Med Surg Lewis Ch 38 Heart Failure

While assessing an older adult patient, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. What does this finding indicate?

a. Jugular vein atherosclerosis

b. Incompetent jugular vein valves

c. Increased ventricular filling pressure

d. Decreased intravascular fluid volume

c. increased ventricular filling pressure

The jugular veins empty into the superior vena cava and then into the right atrium and ventricle, so JVD with the patient sitting at a 45-degree angle reflects increased atrial and ventricular pressure. JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume. JVD is not caused by incompetent jugular vein valves or atherosclerosis.

The nurse is caring for a patient who is receiving IV furosemide and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective?

a. Weight loss of 2 lb in 24 hours

b. Hourly urine output greater than 60 mL

c. Reduced dyspnea with the head of bed at 30 degrees

d. Patient denies experiencing chest pain or chest pressure

c. Reduced dyspnea with the head of bed at 30 degrees

Which topic will the nurse plan to include in discharge teaching for a patient who has heart failure with reduced ejection fraction (HFrEF)?

a. Need to begin an aerobic exercise program several times weekly

b. Benefits and effects of angiotensin-converting enzyme (ACE) inhibitors

c. Use of salt substitutes to replace table salt when cooking and at the table

d. Importance of making an annual appointment with the health care provider

b. Benefits and effects of angiotensin-converting enzyme (ACE) inhibitors

IV sodium nitroprusside is prescribed for a patient with acute pulmonary edema. Which reassessment finding indicates that the nurse should decrease the rate of nitroprusside infusion?

a. Ventricular ectopy

b. Dry, hacking cough

c. Systolic BP below 90 mm Hg

d. Heart rate below 50 beats/min

c. Systolic BP below 90 mmHg

A patient who has chronic heart failure tells the nurse, "I was fine when I went to bed, but I woke up feeling like I was suffocating!" How would the nurse document this finding?

a. Orthopnea

b. Pulsus alternans

c. Paroxysmal nocturnal dyspnea

d. Acute bilateral pleural effusion

c. Paroxysmal nocturnal dyspnea

Which statement by a patient newly diagnosed with heart failure indicates to the nurse that teaching was effective?

a. "I will take furosemide (Lasix) every day just before bedtime."

b. "I will use the nitroglycerin patch whenever I have chest pain."

c. "I will use an additional pillow if I am short of breath at night."

d. "I will call the clinic if my weight goes up 3 pounds in a week."

d. "I will call the clinic if my weight goes up 3 pounds in a week."

Which foods would the nurse recommend limiting for a patient on a 2000-mg sodium diet?

a. Chicken and eggs

b. Canned and frozen fruits

c. Yogurt and milk products

d. Fresh or frozen vegetables

c. Yogurt and milk products

While admitting an 82-yr-old patient with acute decompensated heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." What would the nurse include in the discharge plan?

a. Consult with a psychologist

b. Transfer to a long-term care facility

c. Referral to a home health care agency

d. Arrangements for around-the-clock care

c. Referral to a home health care agency

Following an acute myocardial infarction, a previously healthy 63-yr-old develops heart failure. Which medication topic would the nurse anticipate including in discharge teaching?

a. Calcium channel blocker

b. Selective SA node inhibitor

c. Digoxin and potassium therapy regimen

d. Angiotensin-converting enzyme (ACE) inhibitor

d. Angiotensin-converting enzyme (ACE) inhibitor

A 53-yr-old patient with stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is an option. Which response is accurate?

a. "Your heart failure has not reached the end stage yet."

b. "You could not manage the multiple complications of surgery."

c. "The suitability of a heart transplant depends on many factors."

d. "Because you have diabetes, you would not be a heart transplant candidate."

c. "The suitability of a heart transplant depends on many factors."

Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure?

a. Serum troponin

b. Arterial blood gases

c. B-type natriuretic peptide

d. 12-lead electrocardiogram

c. B-type natriuretic peptide

A hospitalized patient with chronic heart failure has a new order for captopril 12.5 mg PO. After giving the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective?

a. "I plan to take the medication with food."

b. "I should eat more potassium-rich foods."

c. "I will call for help when I need to get up to use the bathroom."

d. "I can expect to feel more short of breath for the next few days."

c. "I will call for help when I need to get up to use the bathroom"

A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication would the nurse question before giving?

a. Captopril (Capoten) 25 mg

b. Furosemide (Lasix) 60 mg

c. Digoxin (Lanoxin) 0.125 mg

d. Carvedilol (Coreg) 3.125 mg

d. Carvedilol (Coreg) 3.125 mg

A patient who has chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. Which action would the nurse take first?

a. Auscultate the abdomen.

b. Check the capillary refill.

c. Auscultate the breath sounds.

d. Ask about the patient's allergies.

c. Auscultate the breath sounds.

A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor is on a low-sodium diet. The patient tells the home health nurse about a 5-lb weight gain in the past 3 days. Which action is the nurse's priority?

a. Teach the patient about restricting dietary sodium.

b. Assess the patient for manifestations of acute heart failure.

c. Ask the patient about the use of the prescribed medications.

d. Have the patient recall the dietary intake for the past 3 days.

b. Assess the patient for manifestations of acute heart failure.

A patient in the intensive care unit who has acute decompensated heart failure (ADHF) reports severe dyspnea and is anxious, tachypneic, and tachycardic. Several drugs have been prescribed for the patient. Which action would the nurse take first?

a. Give PRN IV morphine sulfate 4 mg.

b. Give PRN IV diazepam (Valium) 2.5 mg.

c. Increase nitroglycerin infusion by 5 mcg/min.

d. Increase dopamine infusion by 2 mcg/kg/min

a. Give PRN IV morphine sulfate 4 mg.

After receiving change-of-shift report on four patients admitted to a heart failure unit, which patient would the nurse assess first?

a. A patient who has dizziness after a dose of captopril.

b. A patient who has new-onset confusion and restlessness.

c. A patient who is receiving oxygen and has crackles in the bilateral lung bases.

d. A patient who is receiving IV nesiritide (Natrecor), with a BP of 100/62.

b. A patient who has new-onset confusion and restlessness.

Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires immediate action by the nurse?

a. O2 saturation of 88%

b. Weight gain of 1 kg (2.2 lb)

c. Heart rate of 106 beats/min

d. Urine output of 50 mL over 2 hours

a. O2 saturation of 88%

A patient who has heart failure recently started taking digoxin in addition to furosemide and captopril. Which finding by the home health nurse is a priority to communicate to the health care provider?

a. Presence of 1+ to 2+ edema in the feet and ankles

b. Palpable liver edge 2 cm below the ribs on the right side

c. Serum potassium level 3.0 mEq/L after 1 week of therapy

d. Weight increase from 120 pounds to 122 pounds over 3 days

c. Serum potassium level 3.0 mEq/L after 1 week of therapy

An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider?

a. 2+ bilateral pedal edema

b. Heart rate of 52 beats/min

c. Report of increased fatigue

d. Blood pressure 88/42 mm Hg

d. Blood pressure 88/42 mm Hg

A patient who is receiving dobutamine for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action would be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)?

a. Teach the patient the reasons for remaining on bed rest.

b. Change the peripheral IV site according to agency policy.

c. Monitor the patient's blood pressure and heart rate every hour.

d. Titrate the dobutamine to keep the systolic blood pressure >90 mm Hg

c. Monitor the patient's blood pressure and heart rate every hour.

After receiving change-of-shift report, which patient would the nurse assess first?

a. Patient who is taking carvedilol (Coreg) and has a heart rate of 58

b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L

c. Patient who is taking captopril and has a frequent nonproductive cough

d. Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache

b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L

An intraaortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. Which data would indicate to the nurse that the goals of IABP treatment are being met?

a. Urine output of 25 mL/hr

b. Heart rate of 110 beats/min

c. Cardiac output (CO) of 5 L/min

d. Stroke volume (SV) of 40 mL/beat

c. Cardiac output (CO) of 5 L/min

The nurse is caring for a patient who has an intra-aortic balloon pump in place. Which action would the nurse include in the plan of care?

a. Avoid the use of anticoagulant medications.

b. Monitor the patient's urinary output every hour.

c. Provide passive range of motion for all extremities.

d. Position the patient supine with head flat at all times.

b. Monitor the patient's urinary output every hour

While waiting for heart transplantation, a patient with severe cardiomyopathy has a ventricular assist device (VAD) implanted. Which action would the nurse include in the plan of care for this patient?

a. Preparing the patient for a permanent VAD

b. Teaching the patient the reason for bed rest

c. Monitoring the incision for signs of infection

d. Administering immunosuppressants medications

c. Monitoring the incision for signs of infection