Lewis Ch 34: Heart Failure Review Questions

The home care nurse visits a patient with chronic heart failure. Which clinical manifestations, assessed by the nurse, would indicate acute decompensated heart failure (pulmonary edema)?
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A) Fatigue, orthopnea, and dependent edema
B) Severe dyspnea and blood-streaked, frothy sputum
C) Temperature is 100.4oF and pulse is 102 beats/min
D) Respirations 26 breaths/min despite oxygen by nasal cannula

Answer: B
Clinical manifestations of pulmonary edema include anxiety, pallor, cyanosis, clammy and cold skin, severe dyspnea, use of accessory muscles of respiration, a respiratory rate greater than 30 breaths/min, orthopnea, wheezing, and coughing with the production of frothy, blood-tinged sputum. Auscultation of the lungs may reveal crackles, wheezes, and rhonchi throughout the lungs. The heart rate is rapid, and blood pressure may be elevated or decreased.
A) Avoid high-potassium foods
B) Avoid drugs to treat erectile dysfunction
C) Avoid over-the-counter H2-receptor blockers
D) Avoid nonsteroidal antiinflammatory drugs (NSAIDS)

Answer: B
The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. High-potassium foods, NSAIDs, and H2-receptor blockers do not pose a risk in combination with nitrates.
A) Left ventricular function is documented.
B) Controlling dysrhythmias will eliminate HF.
C) Prescription for digoxin (Lanoxin) at discharge
D) Prescription for angiotensin-converting enzyme inhibitor at discharge
E) Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen

Answer: A, D, E
The Joint Commission has identified these three core measures for heart failure patients. Although controlling dysrhythmias will improve CO and workload, it will not eliminate HF. Prescribing digoxin for all HF patients is no longer done because there are newer effective drugs and digoxin toxicity occurs easily related to electrolyte levels and the therapeutic range must be maintained.
A) Muscle aches
B) Constipation
C) Pounding headache
D) Anorexia and nausea

Answer: D
Anorexia, nausea, vomiting, blurred or yellow vision, and cardiac dysrhythmias are all signs of digitalis toxicity. The nurse would become concerned and notify the health care provider if the patient exhibited any of these symptoms.
A) Promote vasodilation.
B) Reduction of preload.
C) Decrease in afterload.
D) Increase in contractility.

Answer: B
Diuretics such as furosemide are used in the treatment of heart failure to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.
A) Taper the patient off his current medications.
B) Continue education for the patient and his family.
C) Pursue experimental therapies or surgical options.
D) Choose interventions to promote comfort and prevent suffering.

Answer: D
The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount. Medications should be continued unless they are not tolerated. Experimental therapies and surgeries are not commonly used in the care of hospice patients.
A) "I will limit the amount of milk and cheese in my diet."
B) "I can add salt when cooking foods but not at the table."
C) "I will take an extra diuretic pill when I eat a lot of salt."
D) "I can have unlimited amounts of foods labeled as reduced sodium."

Answer: A
Milk products should be limited to 2 cups per day for a 2500-mg sodium-restricted diet. Salt should not be added during food preparation or at the table. Diuretics should be taken as prescribed (usually daily) and not based on sodium intake. Foods labeled as reduced sodium contain at least 25% less sodium than regular.
A) Withhold the daily dose until the following day.
B) Withhold the dose and report the potassium level.
C) Give the digoxin with a salty snack, such as crackers.
D) Give the digoxin with extra fluids to dilute the sodium level.

Answer: C
The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and wait for the potassium level to normalize. The physician may order the digoxin to be given once the potassium level has been treated and decreases to within normal range.
A patient admitted with heart failure is anxious and reports shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply.)?A) Administer ordered morphine sulfate. B) Position patient in a semi-Fowler's position. C) Position patient on left side with head of bed flat. D) Instruct patient on the use of relaxation techniques. E) Use a calm, reassuring approach while talking to patient. Answer: B, D, E Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety.The nurse prepares to administer digoxin 0.125 mg to a patient admitted with influenza and a history of chronic heart failure. What should the nurse assess before giving the medication?A) Prothrombin time B) Urine specific gravity C) Serum potassium level D) Hemoglobin and hematocrit Answer: C Serum potassium should be monitored because hypokalemia increases the risk for digoxin toxicity. Changes in prothrombin time, urine specific gravity, and hemoglobin or hematocrit would not require holding the digoxin dose.An asymptomatic patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before dangling the patient on the bedside, what should the nurse assess first?A) Urine output B) Heart rhythm C) Breath sounds D) Blood pressure Answer: D The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the semi-Fowler's position and use other measures to improve gas exchange.A patient has been diagnosed with early left ventricular heart failure (HF). The nurse knows that the following changes occur as the disease progresses. In which order do the changes involved in the development of dyspnea associated with left ventricular HF occur? (Answer with a letter followed by a comma and a space (e.g. A, B, C, D).) __ a. Inadequate alveolar gas exchange b. Elevated pressure in the left atrium c. Ineffective ventricular contractility d. Fluid leaking into interstitial spacesC, B, D, A In left ventricular HF, ineffective ventricular contractions impair the normal forward flow of blood to the body. As a result, fluid returning to the heart from the lungs backs up in the heart and increases the pressure in the left atrium. If contractility continues to falter, the blood continues to back up into the pulmonary vasculature and eventually can result in fluid leaking into the interstitial spaces and alveoli of the lungs. This abnormal fluid in the parenchyma and alveoli impairs gas exchange, which causes dyspnea.What should the nurse recognize as an indication for the use of dopamine in the care of a patient with heart failure?A) Acute anxiety B) Hypotension and tachycardia C) Peripheral edema and weight gain D) Paroxysmal nocturnal dyspnea (PND) Answer: B Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.What is the priority assessment by the nurse caring for a patient receiving IV nesiritide to treat heart failure?A) Urine output B) Urine output C) Blood pressure D) Respiratory rate Answer: C Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to acute decompensated heart failure (ADHF)?A) Take medications as prescribed. B) Take medications as prescribed. C) Only ask the physician's office questions. D) Encourage most activity in the morning when rested. Answer: A The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies such as alternating activity with rest will help the patient meet this goal. If the patient needs to use oxygen at home, it will probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient. This nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening HF.A patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first?A) Perform a bladder scan to assess for urinary retention. B) Restrict the patient's oral fluid intake to 500 mL per day. C) Assist the patient to a sitting position with arms on the overbed table. D) Instruct the patient to use pursed-lip breathing until the dyspnea subsides. Answer: C The nurse should place the patient with ADHF in a high Fowler's position with the feet horizontal in the bed or dangling at the bedside. This position helps decrease venous return because of the pooling of blood in the extremities. This position also increases the thoracic capacity, allowing for improved ventilation. Pursed-lip breathing helps with obstructive air trapping but not with acute pulmonary edema. Restricting fluids takes considerable time to have an effect.An older adult patient with chronic heart failure (HF) and atrial fibrillation asks the nurse why warfarin has been prescribed to continue at home. What is the best response by the nurse?A) "The medication prevents blood clots from forming in your heart." B) "The medication prevents blood clots from forming in your heart." C) "The medication reduces clotting by decreasing serum potassium levels." D) "The medication increases your heart rate so that clots do not form in your heart." Answer: A Chronic HF causes enlargement of the chambers of the heart and an altered electrical pathway, especially in the atria. When numerous sites in the atria fire spontaneously and rapidly, atrial fibrillation occurs. Atrial fibrillation promotes thrombus formation within the atria with an increased risk of stroke and requires treatment with cardioversion, antidysrhythmics, and/or anticoagulants. Warfarin is an anticoagulant that interferes with hepatic synthesis of vitamin K-dependent clotting factors.A patient is scheduled for a heart transplant. Beyond the first year after a heart transplant, the nurse knows that what is a major cause of death?A) Infection B) Acute rejection C) Immunosuppression D) Cardiac vasculopathy Answer: D Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated coronary artery disease) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection.