Question 1

A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion?

Accepted Answer

D

Question 2

The nurse is preparing a client for a multiple gated acquisition (MUGA) scan. What would be an important instruction for the nurse to give a client who is to undergo a MUGA scan?

Accepted Answer

It is important for the client to lie very still during the MUGA scan to ensure accurate imaging of the heart's function. This may require intermittent periods of lying still during the test. While it is important to stay hydrated, there is no specific recommendation for drinking fluids during the test. Avoiding dairy products is not necessary for a MUGA scan, and there is no specific recommendation to avoid activity before the test.

Question 3

Nursing management of a client in heart failure with pulmonary edema includes which of the following?

Accepted Answer

In heart failure with pulmonary edema, emergency drug therapy is crucial to stabilize the patient, so observing its effectiveness is a key nursing management task.

Question 4

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?

Accepted Answer

Using a urinary catheter would allow the nurse to monitor the client's urine output, which is important in assessing the effectiveness of diuretics. Mechanical ventilation, pulmonary artery catheter, and biventricular pacemaker are not relevant in evaluating the client's response to diuretics.

Question 5

You are caring for a client with a cardiac disorder who is prescribed diuretics. What important factor should you include in this client's teaching plan?

Accepted Answer

Diuretics increase urine output and can lead to electrolyte and water loss, which can result in dehydration, electrolyte imbalances, and other complications. Therefore, it is important for the client to understand the signs and symptoms of electrolyte and water loss and know when to contact their healthcare provider. The other options are not directly related to diuretic therapy.

Question 6

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?

Accepted Answer

Clients with right-sided heart failure may experience gradual unexplained weight gain due to fluid buildup in the body (edema) caused by the heart's inability to pump blood effectively. Increased urine output (Option A) and increased perspiration (Option C) are not commonly associated with right-sided heart failure. Sleeping in a chair or recliner (Option D) may help alleviate symptoms of breathlessness while lying flat but is not a specific symptom of right-sided heart failure.

Question 7

A client diagnosed with heart failure has been admitted to the ICU prior to invasive treatment. What treatment could be considered curative for this client?

Accepted Answer

Surgical ventricular restoration is the only option listed that could potentially be curative for heart failure. Cardiomyoplasty, external pacemaker placement, and ventricular assist devices are all supportive or palliative treatments for heart failure.

Question 8

A class of beginning nursing students is learning about heart failure in their pathophysiology class. What should the students be taught is the reason for heart failure?

Accepted Answer

Heart failure occurs when the heart is unable to pump sufficient blood to meet the body's metabolic needs. This can be caused by a variety of factors such as damage to the heart muscle, high blood pressure, or disease. It is not caused by the heart pumping too fast or too slow, or by fibrillation.

Question 9

The triage nurse in the Emergency Department (ED) is admitting a client with a history of Class III heart failure. What symptoms would the nurse expect the client to exhibit?

Accepted Answer

Class III heart failure is characterized by a marked limitation in physical activity. The patient is comfortable at rest, but less than ordinary activity causes symptoms such as fatigue, palpitation, or dyspnea.

Question 10

You are assessing a client for heart failure and find that there is an underlying structural heart disease and prior symptoms of heart failure. In what stage of chronic heart failure should the nurse categorize this client?

Accepted Answer

The answer of You are assessing a client for heart...

Question 11

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?

Accepted Answer

The symptoms of weakness, ascites, weight gain, and jugular vein distention are characteristic of right-sided heart failure.

Question 12

A client in pulmonary edema has been admitted to the ICU. What would be the standard care for this client?

Accepted Answer

Monitoring blood pressure and pulse frequently is crucial in managing pulmonary edema to assess the client's hemodynamic status and response to treatment.

Question 13

A client with severe mitral valve insufficiency has been admitted to your unit. The client is in heart failure and has developed pulmonary edema. What would be the best course of treatment for this client?

Accepted Answer

This client's severe mitral valve insufficiency and resultant heart failure and pulmonary edema may require surgical intervention to repair or replace the valve. Cardiac glycosides and beta blockers may provide temporary symptomatic relief, but will not address the underlying issue. Palliative care may be appropriate if the client is not a candidate for surgery or if the disease progresses to a point where comfort measures are necessary. However, surgery is the best option for the client's long-term health and quality of life.

Question 14

During a pre-nursing pharmacology class, the students learn about cardiac medications. When administering a cardiac glycoside or digitalis to a client with tachycardia, when would the students learn to withhold the dose until the physician is consulted?

Accepted Answer

Digitalis is a cardiac glycoside used to treat tachycardia by slowing down the heart rate. However, if the client's heart rate is already dangerously low (less than 60 beats per minute), the administration of digitalis could cause further slowing and potentially harm the client. Therefore, the dose should be withheld and the physician consulted before administering the medication. A pulse pressure of 35 mm Hg or 50 mm Hg does not indicate the need to withhold the medication.

Question 15

The Cardiac Nurse Clinician is teaching a group of clients with heart failure about self-management of their disease. What dietary advice should the Nurse Clinician give to clients with severe heart failure until edema resolves?

Accepted Answer

Processed and commercially prepared foods often contain high levels of sodium, which can exacerbate fluid retention and edema in patients with heart failure. Reducing sodium intake is crucial in managing heart failure symptoms.

Question 16

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?

Accepted Answer

Nocturnal dyspnea refers to difficulty breathing while lying down and may be an early sign of congestive heart failure. Asking the client how many pillows they normally use for sleep can give an indication of whether they need to prop themselves up to breathe better. Collecting urine output, observing diet, and measuring abdominal girth are not directly related to assessing for nocturnal dyspnea.

Question 17

The nursing instructor is teaching the nursing class about care of the client in pulmonary edema who has been intubated to maintain blood gas levels. What would the instructor teach the students about care of this intubated client?

Accepted Answer

The best choice for care of an intubated client with pulmonary edema is to establish an alternative method for verbal communication, such as a communication board or a writing pad. Deep suction every 15 minutes is not recommended as it can cause damage to the respiratory system. Keeping the client sedated is not necessary if their oxygen levels are being maintained and can prolong their recovery time. Providing oral fluids at room temperature is not necessary for care of an intubated client with pulmonary edema.

Question 18

The nurse is caring for a client with heart failure that has developed pulmonary edema. The client has become very anxious. What medication would the nurse expect to be ordered to assist this client's breathing and anxiety?

Accepted Answer

Morphine sulfate is commonly used to manage anxiety and dyspnea in clients with pulmonary edema by reducing preload and afterload, which decreases the workload of the heart and improves oxygenation. Intropin is used for clients with cardiac shock, Calcium channel blockers are used in hypertension and arrhythmias, and Lasix is a diuretic used to reduce fluid overload.

Question 19

The nurse documents 3+ pitting edema in the bilateral lower extremities of the client. What does this documentation mean?

Accepted Answer

Pitting edema is a sign of excess fluid volume in the interstitial space, which can occur in areas affected by gravity such as the lower extremities.

Question 20

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?

Accepted Answer

Older adults are more sensitive to the effects of digitalis, and therefore, are at an increased risk for toxicity from this medication. Close monitoring is important to prevent adverse effects and ensure safety.

Quiz 28: Caring for Clients With Heart Failure