervention is to monitor blood pressure, because symptomatic hypotension is the main adverse effect of sodium nitroprusside. Monitoring urinary output is not necessary during a continuous intravenous infusion of sodium nitroprusside. Hyperkalemia may occur with renin-angiotensin-aldosterone inhibitors, angiotensin II receptor blockers, and aldosterone antagonists. Assessment is needed for the skin around an intravenous infusion of dopamine (Intropin) because it can cause tissue necrosis with sloughing.
A nurse reviews the medical record of a patient with pulmonary embolism and notes the presence of cor pulmonale. The nurse recalls that this refers to a disorder of the heart that is caused by what? 1 Liver disease 2 Renal disease 3 Pulmonary disease 4 Preexisting heart disease
3 Cor pulmonale is a cardiac condition in which a disease of the pulmonary system causes an increase in right ventricular pressure. This increased right ventricular pressure causes right ventricular failure, which may eventually lead to heart failure. This term is not used for heart disease caused by liver, kidney, or preexisting heart diseases.
A patient has been diagnosed with dilated cardiomyopathy (DCM). The nurse identifies that the patient is at risk for what condition? 1 Systolic failure 2 Diastolic failure 3 Left ventricular hypertrophy 4 Mixed systolic and diastolic failure
4 Dilated cardiomyopathy is a condition in which already compromised systolic function is further compromised by dilated left ventricular walls, which are unable to relax. With this condition, patients usually have very low ejection factor, as well as biventricular failure, which is a characteristic of mixed systolic and diastolic failure. Systolic failure is characterized by a decrease in left ventricular ejection factor because of the heart's inability to pump blood effectively. Diastolic failure is referred to as a heart failure with normal ejection factor. Left ventricular hypertrophy is the thickening of the left ventricle muscle, which may result in heart failure, but left ventricular hypertrophy is not a type of heart failure itself.
A patient with a history of left-sided heart failure arrives in the emergency department reporting extreme shortness of breath and a persistent cough with pink, frothy sputum. On auscultation of the heart, the nurse notes an S3 gallop. The nurse recognizes those symptoms as being caused by what? 1 Pneumonia 2 An asthma attack 3 A myocardial infarction 4 Acute pulmonary edema
4 Extreme shortness of breath and a persistent cough with pink, frothy sputum are symptoms of pulmonary edema. Pneumonia, an asthma attack, and a myocardial infarction are not correct because pink frothy sputum and an S3 gallop are not symptoms of any of these.
A patient is admitted with acute decompensated heart failure. Which part of the treatment plan will increase fatigue in this patient? 1 A 2-g sodium diet 2 Cardiac monitoring 3 Oxygen at 2 L by nasal cannula 4 Intravenous (IV) furosemide 40 mg every six hours
4 Furosemide will cause diuresis and frequent trips to the bedside commode or bathroom, leading to fatigue. Oxygen will improve the patient's tolerance of activity. A cardiac monitor will monitor for electrolyte imbalances due to furosemide administration and will not affect fatigue. A 2-g sodium diet will help reduce the sodium load to the heart and reduce fatigue.
A patient with chronic heart failure asks the nurse about heart transplantation. The nurse identifies that the surgery is absolutely contraindicated if the patient has what history findings? Select all that apply. 1 Severe obesity 2 Age over 70 years 3 Recurrent life-threatening dysrhythmias 4 Cardiac abnormalities that severely limit normal function 5 Advanced cerebral or vascular disease not amenable to correction
1,5 Absolute contraindications for heart transplant include chronologic age over 70 and advanced cerebral or vascular disease not amenable to correction. Indications for heart transplant include recurrent life-threatening dysrhythmias not responsive to maximal interventions and cardiac abnormalities that severely limit normal function. Severe obesity is a relative contraindication.
Diagnostic results of a patient reveal an ejection fraction (EF) of 32%. The nurse recognizes that the finding may be indicative of what conditions? Select all that apply. 1 Systolic failure 2 Diastolic failure 3 Myocardial infarction 4 Coronary heart disease 5 Mixed systolic and diastolic failure
1,5 Ejection factor (EF) is defined as the amount of blood ejected from the left ventricle after each contraction. Normal EF is 55-60%. The hallmark of systolic failure is a decrease in EF (less than 45%). Patients with mixed systolic and diastolic failure have extremely low EF (less than 35%). The EF in diastolic failure is normal. Myocardial infarction is the damage to the heart muscle due to decreased blood flow and oxygen supply, which may or may not result in low EF. Coronary heart disease, if not severe, may not affect the EF.
A patient newly diagnosed with heart failure is being discharged from the hospital. Which health care team member frequently works with protocols set up with the patient's health care provider to identify problems and start interventions? 1 Physical therapist 2 Home health nurse 3 Occupational therapist 4 Social services provider
2 Home health nurses frequently work with protocols set up with the patient's health care provider. The protocols help the patient to identify problems, such as an increase in weight or dyspnea, both of which are symptoms of worsening heart failure. Physical therapy or occupational therapy may not be needed. Social services can assist with obtaining community resources the patient may need.
The nurse reviews compensatory mechanisms associated with heart failure (HF). The nurse recalls that the sequence of events in the renin-angiotensin-aldosterone system (RAAS) occur in what order? 1. Renin is released. 2. Cardiac output falls. 3. Vasoconstriction occurs. 4. Angiotensinogen is activated. 5. Angiotensin I is converted to angiotensin II.
2. Cardiac output falls. 1. Renin is released. 4. Angiotensinogen is activated. 5. Angiotensin I is converted to angiotensin II. Vasoconstriction occurs. In the RAAS, decreased cardiac output leads to release of renin from the kidneys. Renin causes activation of angiotensinogen, which is the enzyme that changes angiotensin I into angiotensin II, which is a potent vasoconstrictor.
The nurse is caring for a patient with chronic heart failure and atrial fibrillation that takes digoxin and a thiazide diuretic. Which statement made by the patient indicates that the patient is experiencing a complication related to the medication? 1 "My ankles are still slightly swollen." 2 "I have to urinate a lot after I take those pills!" 3 "I'm not really hungry for lunch. I feel so nauseated and tired." 4 "I check my heart rate regularly. It is usually 80-90 beats per minute."
3 Drug therapy with digoxin and potassium-losing diuretics (thiazides or loop diuretics) may lead to hypokalemia. The presence of hypokalemia while the patient is on digoxin may lead to digoxin toxicity. Signs of early digoxin toxicity include anorexia, nausea and vomiting, fatigue, headache, depression, and visual changes. Slightly swollen ankles are an expected finding with chronic heart failure; frequent urination is an expected effect of the diuretic. The heart rate of 90 beats/minute is normal.
An acutely ill patient develops unexplained, new-onset heart failure (HF) that is unresponsive to usual care. The nurse anticipates a prescription for which diagnostic procedure that is commonly done as part of a heart catheterization?? 1 Chest x-ray 2 Intraarterial BP 3 Endomyocardial biopsy (EMB) 4 Multigated acquisition (MUGA) scan
3 Endomyocardial biopsy is an investigation to find out the cause of new-onset heart failure that is unresponsive to routine care. Hemodynamic monitoring (e.g., intraarterial BP) is included in the care plan for a patient with acute decompensated heart failure (ADHF). A chest x-ray and MUGA scan are common diagnostic studies used for many types of patients suspected of having cardiac problems; they are not done as part of a cardiac catheterization.
A patient has undergone cardiac transplantation. The nurse expects that which treatment will be prescribed? 1 Antibiotic therapy 2 Antifungal therapy 3 Immunosuppressive therapy 4 Intravenous immunoglobulin (IVIG) therapy
3 Immunosuppressive therapy is used to suppress the immune system and prevent rejection of the transplanted heart. Intravenous immunoglobulin (IVIG) is a blood product that is administered intravenously. It contains the pooled, polyvalent, and IgG antibodies extracted from the plasma of over one thousand blood donors and is used to boost the immune system. Antibiotic therapy is used to prevent infection. Antifungal therapy is used to treat fungal infections.
The nurse is caring for a patient with left-sided heart failure and expects what assessment finding? 1 Hepatomegaly 2 Splenomegaly 3 Pulmonary congestion 4 Vascular congestion of gastrointestinal tract
3 Left-sided heart failure results from left ventricular dysfunction; this is manifested as pulmonary congestion and edema. Venous congestion in the systemic circulation results in jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract, and peripheral edema.
A patient dies of irreversible brain injury. The nurse recognizes that which assessments must be performed to determine the suitability of harvesting the heart for cardiac transplantation? Select all that apply. 1 Gram stain 2 Bronchoscopy 3 ABO blood type 4 Body size and heart size 5 Human leukocyte antigen typing 6 Panel of reactive antibody (PRA) level
3,4,5,6 In order to avoid complications after cardiac transplantation, a careful selection of the donor's heart must be performed. The donor's organ must fulfill certain matching criteria with the recipient. These assessments include: ABO blood type, body size, heart size, human leukocyte antigen, and panel antibody reactive level. Gram stain and bronchoscopy findings are the matching criteria to be fulfilled for lung transplantation.
