Management of Patients With Complications from Heart Disease
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 three pillows each night." "My feet are bigger than normal." "My pants don't fit around my waist." "I don't have the same appetite I used to."
"I sleep on three pillows each night."
A client has been diagnosed with systolic heart failure. What percentage will the nurse expect the patient's ejection fraction to be? 5% 30% 55% 65%
30%
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%
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 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 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? Blood urea nitrogen (BUN) Complete blood count (CBC) B-type natriuretic peptide (BNP) Serum electrolytes
B-type natriuretic peptide (BNP)
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? By collecting the client's urine output By observing the client's diet during the day By measuring the client's abdominal girth By questioning how many pillows the client normally uses for sleep
By questioning how many pillows the client normally uses for sleep
Which medication reverses digitalis toxicity? Ibuprofen Warfarin Amlodipine Digoxin immune FAB
Digoxin immune FAB
The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure? Decreased urinary output Dyspnea on exertion Hypotension Tachycardia
Dyspnea on exertion
Which diagnostic study is usually performed to confirm the diagnosis of heart failure? Electrocardiogram (ECG) Echocardiogram Serum electrolytes Blood urea nitrogen (BUN)
Echocardiogram
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? Head of the bed elevated 30 degrees and legs elevated on pillows Head of the bed elevated 45 degrees and lower arms supported by pillows Supine with arms elevated on pillows above the level of the heart Prone with legs elevated on pillows
Head of the bed elevated 45 degrees and lower arms supported by pillows
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.
Which is a characteristic of right-sided heart failure? Jugular vein distention Dyspnea Pulmonary crackles Cough
Jugular vein distention
The nurse identifies which symptom as a characteristic of right-sided heart failure? Jugular vein distention (JVD) Dyspnea Pulmonary crackles Cough
Jugular vein distention (JVD)
Which describes difficulty breathing when a client is lying flat? Paroxysmal nocturnal dyspnea (PND) Orthopnea Tachypnea Bradypnea
Orthopnea
A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient? Vasculitis Potassium levels Flexion contractures Enlargement of joints
Potassium levels
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
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.) Jugular vein distention Ascites Pulmonary crackles Dyspnea Cough
Pulmonary crackles Dyspnea Cough
The nurse recognizes which symptom as a classic sign of cardiogenic shock? Restlessness and confusion Hyperactive bowel sounds High blood pressure Increased urinary output
Restlessness and confusion
Which is a manifestation of right-sided heart failure? Accumulation of blood in the lungs Systemic venous congestion Increase in forward flow Paroxysmal nocturnal dyspnea
Systemic venous congestion
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 keeps the vessels open so that blood will adequately deliver to the myocardium. The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart. The balloon delivers an electrical impulse to correct dysrhythmias the patient experiences. The balloon will inflate at the beginning of systole and deflate before diastole to provide a long-term solution to a failing myocardium.
The balloon inflates at the beginning of diastole and deflates before systole to augment the pumping action of the heart.
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? The development of chronic obstructive pulmonary disease (COPD) The development of left-sided heart failure The development of right-sided heart failure The development of cor pulmonale
The development of left-sided heart failure
The student nurse is caring for a client with heart failure. Diuretics have been ordered. What method might be used with a debilitated client to help the nurse evaluate the client's response to diuretics? Using mechanical ventilation Using a urinary catheter Using a pulmonary artery catheter Using a biventricular pacemaker
Using a urinary catheter
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 first heart sound (S1). a third heart sound (S3). a fourth heart sound (S4). a murmur.
a third heart sound (S3).
A client with left-sided heart failure reports 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 what condition? right-sided heart failure. acute pulmonary edema. pneumonia. cardiogenic shock.
acute pulmonary edema.
The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema? decreased left ventricular pumping decreased right ventricular elasticity increased left atrial contractility increased right atrial resistance
decreased left ventricular pumping
Frequently, what is the earliest symptom of left-sided heart failure? dyspnea on exertion anxiety confusion chest pain
dyspnea on exertion
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? furosemide spironolactone mannitol metolazone
furosemide
The nurse is assessing a client with crackling breath sounds or pulmonary congestion. What is the cause of the congestion? ascites hepatomegaly inadequate cardiac output nocturia
inadequate cardiac output
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
A client is receiving captopril for heart failure. During the nurse's assessment, what sign indicates that the medication therapy is ineffective? skin rash peripheral edema bradycardia postural hypotension
peripheral edema
The nurse is administering digoxin to a client with heart failure. What laboratory value may predispose the client to digoxin toxicity? magnesium level of 2.5 mg/dL calcium level of 7.5 mg/dL sodium level of 152 mEq/L potassium level of 2.8 mEq/L
potassium level of 2.8 mEq/L
Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest? I II III IV
IV
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 client with right-sided heart failure is admitted to the medical-surgical unit. What information obtained from the client may indicate the presence of edema? The client says that he has been urinating less frequently at night. The client says he has been hungry in the evening. The client says his rings have become tight and are difficult to remove. The client says he is short of breath when ambulating.
The client says his rings have become tight and are difficult to remove.
A client with left-sided heart failure reports 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 what condition? right-sided heart failure. acute pulmonary edema. pneumonia. cardiogenic shock.
acute 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 electrocardiogram cardiac catheterization cardiac ultrasound
echocardiogram
A client with pulmonary edema has been admitted to the ICU. What would be the standard care for this client? Intubation of the airway BP and pulse measurements every 15 to 30 minutes Insertion of a central venous catheter Hourly administration of a fluid bolus
BP and pulse measurements every 15 to 30 minutes
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.
A client has been diagnosed with right-sided heart failure based on symptomology. The cardiologist will confirm this suspicion through diagnostics. Which diagnostics are used to reveal right ventricular enlargement? Select all that apply. electrocardiogram chest radiograph echocardiography pulmonary arteriography
electrocardiogram chest radiograph echocardiography
The nurse is assessing a newly admitted client with chest pain. What medical disorder is most likely causing the client to have jugular vein distention? abdominal aortic aneurysm heart failure myocardial infarction (MI) pneumothorax
heart failure
