Test: Heart Failure

A nurse is planning care for a client who has heart failure. Which of the following interventions should the nurse include in the plan of care? Maintain sodium intake at 3.5mg daily Limit fluid intake to 2 L per day Administer NSAIDs for minor discomfort Place the client in a lateral recumbent position.

Limit fluid intake to 2 L per day. The nurse should plan to limit the client's fluid intake to 2 L daily to decrease fluid retention, which decreases the workoad of the heart. Sodium (decreased between 2-3mg daily) NSAIDs (should avoid) Lateral (head of head at 45 degress

A nurse is assessing a client who has left-sided heart failure with decreased cardiac output. Which of the following manifestations should the nurse expect? Flushing of the skin on exertion Nocturia at night Warm lower extremities Respiratory rate of 16/min

Nocturia at night The client who has left-sided heart failure with decreased cardiac output can have oliguria during the day and nocuria at night due to poor tissue perfusion to the kidneys flushed (will be pale) Warm (cool extremities) Respiratory rate (will be tachypnea due to intraalveolar fluid causing engorgement of pulmonary vessels)

A nurse is monitoring a client who has received enalapril for heart failure. The nurse shoudl identify which of the following findings as an adverse effect? Bradycardia Orthostatic hypotention Increased perspiration Somnolence

Orthostatic hypotension Enalapril, which is an angiotensin-converting emzyme, prevents conversion of angiotensin I to angiotension II, causing dilation of the arterial and venous vessels. This can lead to the client developing orthostatic hypotension. Bradycardia (Tachycardia) Perspiration (is decreased) Somnolence (Insomnia)

A nurse is assessing a client who is restricted to bedrest for manifestations of right-sided heart failure. Which of the following findings should the nurse expect? Weak peripheral pulses Angina Sacrum edema Crackles in the lungs

Sacrum edema A client who has right-sided heart failure and is restricted to bedrest will often have fluid accumulation in the sacral area when compared to a client who is ambulatory. The edema is due to increased systemic venous pressures and congestion. Weak pulses (with left-sided) Angina (with left-sided) crackles in the lungs (left-sided)

A nurse is reviewing the laboratory values for a client who is taking an ACE inhibitor and spironolactone for heart failure. The nurse should notify the provider for which of the following laboratory values? Creatinine 1.8mg/dL Potassium 4.2 mEq/L BNP 98 pg/mL d-Dimer 0.3 mcg/mL

Creatinine 1.8mg/dL The nurse should notify the provider of a creatintine of 1.8 mg/dL. Clients receiving an ACE inhibitor and spironolactone together, may develop hyperkalemia and dysthymias Potassium (expected range) BNP (expected range) d-Dimer (expected range)