Med surg 2 ch. 29

The nurse is caring for a client with heart failure. What procedure should the nurse prepare the client for in order to determine the ejection fraction to measure the efficiency of the heart as a pump?

Echocardiogram

A nurse is administering lanoxin, which she knows increases contractility as well as cardiac output. Contractility refers to which of the following?

The force of the contraction related to the status of the myocardium

A nurse is caring for a client with heart failure. The nurse knows that the client has left-sided heart failure when he makes which statement?

"I sleep on three pillows each night."

A nurse has come upon an unresponsive, pulseless victim. She has placed a 911 call and begins CPR. The nurse understands that if the patient has not been defibrillated within which time frame, the chance of survival is close to zero?

10 minutes

A 76-year-old client has a significant history of congestive heart failure. During his semiannual cardiology examination, for what should you, as his nurse, specifically assess? Select all that apply.

-Examine the client's neck for distended veins. -Monitor the client for signs of lethargy or confusion.

A client is receiving furosemide (Lasix), a loop diuretic, to prevent fluid overload. The order is for 50 mg intraveneous now. The pharmacy supplies Lasix 80 mg per 2 mL. How many mL will the nurse give the client? Enter the correct number ONLY

1.25

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

On his return to the cardiac step-down unit after his diagnostic procedure, a client awaits the report from his cardiologist. As the client's nurse, you review the process of measuring ejection fraction and explain to the client that it measures the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects?

55%

The nurse observes that a patient has 2+ pitting edema in the lower extremities. What does the nurse know that the presence of pitting edema indicates regarding fluid retention?

A weight gain of 10 lbs

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)

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

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

Echocardiogram

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

B-type natriuretic peptide (BMP)

Which of the following is a key diagnostic indicator of heart failure?

BNP

A client is returning from the operating room after inguinal hernia repair. The nurse notes that he has fluid volume excess from the operation and is at risk for left-sided heart failure. Which sign or symptom indicates left-sided heart failure?

Bibasilar crackles

Which of the following is a key diagnostic indicator of heart failure (HF)?

Brain 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 questioning how many pillows the client normally uses for sleep

Ronald is a 46-year-old who has developed congestive heart failure. He has to learn to adapt his diet and you are his initial counselor. Which of the following should you tell him to avoid?

Canned peas

Which pulse should the nurse palpate during rapid assessment of an unconscious adult

Carotid

A client has been prescribed furosemide (Lasix) 80 mg twice daily. The cardiac monitor technician informs the nurse that the client has started having rare premature ventricular contractions followed by runs of bigeminy lasting 2 minutes. During the assessment, the nurse determines that the client is asymptomatic and has stable vital signs. Which of the following actions should the nurse perform next?

Check the client's potassium level.

A client with chronic heart failure is able to continue with his regular physical activity and does not have any limitations as to what he can do. According to the New York Heart Association (NYHA), what classification of chronic heart failure does this client have?

Class I (Mild)

A nurse taking care of a patient recently admitted to the ICU observes the patient coughing up large amounts of pink, frothy sputum. Auscultation of the lungs reveals course crackles to lower lobes bilaterally. Based on this assessment, the nurse recognizes this patient is developing which of the following problems?

Decompensated heart failure with pulmonary edema

The nurse assessing a patient with an exacerbation of heart failure identifies which of the following symptoms as a cerebrovascular manifestation of heart failure (HF)?

Dizziness

The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure

Dyspnea on exertion

A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient?

Electrolyte and water loss

A patient with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, bradycardia, and muffled heart sounds. The senior nursing student recognizes these symptoms occur when

Excess pericardial fluid compresses the heart and prevents adequate diastolic filling.

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

Fatigue

Which of the following medications is categorized as a loop diuretic

Furosemide (Lasix)

You are caring for a client with suspected right-sided heart failure. What would you know that clients with suspected right-sided heart failure may experience

Gradual unexplained weight gain

A patient with congestive heart failure is admitted to the hospital with complaints of shortness of breath. How should the nurse position the patient in order to decrease preload?

Head of the bed elevated at 45 degrees and lower arms supported by pillows

With which disorder is jugular vein distention prominent?

Heart Failure

A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect?

Heart failure

Which of the following therapies are for patient who have advanced heart failure (HF) after all other therapies have failed?

Heart transplant

The nurse is preparing to administer hydralazine and isosorbide dinitrate (Dilatrate). When obtaining vital signs, the nurse notes that the blood pressure is 90/60. What is the priority action by the nurse?

Hold the medication and call the physician

Sixty six-year-old David Steiner is already being treated for hypertension. His doctor, concerned about the potential for heart failure, has him come back for check-ups regularly. 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

The pathophysiology of pericardial effusion is associated with all of the following except:

Increased venous return.

What mechanical device increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen consumption in a client with cardiogenic shock?

Intra-aortic balloon pump

Which of the following is a characteristic of right-sided heart failure

JVD

The nurse identifies which of the following symptoms as a characteristic of right-sided heart failure?

Jugular vein distention (JVD)

A new client has been admitted with right-sided heart failure. The nurse knows to look for which of the following assessment findings when assessing this client?

Jugular venous distention

In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure?

Leg edema

A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status?

Weighing the client daily at the same time each day

The nurse is providing discharge instructions to a client with heart failure preparing to leave the following day. What type of diet should the nurse request the dietitian to discuss with the client?

Low-sodium diet

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

Morphine sulfate

You are working in a long-term care facility with a group of older adults with cardiac disorders. Why would it be important for you to closely monitor an older adult receiving digitalis preparations for cardiac disorders?

Older adults are at increased risk for toxicity.

Which of the following describes difficulty breathing when a patient is lying flat?

Orthopnea

Which of the following clinical manifestations are consistent with right-sided heart failure (HF)?

Positive hepatojugular reflux

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 physician orders digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity

Potassium level of 2.8 mEq/L

The nurse is preparing to administer furosemide (Lasix) to a client with severe heart failure. What lab study should be of most concern for this client while taking Lasix?

Potassium level of 3.1

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

The nurse recognizes which of the following symptoms as a classic sign of cardiogenic shock?

Restlessness and confusion

A client is admitted to the ICU with a diagnosis of heart failure. The client is exhibiting symptoms of weakness, ascites, weight gain, and jugular vein distention. The nurse would know that the client is exhibiting signs of what kind of heart failure?

Right-sided heart failure

A patient has been diagnosed with systolic heart failure. The nurse would expect the patient's ejection fraction to be at which level?

Severely reduced

Which is a potassium-sparing diuretic used in the treatment of heart failure?

Spironolactone (Aldactone)

The nurse is discussing cardiac hemodynamics with a nursing student, who understands the following formula: CO = HR X SV (cardiac output equals heart rate times stroke volume). The student asks what determines stroke volume. The correct response by the nurse is which of the following?

Stroke volume depends on three factors: preload, afterload, and contractility.

Which of the following is a manifestation of right-sided heart failure?

Systemic venous congestion

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 his rings have become tight and are difficult to remove.

Which treatment is the best therapy for a stable client with digoxin toxicity?

Time and symptomatic treatment

The student nurse is caring for a client with heart failure. Diuretics have been ordered. What method would help the nurse evaluate the client's response to diuretics?

Using a urinary catheter

A patient taking an ACE inhibitor has developed a dry, hacking cough. Because of this side effect, the patient no longer wants to take that medication. What medication that has similar hemodynamic effects does the nurse anticipate the physician ordering?

Valsartan (Diovan)

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?

Valsartan (Diovan)

Which of the following nursing interventions should a nurse perform when a patient with valvular disorder of the heart has a heart rate less than 60 beats per minute before administering beta-blockers?

Withhold the drug and inform the primary health care provider

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). The nurse should document this as:

a third heart sound (S3).

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

When assessing a client with left-sided heart failure, the nurse expects to note:

air hunger.

The nursing instructor is discussing heart failure with their clinical group. The instructor talks about heart failure in terms of a decreasing ejection fraction of the heart. What diagnostic test is used to measure the ejection fraction of the heart?

echocardiogram

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

decreased in renal perfusion

Which of the following is the hallmark of systolic heart failure?

low ejection fraction (EF)

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

orthopnea

The patient with cardiac failure is taught to report which of the following symptoms to the physician or clinic immediately?

persistent cough

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

place in high fowlers

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." The CSU nurse should be especially observant for

pulmonary crackles

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