Management of Patients With Complications from Heart Disease
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? (a) Observe for mist in the endotracheal tube. (b) Listen for breath sounds over the epigastrium. (c) Call for a chest x-ray. (d) Attach a pulse oximeter probe and obtain values.
c
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? (a) hypertension (b) high urine output (c) dry mucous membranes (d) pulmonary crackles
d
The nurse completes an assessment of a client admitted with a diagnosis of right-sided heart failure. What will be a significant clinical finding related to right-sided heart failure? (a) pitting edema (b) oliguria (c) S4 ventricular gallop sign (d) decreased O2 saturation levels
a
The nurse is working in a long-term care facility with a group of older adults with cardiac disorders. Why would it be important for the nurse to closely monitor an older adult receiving digitalis preparations for cardiac disorders? (a) Older adults are at increased risk for toxicity. (b) Older adults are at increased risk for cardiac arrests. (c) Older adults are at increased risk for hyperthyroidism. (d) Older adults are at increased risk for asthma.
a
The nurse recognizes which symptom as a classic sign of cardiogenic shock? (a) Restlessness and confusion (b) Hyperactive bowel sounds (c) High blood pressure (d) Increased urinary output
a
The nurse understands that a client with which cardiac arrhythmia is most at risk for developing heart failure? (a) Atrial fibrillation (b) First-degree heart block (c) Supraventricular tachycardia (d) Sinus tachycardia
a
Which is a characteristic of right-sided heart failure? (a) Jugular vein distention (b) Dyspnea (c) Pulmonary crackles (d) Cough
a
A nurse is administering digoxin. What client parameter would cause the nurse to hold the digoxin and notify the health care prescriber? (a) blood pressure of 125/80 (b) urine output of 300 mL in eight hours (c) atrial fibillation rhythm (d) heart rate of 55 beats per minute
d
The critical care nurse is caring for a client with cardiogenic shock. What is the premise for inserting an intra-aortic balloon pump? (a) coronary artery stenosis (b) inadequate tissue perfusion (c) myocardial ischemia (d) right atrial flutter
b--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
A nurse is assessing a client with congestive heart failure for jugular vein distension (JVD). Which observation is important to report to the physician? (a) No JVD is present. (b) JVD is noted at the level of the sternal angle. (c) JVD is noted 2 cm above the sternal angle. (d) JVD is noted 4 cm above the sternal angle.
d
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? (a) BNP of 100 (b) Sodium level of 135 (c) Hemoglobin of 12 (d) Potassium level of 3.1
d
The nursing instructor is teaching their clinical group how to assess a client for congestive heart failure. How would the instructor teach the students to assess a client with congestive heart failure for nocturnal dyspnea? (a) By collecting the client's urine output (b) By observing the client's diet during the day (c) By measuring the client's abdominal girth (d) By questioning how many pillows the client normally uses for sleep
d
Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest? (a) I (b) II (c) III (d) IV
d
Which medication reverses digitalis toxicity? (a) Ibuprofen (b) Warfarin (C) Amlodipine (d) Digoxin immune FAB
d
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? (a) visual disturbances. (b) taste and smell alterations. (c) dry mouth and urine retention. (d) nocturia and sleep disturbances.
a
Frequently, what is the earliest symptom of left-sided heart failure? (a) dyspnea on exertion (b) anxiety (c) confusion (d) chest pain
a
The nurse is teaching a group of clients with heart failure about how to decrease leg edema. What dietary advice will the nurse give to clients with severe heart failure? (a) Avoid the intake of processed and commercially prepared foods. (b) Avoid the intake of canned fruit and fruit juices. (c) Encourage increased intake of vegetables with natural sodium. (d) Encourage increased intake of red meat.
a
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? (a) moist, gurgling respirations (b) drowsiness, numbness (c) increased cardiac output (d) hypertension
a--Clients with acute pulmonary edema experience sudden dyspnea, wheezing, orthopnea, cough, cyanosis, and tachycardia. Respirations sound moist or gurgling
The nurse is assessing a client admitted with cardiogenic shock. What medication will the nurse tritrate to improve blood flow to vital organs? (a) dopamine (b) enalapril (c) furosemide (d) metoprolol
a--It increases perfusion pressure to improve myocardial contractility and blood flow through vital organs.
A nurse is assessing a client with heart failure. What breath sound is commonly auscultated in clients with heart failure? (a) tracheal. (b) fine crackles. (c) coarse crackles. (d) friction rubs.
b
A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect? (a) Pulmonary embolism (b) Heart failure (c) Cardiac tamponade (d) Tension pneumothorax
b
The client with cardiac failure is taught to report which symptom to the physician or clinic immediately? (a) Increased appetite (b) Persistent cough (c) Weight loss (d) Ability to sleep through the night
b
The nurse is asssessing a client with crackling breath sounds or pulmonary congestion. What is the cause of the congestion? (a) ascites (b) hepatomegaly (c) inadequate cardiac output (d) nocturia
c
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? (a) Observe for symptoms of pulmonary edema. (b) Continue the drug and document in the client's chart. (c) Withhold the drug and inform the primary health care provider. (d) Check for signs of toxicity.
c
Which is a key diagnostic indicator of heart failure? (a) Blood urea nitrogen (BUN) (b) Creatinine (c) Brain natriuretic peptide (BNP) (d) Complete blood count (CBC)
c--High levels of BNP are a sign of high cardiac filling pressure and can aid in the diagnosis of heart failure. BUN, creatinine, and a CBC are included in the initial workup.
The nurse assessing a client with an exacerbation of heart failure identifies which symptom as a cerebrovascular manifestation of heart failure (HF)? (a) Tachycardia (b) Ascites (c) Nocturia (d) Dizziness
d
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? (a) Left ventricular function (b) Right ventricular function (c) Left atrial function (d) Right atrial function
a
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? (a) "I sleep on three pillows each night." (b) "My feet are bigger than normal." (c) "My pants don't fit around my waist." (d) "I don't have the same appetite I used to."
a
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? (a) An LVAD only supports a failing left ventricle. (b) It is specifically designed for long-term use. (c) It never needs batteries. (d) It is designed for extremely active patients.
a--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.
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? (a) Monitor blood pressure frequently (b) Encourage the client to ambulate in room (c) Titrate milrinone rate slowly before discontinuing (d) Teach the client about safe home use of the medication
a--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.
What is the main difference between Class I and Class II heart failure as defined by the New York Heart Association (NYHA)? (a) The level of physical activity each allows (b) Duration of symptoms (c) There is a marked limitation of physical activity. (d) The client is unable to carry out any physical activity.
a--Both Class I and Class II levels of heart failure are considered Mild under the New York Heart Association (NYHA) guidelines. The difference is that in Class II, the client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea, whereas in Class I, the client is comfortable both at rest and during ordinary physical activity. A marked limitation of physical activity would be a sign of Moderate heart failure, and inability to carry out any physical activity is a sign of Severe heart failure.
The nurse is teaching a client about medications prescribed for severe volume overload from heart failure. What diuretic is the first-line treatment for clients diagnosed with heart failure? (a) furosemide (b) spironolactone (c) mannitol (d) metolazone
a--Loop diuretics such as furosemide, bumetanide, and torsemide are the preferred first-line diuretics because of their efficacy in patients with and without renal impairment
A client who has developed congestive heart failure must learn to make dietary adaptations. The client should avoid: (a) canned peas. (b) dried peas. (c) angel food cake. (d) ready-to-eat cereals.
a--There is a wide variety of foods that the client can still eat; the key is to have low-salt content.
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? (a) Notify the health care provider. (b) Check the client's potassium level. (c) Calculate the client's intake and output. (d) Administer potassium.
b
A client with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, and muffled heart sounds. The nurse recognizes these as symptoms of what occurrence? (a) The pericardial space is eliminated with scar tissue and thickened pericardium. (b) Excess pericardial fluid compresses the heart and prevents adequate diastolic filling. (c) The parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction. (d) Fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction.
b
The diagnosis of heart failure is usually confirmed by which of the following? (a) Chest x-ray (b) Echocardiogram (c) Electrocardiogram (12-lead) (d) Ventriculogram
b
The nurse identifies which symptom as a manifestation of right-sided heart failure (HF)? (a) Accumulation of blood in the lungs (b) Congestion in the peripheral tissues (c) Reduction in forward flow (d) Reduction in cardiac output
b
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) a first heart sound (S1). (b) a third heart sound (S3). (c) a fourth heart sound (S4). (d) a murmur.
b--An S3 is heard following an S2, which commonly occurs in clients experiencing heart failure and results from increased filling pressures
The nurse is caring for a client with suspected right-sided heart failure. What would the nurse know that clients with suspected right-sided heart failure may experience? (a) Increased urine output (b) Gradual unexplained weight gain (c) Increased perspiration (d) Sleeping in a chair or recliner
b--Clients with right-sided heart failure may have a history of gradual, unexplained weight gain from fluid retention. Left-sided heart failure produces paroxysmal nocturnal dyspnea, which may prompt the client to use several pillows in bed or to sleep in a chair or recliner.
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? (a) Head of the bed elevated 30 degrees and legs elevated on pillows (b) Head of the bed elevated 45 degrees and lower arms supported by pillows (c) Supine with arms elevated on pillows above the level of the heart (d) Prone with legs elevated on pillows
b--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.
Which is a manifestation of right-sided heart failure? (a) Accumulation of blood in the lungs (b) Systemic venous congestion (c) Reduction in forward flow (d) Reduction in cardiac output
b--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 client develops cardiogenic pulmonary edema and is extremely apprehensive. What medication can the nurse administer with physician orders that will relieve anxiety and slow respiratory rate? (a) Furosemide (b) Nitroglycerin (c) Dopamine (d) Morphine sulfate
d--Morphine seems to help relieve respiratory symptoms by depressing higher cerebral centers, thus relieving anxiety and slowing respiratory rate. Morphine also promotes muscle relaxation and reduces the work of breathing
