Deck 35: Nursing Management: Heart Failure

Question 1

Following an acute myocardial infarction, a previously healthy 67-year-old patient develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about

A) digitalis preparations, such as digoxin (Lanoxin).
B) calcium-channel blockers, such as diltiazem (Cardizem).
C) b-adrenergic agonists, such as dobutamine (Dobutrex).
D) angiotensin-converting enzyme (ACE) inhibitors, such as captopril (Capoten).

Answer 1

angiotensin-converting enzyme (ACE) inhibitors, such as captopril (Capoten).

Question 2

The nurse is caring for a patient receiving IV furosemide (Lasix) 40 mg and enalapril (Vasotec) 5 mg PO bid for ADHF with severe orthopnea. When evaluating the patient response to the medications, the best indicator that the treatment has been effective is

A) weight loss of 2 pounds overnight.
B) improvement in hourly urinary output.
C) reduction in systolic BP.
D) decreased dyspnea with the head of the bed at 30 degrees.

Answer 2

decreased dyspnea with the head of the bed at 30 degrees.

Question 3

A patient with chronic heart failure who has been following a low-sodium diet tells the nurse at the clinic about a 5-pound weight gain in the last 3 days. The nurse's first action will be to

A) ask the patient to recall the dietary intake for the last 3 days because there may be hidden sources of sodium in the patient's diet.
B) instruct the patient in a low-calorie, low-fat diet because the weight gain has likely been caused by excessive intake of inappropriate foods.
C) assess the patient for clinical manifestations of acute heart failure because an exacerbation of the chronic heart failure may be occurring.
D) educate the patient about the use of diuretic therapy because it is likely that the patient will need medications to reduce the hypervolemia.

Answer 3

assess the patient for clinical manifestations of acute heart failure because an exacerbation of the chronic heart failure may be occurring.

Question 4

An outpatient who has developed heart failure after having an acute myocardial infarction has a new prescription for carvedilol (Coreg). After 2 weeks, the patient returns to the clinic. The assessment finding that will be of most concern to the nurse is that the patient

A) has BP of 88/42.
B) has an apical pulse rate of 56.
C) complains of feeling tired.
D) has 2+ pedal edema.

Question 5

When the nurse is developing a teaching plan to prevent the development of heart failure in a patient with stage 1 hypertension, the information that is most likely to improve compliance with antihypertensive therapy is that

A) hypertensive crisis may lead to development of acute heart failure in some patients.
B) hypertension eventually will lead to heart failure by overworking the heart muscle.
C) high BP increases risk for rheumatic heart disease.
D) high systemic pressure precipitates papillary muscle rupture.

Question 6

When developing a plan to decrease preload in the patient with heart failure, the nurse will include actions such as

A) administering sedatives to promote rest and decrease myocardial oxygen demand.
B) positioning the patient in a high-Fowler's position with the feet horizontal in the bed.
C) administering oxygen per mask or nasal cannula.
D) encouraging leg exercises to improve venous return.

Question 7

A patient in the intensive care unit with ADHF complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been ordered for the patient. The first action by the nurse will be to

A) administer IV morphine sulfate 2 mg.
B) give IV diazepam (Valium) 2.5 mg.
C) increase dopamine (Intropin) infusion by 2 mcg/kg/min.
D) increase nitroglycerin (Tridil) infusion by 5 mcg/min.

Question 8

A patient with a history of chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. The patient has pitting edema in both ankles, blood pressure (BP) of 170/100, an apical pulse rate of 92, and respirations 28. The most important assessment for the nurse to accomplish next is to

A) auscultate the lung sounds.
B) assess the orientation.
C) check the capillary refill.
D) palpate the abdomen.

Question 9

A home health care patient has recently started taking oral digoxin (Lanoxin) and furosemide (Lasix) for control of heart failure. The patient data that will require the most immediate action by the nurse is if the patient's

A) weight increases from 120 pounds to 122 pounds over 3 days.
B) liver is palpable 2 cm below the ribs on the right side.
C) serum potassium level is 3.0 mEq/L after 1 week of therapy.
D) has 1 to 2+ edema in the feet and ankles in the morning.

Question 10

During a visit to an elderly patient with chronic heart failure, the home care nurse finds that the patient has severe dependent edema and that the legs appear to be weeping serous fluid. Based on these data, the best nursing diagnosis for the patient is

A) activity intolerance related to venous congestion.
B) disturbed body image related to massive leg swelling.
C) impaired skin integrity related to peripheral edema.
D) impaired gas exchange related to chronic heart failure.

Question 11

The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin), hydrochlorothiazide (HydroDIURIL), and a potassium supplement. Appropriate instructions for the patient include

A) avoid dietary sources of potassium because too much can cause digitalis toxicity.
B) take the pulse rate daily and never take digoxin if the pulse is below 60 beats/min.
C) take the hydrochlorothiazide before bedtime to maximize activity level during the day.
D) notify the health care provider immediately if nausea or difficulty breathing occurs.

Question 12

During assessment of a 72-year-old with ankle swelling, the nurse notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates

A) decreased fluid volume.
B) incompetent jugular vein valves.
C) elevated right atrial pressure.
D) jugular vein atherosclerosis.

Question 13

An elderly patient with a 40-pack-year history of smoking and a recent myocardial infarction is admitted to the medical unit with acute shortness of breath; the nurse need to rule out pneumonia versus heart failure. The diagnostic test that the nurse will monitor to help in determining whether the patient has heart failure is

A) 12-lead electrocardiogram (ECG).
B) arterial blood gases (ABGs).
C) B-type natriuretic peptide (BNP).
D) serum creatine kinase (CK).

Question 14

A 55-year-old patient with inoperable coronary artery disease and end-stage heart failure asks the nurse whether heart transplant is a possible therapy. The nurse's response to the patient will be based on the knowledge that

A) heart transplants are experimental surgeries that are not covered by most insurance.
B) the patient is too old to be placed on the transplant list.
C) the diagnoses and symptoms indicate that the patient is not an appropriate candidate.
D) candidacy for heart transplant depends on many factors.

Question 15

The nurse working in the heart failure clinic will know that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient

A) says that the nitroglycerin patch will be used for any chest pain that develops.
B) calls when the weight increases from 124 to 130 pounds in a week.
C) tells the home care nurse that furosemide (Lasix) is taken daily at bedtime.
D) makes an appointment to see the doctor at least once yearly.

Question 16

A patient admitted to the hospital with an exacerbation of chronic heart failure tells the nurse, "I felt fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse can best document this assessment information as

A) pulsus alternans.
B) paroxysmal nocturnal dyspnea.
C) two-pillow orthopnea.
D) acute bilateral pleural effusion.

Question 17

The nurse identifies the collaborative problem of potential complication: pulmonary edema for a patient in ADHF. When assessing the patient, the nurse will be most concerned about

A) an apical pulse rate of 106 beats/min.
B) an oxygen saturation of 88% on room air.
C) weight gain of 1 kg (2.2 lb) over 24 hours.
D) decreased hourly patient urinary output.

Question 18

Intravenous sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to adjust the Nipride rate if the patient develops

A) a drop in heart rate to 54 beats/min.
B) a systolic BP <90 mm Hg.
C) any symptoms indicating cyanide toxicity.
D) an increased amount of ventricular ectopy.

Question 19

When teaching the patient with heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include

A) eggs and other high-cholesterol foods.
B) canned and frozen fruits.
C) fresh or frozen vegetables.
D) milk, yogurt, and other milk products.

Question 20

While admitting an 80-year-old patient with heart failure to the medical unit, the nurse obtains the information that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." The nurse makes a note that discharge planning for the patient will need to include

A) transfer to a dementia care service.
B) referral to a home health care agency.
C) placement in a long-term-care facility.
D) arrangements for around-the-clock care.

Question 21

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

A) "I will need to include more high-potassium foods in my diet."
B) "I will expect to feel more short of breath for the next few days."
C) "I will be sure to take the medication after eating something."
D) "I will call for help when I need to get up to the bathroom."

Question 22

A patient with ADHF who is receiving nesiritide (Natrecor) asks the nurse how the medication will work to help improve the symptoms of dyspnea and orthopnea. The nurse's reply will be based on the information that nesiritide will

A) dilate arterial and venous blood vessels, decreasing ventricular preload and afterload.
B) improve the ability of the ventricular myocardium to contract, strengthening contractility.
C) enhance the speed of impulse conduction through the heart, increasing the heart rate.
D) increase calcium sensitivity in vascular smooth muscle, boosting systemic vascular resistance.

Question 23

A patient who is receiving dobutamine (Dobutrex) for the treatment of ADHF has all of the following nursing actions included in the plan of care. Which action will be best for the RN to delegate to an experienced LPN/LVN?

A) Teach the patient the reasons for remaining on bed rest.
B) Monitor the patient's BP every hour.
C) Adjust the drip rate to keep the systolic BP >90 mm Hg.
D) Call the health care provider about a decrease in urine output.