Question 1

After receiving change-of-shift report on a heart failure unit,which patient should the nurse assess first?

Accepted Answer

The patient who has "wet-cold" clinical manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management.The other patients also should be assessed as quickly as possible but do not have indications of severe decreases in tissue perfusion.

Question 2

While assessing a 68-year-old with ascites,the nurse also notes jugular venous distention (JVD)with the head of the patient's bed elevated 45 degrees.The nurse knows this finding indicates

Accepted Answer

The jugular veins empty into the superior vena cava and then into the right atrium,so JVD with the patient sitting at a 45-degree angle reflects increased right atrial 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.

Question 3

While admitting an 82-year-old 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." When planning for the patient's discharge the nurse will facilitate a

Accepted Answer

The data about the patient suggest that assistance in developing a system for taking medications correctly at home is needed.A home health nurse will assess the patient's home situation and help the patient develop a method for taking the two medications as directed.There is no evidence that the patient requires services such as a psychologist consult,long-term care,or around-the-clock home care.

Question 4

A patient who has chronic heart failure tells the nurse,"I was fine when I went to bed,but I woke up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment finding as

Accepted Answer

Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation.Pulsus alternans is the alternation of strong and weak peripheral pulses during palpation.Orthopnea indicates that the patient is unable to lie flat because of dyspnea.Pleural effusions develop over a longer time period.

Question 5

A patient in the intensive care unit with acute decompensated heart failure (ADHF)complains of severe dyspnea and is anxious,tachypneic,and tachycardic.All of the following medications have been ordered for the patient.The nurse's priority action will be to

Accepted Answer

Morphine improves alveolar gas exchange,improves cardiac output by reducing ventricular preload and afterload,decreases anxiety,and assists in reducing the subjective feeling of dyspnea.Diazepam may decrease patient anxiety,but it will not improve the cardiac output or gas exchange.Increasing the dopamine may improve cardiac output,but it will also increase the heart rate and myocardial oxygen consumption.Nitroglycerin will improve cardiac output and may be appropriate for this patient,but it will not directly reduce anxiety and will not act as quickly as morphine to decrease dyspnea.

Question 6

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

Accepted Answer

Milk and yogurt naturally contain a significant amount of sodium,and intake of these should be limited for patients on a diet that limits sodium to 2000 mg daily.Other milk products,such as processed cheeses,have very high levels of sodium and are not appropriate for a 2000-mg sodium diet.The other foods listed have minimal levels of sodium and can be eaten without restriction.

Question 7

Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 33%?

Accepted Answer

The core measures for the treatment of heart failure established by The Joint Commission indicate that patients with an ejection fraction (EF)<40% receive an ACE inhibitor to decrease the progression of heart failure.Aerobic exercise may not be appropriate for a patient with this level of heart failure,salt substitutes are not usually recommended because of the risk of hyperkalemia,and the patient will need to see the primary care provider more frequently than annually.

Question 8

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

Accepted Answer

The 5-pound weight gain over 3 days indicates that the patient's chronic heart failure may be worsening.It is important that the patient be assessed immediately for other clinical manifestations of decompensation,such as lung crackles.A dietary recall to detect hidden sodium in the diet,reinforcement of sodium restrictions,and assessment of medication compliance may be appropriate interventions but are not the first nursing actions indicated.

Question 9

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

Accepted Answer

Nausea is an indication of digoxin toxicity and should be reported so that the provider can assess the patient for toxicity and adjust the digoxin dose,if necessary.The patient will need to include potassium-containing foods in the diet to avoid hypokalemia.Patients should be taught to check their pulse daily before taking the digoxin and if the pulse is less than 60,to call their provider before taking the digoxin.Diuretics should be taken early in the day to avoid sleep disruption.

Question 10

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

Accepted Answer

Although carvedilol is appropriate for the treatment of chronic heart failure,it is not used for patients with acute decompensated heart failure (ADHF)because of the risk of worsening the heart failure.The other medications are appropriate for the patient with ADHF.

Question 11

Which action should the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF)who is receiving nesiritide (Natrecor)?

Accepted Answer

Nesiritide is a potent arterial and venous dilator,and the major adverse effect is hypotension.Because the patient is likely to have orthostatic hypotension,the patient should not be encouraged to ambulate.Nesiritide does not require titration and is used for ADHF but not in a home setting.

Question 12

The nurse is caring for a patient who is receiving IV furosemide (Lasix)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?

Accepted Answer

Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli),the best indicator that the medications are effective is a decrease in dyspnea with the head of the bed at 30 degrees.The other assessment data also may indicate that diuresis or improvement in cardiac output has occurred,but are not as specific to evaluating this patient's response.

Question 13

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

Accepted Answer

B-type natriuretic peptide (BNP)is secreted when ventricular pressures increase,as they do with heart failure.Elevated BNP indicates a probable or very probable diagnosis of heart failure.A twelve-lead electrocardiogram,arterial blood gases,and troponin may also be used in determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as BNP.

Question 14

The nurse working on the heart failure unit knows that teaching an older female patient with newly diagnosed heart failure is effective when the patient states that

Accepted Answer

Teaching for a patient with heart failure includes information about the need to weigh daily and notify the health care provider about an increase of 3 pounds in 2 days or 3 to 5 pounds in a week.Nitroglycerin patches are used primarily to reduce preload (not to prevent chest pain)in patients with heart failure and should be used daily,not on an "as needed" basis.Diuretics should be taken earlier in the day to avoid nocturia and sleep disturbance.The patient should call the clinic if increased orthopnea develops,rather than just compensating by further elevating the head of the bed.

Question 15

Following an acute myocardial infarction,a previously healthy 63-year-old develops clinical manifestations of heart failure.The nurse anticipates discharge teaching will include information about

Accepted Answer

ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure.Digoxin therapy for heart failure is no longer considered a first-line measure,and digoxin is added to the treatment protocol when therapy with other medications such as ACE-inhibitors,diuretics,and b-adrenergic blockers is insufficient.Calcium channel blockers are not generally used in the treatment of heart failure.The b-adrenergic blockers are not used as initial therapy for new onset heart failure.

Question 16

During a visit to a 78-year-old with chronic heart failure,the home care nurse finds that the patient has ankle edema,a 2-kg weight gain over the past 2 days,and complains of "feeling too tired to get out of bed." Based on these data,the best nursing diagnosis for the patient is

Accepted Answer

The patient's statement supports the diagnosis of activity intolerance.There are no data to support the other diagnoses,although the nurse will need to assess for other patient problems.

Question 17

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

Accepted Answer

Sodium nitroprusside is a potent vasodilator,and the major adverse effect is severe hypotension.Coughing and bradycardia are not adverse effects of this medication.Nitroprusside does not cause increased ventricular ectopy.

Question 18

A patient with a history of chronic heart failure is admitted to the emergency department (ED)with severe dyspnea and a dry,hacking cough.Which action should the nurse do first?

Accepted Answer

This patient's severe dyspnea and cough indicate that acute decompensated heart failure (ADHF)is occurring.ADHF usually manifests as pulmonary edema,which should be detected and treated immediately to prevent ongoing hypoxemia and cardiac/respiratory arrest.The other assessments will provide useful data about the patient's volume status and also should be accomplished rapidly,but detection (and treatment)of pulmonary complications is the priority.

Question 19

A 53-year-old patient with Stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy.Which response by the nurse is most appropriate?

Accepted Answer

Indications for a heart transplant include end-stage heart failure (Stage D),but other factors such as coping skills,family support,and patient motivation to follow the rigorous posttransplant regimen are also considered.Diabetic patients who have well-controlled blood glucose levels may be candidates for heart transplant.Although heart transplants can be associated with many complications,this response does not address the patient's question.

Question 20

A 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 the drug,which statement by the patient indicates that teaching has been effective?

Accepted Answer

Captopril can cause hypotension,especially after the initial dose,so it is important that the patient not get up out of bed without assistance until the nurse has had a chance to evaluate the effect of the first dose.The angiotensin-converting enzyme (ACE)inhibitors are potassium sparing,and the nurse should not teach the patient to purposely increase sources of dietary potassium.Increased shortness of breath is expected with the initiation of b-adrenergic blocker therapy for heart failure,not for ACE inhibitor therapy.ACE inhibitors are best absorbed when taken an hour before eating.

Quiz 35: Nursing Management: Heart Failure

After receiving change-of-shift report on a heart failure unit,which patient should the nurse assess first?

While assessing a 68-year-old with ascites,the nurse also notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees.The nurse knows this finding indicates

While admitting an 82-year-old 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." When planning for the patient's discharge the nurse will facilitate a

A patient who has chronic heart failure tells the nurse,"I was fine when I went to bed,but I woke up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment finding as

A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious,tachypneic,and tachycardic.All of the following medications have been ordered for the patient.The nurse's priority action will be to

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

Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 33%?

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

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

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

Which action should the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor) ?

The nurse is caring for a patient who is receiving IV furosemide (Lasix) 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?

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

The nurse working on the heart failure unit knows that teaching an older female patient with newly diagnosed heart failure is effective when the patient states that

Following an acute myocardial infarction,a previously healthy 63-year-old develops clinical manifestations of heart failure.The nurse anticipates discharge teaching will include information about

During a visit to a 78-year-old with chronic heart failure,the home care nurse finds that the patient has ankle edema,a 2-kg weight gain over the past 2 days,and complains of "feeling too tired to get out of bed." Based on these data,the best nursing diagnosis for the patient is

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

A patient with a history of chronic heart failure is admitted to the emergency department (ED) with severe dyspnea and a dry,hacking cough.Which action should the nurse do first?

A 53-year-old patient with Stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy.Which response by the nurse is most appropriate?

A 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 the drug,which statement by the patient indicates that teaching has been effective?