Deck 7: Care of the Patient Experiencing Heart Failure

Question 1

A patient is diagnosed with left-sided heart failure. What should the nurse include when describing the disease process to this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Pumping action of the heart is impaired.
2) Filling action of the heart is impaired.
3) Blood backs up in the left side of the heart.
4) Extra fluid can build up in the lungs.
5) Extra fluid can build up in the lower extremities.

Answer 1

1, 2, 3, 4
Explanation: 1. In left-sided heart failure, the pumping action or systolic action of the left ventricle is impaired.
2. In left-sided heart failure, the ability of the left ventricle to fill or diastolic action of the left ventricle is impaired.
3. In left-sided heart failure, blood backs up from the left ventricle to the left atrium.
4. In left-sided heart failure, fluid eventually builds up in the lungs.
5. Extra fluid does not build up in the lower extremities in left-sided heart failure.

Question 2

Which assessment finding indicates that a patient's heart failure (HF) is worsening?
1) An increase in O₂ saturation to greater than 90%
2) A decrease in heart rate to 66 bpm
3) The onset of atrial fibrillation
4) Louder S₁ and S₂ heart sounds

Answer 2

3
Explanation: 1. Oxygenation saturations will decline to less than 90% and not increase to more than 90%. Declining O₂ saturation levels reflect deteriorating pulmonary status from a buildup of fluids with pulmonary edema.
2. Tachycardia increases to compensate for the decreasing O₂ levels by trying to circulate what cells are present, but at the same time it increases the O₂ demand by increased cardiac functioning.
3. As heart failure continues to progress, less oxygenation occurs all over the body, especially the myocardium, which is sensitive to the hypoxia and will result in dysrhythmias, such as ventricular ectopy or atrial fibrillation.
4. The S₁ and S₂ sounds remain the same.

Question 3

An 82-year-old patient is readmitted for heart failure (HF) 1 week after being discharged for the same diagnosis. Which findings most likely contributed to the patient's readmission? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Not knowing how or when to take medications
2) Not prescribed appropriate medications, including ACE inhibitors and beta blockers
3) No record of body weight since discharge
4) Not filling prescribed medications
5) Received the pneumococcal immunization during the last hospitalization

Answer 3

1, 2, 3, 4
Explanation: 1. Some studies indicate that older patients with heart failure have poor knowledge of appropriate medication management.
2. There is evidence that a significant number of older adults with heart failure do not receive evidence-based, AHA-recommended care including angiotensin-converting enzymes (ACE) inhibitors and beta blockers.
3. Patient records indicate that daily weights are not consistently obtained.
4. Pharmacy records indicate that prescriptions are not promptly refilled.
5. Pneumococcal immunization is recommended and would not contribute to a readmission for the diagnosis of heart failure.

Question 4

The nurse notes that the QRS duration of a patient with a biventricular pacemaker is widening. What does this most likely indicate?
1) Worsening of the patient's underlying cardiomyopathy
2) Loss of ventricular capture
3) Loss of ventricular synchronization
4) Battery failure

Question 5

The nurse assesses a patient for heart failure (HF). Which early findings would indicate decreased cardiac output and a potential for fluid overload from heart failure?
1) Orthopnea, peripheral edema, crackles
2) Dizziness, syncope, palpitations
3) Pallor and/or cyanosis of extremities
4) PAWP of 12 and CVP of 6

Question 6

What is the nurse least likely to assess in a patient experiencing acute decompensated heart failure with pulmonary edema?
1) Dyspnea at rest, peripheral edema
2) Hypertension, bradycardia
3) Increased coughing, crackles
4) Decreased O₂ saturation, increased PAWP

Question 7

The nurse is reviewing a patient's medical history. Which factor in the history most likely contributed to the patient's development of heart failure? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Hypertension
2) Diabetes mellitus
3) Drinking one or two alcoholic drinks daily
4) Being overweight
5) Ischemic heart disease

Question 8

A patient with heart failure has a decreasing cardiac output. Why should the nurse expect compensatory mechanisms to be activated?
1) To decrease the heart rate
2) To maintain perfusion to vital organs
3) To cause arteriolar vasodilation in nonessential vascular beds
4) To inhibit the release of aldosterone

Question 9

How should the nurse explain to a patient in heart failure the mechanism of action of an aldosterone antagonist?
1) Reducing sodium and water retention
2) Filtering potassium out with the water in the renal tubules
3) Promoting the excretion of the urinary waste products urea and creatinine
4) Retaining calcium to improve the condition of blood vessels in the glomeruli

Question 10

Which finding should cause the nurse to suspect a patient with heart failure is experiencing end organ hypoperfusion? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Confusion
2) Dropping blood pressure
3) Urine output 15 mL per hour
4) Heart rate 124
5) Peripheral edema

Question 11

What should the nurse realize when planning care for a patient with a body mass index of 40 who is newly diagnosed with heart failure?
1) The prognosis will be better.
2) Central obesity limits respiratory excursion.
3) Activity needs to be emphasized.
4) Medication adjustment is required.

Question 12

Which finding would support the diagnosis of heart failure (HF)?
1) RA/CVP of 8 mm Hg
2) PCWP of 20 mm Hg
3) Cardiac index of 3
4) Peripheral vasodilation reflected by normalizing capillary refill times

Question 13

After teaching a patient with heart failure about beta blocking agents, the nurse recognizes that additional teaching is needed when the patient makes which statement?
1) "I should weigh myself every day."
2) "I need to check my blood sugar regularly."
3) "I will notify my health care provider if I become increasingly short of breath."
4) "I need to monitor myself daily for an increased heart rate and blood pressure."

Question 14

A patient in heart failure is being given a first dose of lisinopril (Prinivil) 10 mg PO. Which finding should cause the nurse to question the administration of the first dose?
1) Heart rate 92 beats per minute
2) Blood pressure 100/72
3) Potassium 5.7 mEq/dL
4) Urine output 35 mL/hr

Question 15

While caring for a patient in heart failure, the nurse assesses an elevated blood pressure and significant peripheral edema. How is the renin-angiotensin-aldosterone system causing these symptoms? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Releases angiotensin II
2) Releases aldosterone
3) Decreases cardiac output
4) Decreases heart rate
5) Causes arteriolar vasodilation

Question 16

A patient is very short of breath. Which finding should cause the nurse to consider that the shortness of breath might be due to heart failure?
1) An echocardiogram that reflects increased right ventricular wall thickening
2) A B-type natriuretic peptide (BNP) of 300 pg/mL
3) A left ventricular ejection fraction (VEF) of 50%
4) A serum sodium of 135

Question 17

When teaching a patient with heart failure about ventricular remodeling, the nurse should recognize that additional teaching is needed if the patient makes which statement about remodeling?
1) "It leads to progressive worsening of heart function."
2) "It can be described as an enlargement of the pumping chamber."
3) "It occurs with an increase in blood pressure and results in weight gain."
4) "It develops primarily because the heart is pumping harder."

Question 18

The nurse is caring for a patient with acute decompensated heart failure (HF) receiving BiPAP. What is the purpose of this treatment?
1) Reduce lung compliance
2) Increase respiratory rate
3) Decrease tidal volume
4) Increase surface area

Question 19

A patient in heart failure is to be started on an infusion of dobutamine (Dobutrex). What is most important for the nurse to assess before starting the infusion?
1) Breath sounds
2) Blood pressure
3) Level of consciousness
4) Urine output

Question 20

A patient is diagnosed with diastolic heart failure. What should the nurse realize is the cause of this type of heart failure? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Normal-sized but hypertrophied left ventricle
2) Blood backing up into the right atrium
3) Loss of ventricular diastolic relaxation
4) Blood backing up into the left atrium
5) Excessive fluid in the lower extremities

Question 21

While transferring a patient with heart failure from the bed to a chair, the nurse stops and decides to keep the patient in bed. What patient manifestation indicated to the nurse that this patient's status was deteriorating? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Respiratory rate 30
2) Heart rate 134 on the cardiac monitor
3) Gasping for breath
4) Productive cough
5) Jugular vein distention

Question 22

The nurse teaches a patient with heart failure nonpharmacological strategies to improve quality of life. What should be included in these instructions? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Stop smoking.
2) Reduce salt intake to 1 gram per day.
3) Restrict caloric intake to attain recommended body weight.
4) Attend cardiac rehabilitation sessions as prescribed.
5) Ingest no more than three alcoholic drinks per day.

Question 23

A patient has been receiving milrinone (Primacor) for cardiogenic shock from acute decompensated heart failure. What finding indicates that this medication has been effective in the patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Increased cardiac output
2) Reduced pulmonary arterial wedge pressure
3) Dropping blood pressure
4) Onset of ventricular dysrhythmias
5) Respiratory rate 28 and regular

Question 24

A patient with heart failure is scheduled for an echocardiogram. When should the nurse expect to schedule a cardiac catheterization for this patient?
1) When the etiology of heart failure cannot be determined through noninvasive testing
2) Immediately after the echocardiogram is completed
3) After medication therapy and nonpharmacological measures are implemented
4) Before starting cardiac medications

Question 25

The nurse suspects that compensatory mechanisms have been activated in a patient with heart failure. What did the nurse assess to make this clinical determination?
1) Temperature 100°F
2) Respiratory rate 20 per minute
3) Blood pressure 138/84 mm Hg
4) Heart rate 118 beats per minute

Question 26

A patient is admitted for treatment of acute decompensated heart failure (ADHF). Which medication should the nurse prepare to administer first?
1) Diuretic
2) Vasopressor
3) Beta blocker
4) Inotropic agent

Question 27

The nurse is preparing medications for the patient experiencing acute decompensated heart failure. Which medication should be administered first to improve gas exchange for the patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Morphine sulfate
2) Nitroglycerin
3) Nesiritide (Natrecor)
4) Dobutamine (Dobutrex)
5) Milrinone (Primacor)

Question 28

The nurse reviews teaching provided to a patient with heart failure. What should be emphasized during this teaching? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Enhanced admission assessment for post-discharge needs
2) Enhanced teaching and learning
3) Patient and family-centered handoff communication
4) Post-acute care follow-up
5) Stress reduction strategies

Question 29

A patient with heart failure is prescribed fosinopril (Monopril). For which reason should the nurse question this medication? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Serum creatinine 5 mg/dL
2) Serum potassium 5.9 mmol/L
3) Blood pressure 74/50 mm Hg
4) Respiratory rate 12 per minute
5) Pulse oximetry 92% on room air

Question 30

The nurse prepares discharge material for a patient with heart failure. What should be included in this teaching?
1) Smoking cessation
2) Activity restriction
3) Calorie-restricted diet
4) Fluid restriction

Question 31

The central venous pressure of a patient with heart failure is slowly increasing. What should this finding suggest to the nurse?
1) Right heart function is deteriorating.
2) Left heart function is deteriorating.
3) Fluid is backing up in the lungs.
4) Right heart function is improving.

Question 32

A patient with heart failure is experiencing increased fatigue and has a weight gain of 1 kg. Of what is this patient demonstrating signs?
1) Systemic deterioration
2) Pulmonary deterioration
3) Cardiac deterioration
4) Renal deterioration

Question 33

The nurse reviews a new order written for a patient with heart failure. When should invasive hemodynamic monitoring be considered for this patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) When the patient is experiencing fatigue
2) When the patient is experiencing severe dyspnea at rest
3) When the patient is experiencing cool, clammy extremities
4) When an inotropic infusion is initiated
5) When doses of pressor therapy are increased

Question 34

Which findings should the nurse report to the health care provider as evidence that the condition of a patient with heart failure is deteriorating? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) S3 and S4 heart sounds
2) Oxygen saturation 80% on 4 L oxygen nasal cannula
3) Urine output 10 mL over the last hour
4) Onset of productive cough
5) Weight loss of 3 lbs from previous weight

Question 35

A patient with a history of type 2 diabetes mellitus and heart failure is prescribed carvedilol (Coreg). What should the nurse assess prior to administering this medication to the patient? Select all that apply. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1) Blood pressure
2) Pulse
3) Blood glucose level
4) Lung sounds
5) Potassium level

Question 36

A patient with heart failure begins to cough pink frothy sputum. Which pressure should the nurse assess to confirm this manifestation?
1) Central venous pressure
2) Pulmonary capillary wedge pressure
3) Arterial pressure
4) Right arterial pressure