Deck 35: Nursing Management: Heart Failure

Question 1

Which action will 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)?

A) Monitor blood pressure frequently.
B) Encourage patient to ambulate in room.
C) Titrate nesiritide rate slowly before discontinuing.
D) Teach patient about safe home use of the medication.

Answer 1

Monitor blood pressure frequently.

Question 2

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) avoid dietary sources of potassium.
B) take the hydrochlorothiazide before bedtime.
C) notify the health care provider about any nausea.
D) never take digoxin if the pulse is below 60 beats/minute.

Answer 2

notify the health care provider about any nausea.

Question 3

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

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

Answer 3

milk, yogurt, and other milk products.

Question 4

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

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

Question 5

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) jugular vein atherosclerosis.
C) elevated right atrial pressure.
D) incompetent jugular vein valves.

Question 6

A patient with chronic heart failure who has prescriptions for a diuretic, an ACE-inhibitor, and a low-sodium diet tells the home health nurse 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.
B) question the patient about the use of the prescribed medications.
C) assess the patient for clinical manifestations of acute heart failure.
D) teach the patient about the importance of dietary sodium restrictions.

Question 7

A patient who has 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 will document this assessment information as

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

Question 8

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) uses an additional pillow to sleep when feeling short of breath at night.
B) tells the home care nurse that furosemide (Lasix) is taken daily at bedtime.
C) calls the clinic when the weight increases from 124 to 130 pounds in a week.
D) says that the nitroglycerin patch will be used for any chest pain that develops.

Question 9

While admitting an 80-year-old with 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) 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 10

A 55-year-old 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 appropriate?

A) "Since you are diabetic, you would not be a candidate for a heart transplant."
B) "The choice of a patient for a heart transplant depends on many different factors."
C) "Your heart failure has not reached the stage in which heart transplants are considered."
D) "People who have heart transplants are at risk for multiple complications after surgery."

Question 11

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 take first?

A) Palpate the abdomen.
B) Assess the orientation.
C) Check the capillary refill.
D) Auscultate the lung sounds.

Question 12

Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 38%?

A) Need to participate in an aerobic exercise program several times weekly
B) Use of salt substitutes to replace table salt when cooking and at the table
C) Importance of making a yearly appointment with the primary care provider
D) Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors

Question 13

During a visit to a 72-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain, and complains of "feeling too tired to do anything." Based on these data, the best nursing diagnosis for the patient is

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

Question 14

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. 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) hourly urine output greater than 60 mL.
C) reduction in patient complaints of chest pain.
D) decreased dyspnea with the head of bed at 30 degrees.

Question 15

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 nitroprusside rate if the patient develops

A) a dry, hacking cough.
B) any ventricular ectopy.
C) a systolic BP <90 mm Hg.
D) a heart rate <50 beats/minute.

Question 16

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

A) angiotensin-converting enzyme (ACE) inhibitors.
B) digitalis preparations.
C) b-adrenergic agonists.
D) calcium channel blockers.

Question 17

A patient in the intensive care unit with acute decompensated heart failure (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) give IV diazepam (Valium) 2.5 mg.
B) administer IV morphine sulfate 2 mg.
C) increase nitroglycerin (Tridil) infusion by 5 mcg/min.
D) increase dopamine (Intropin) infusion by 2 mcg/kg/min.

Question 18

After receiving change-of-shift report, which of these patients admitted with heart failure should the nurse assess first?

A) A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure (BP) of 100/56
B) A patient who is cool and clammy, with new-onset confusion and restlessness
C) A patient who had dizziness after receiving the first dose of captopril (Capoten)
D) A patient who has crackles in both posterior lung bases and is receiving oxygen

Question 19

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

A) furosemide (Lasix) 40 mg
B) captopril (Capoten) 25 mg
C) digoxin (Lanoxin) 0.125 mg
D) carvedilol (Coreg) 3.125 mg

Question 20

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

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

Question 21

An outpatient who has heart failure returns to the clinic after 2 weeks of therapy with carvedilol (Coreg). Which of these assessment findings is most important for the nurse to report to the health care provider?

A) Pulse rate of 56
B) 2+ pedal edema
C) BP of 88/42 mm Hg
D) Complaints of fatigue

Question 22

A patient has recently started taking oral digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for control of heart failure. Which assessment finding by the home health nurse is most important to communicate to the health care provider?

A) Presence of 1 to 2+ edema in the feet and ankles
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) Weight increase from 120 pounds to 122 pounds over 3 days

Question 23

A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has 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) Evaluate the IV insertion site for extravasation.
B) Monitor the patient's BP and heart rate every hour.
C) Adjust the rate to keep the systolic BP >90 mm Hg.
D) Teach the patient the reasons for remaining on bed rest.

Question 24

Which assessment finding in a patient admitted with acute decompensated heart failure ( ADHF ) requires the most rapid action by the nurse?

A) Oxygen saturation of 88%
B) Weight gain of 1 kg ( 2.2 lb )
C) Apical pulse rate of 106 beats/minute
D) Urine output of 50 mL over 2 hours