Deck 37: Care of Patients With Cardiac Problems

Question 1

A client with heart failure is experiencing acute shortness of breath.What is the nurse's priority action?

A) Place the client in a high Fowler's position.
B) Perform nasotracheal suctioning of the client.
C) Auscultate the client's heart and lung sounds.
D) Place the client on a 1000 mL fluid restriction.

Answer 1

Place the client in a high Fowler's position.

Question 2

A client asks the nurse why it is important to be weighed every day if he has right-sided heart failure.What is the nurse's best response?

A) "Weight is the best indication that you are gaining or losing fluid."
B) "Daily weights will help us make sure that you're eating properly."
C) "The hospital requires that all inpatients be weighed daily."
D) "You need to lose weight to decrease the incidence of heart failure."

Answer 2

"Weight is the best indication that you are gaining or losing fluid."

Question 3

The nurse is concerned that an older adult client with heart failure is developing pulmonary edema.What manifestation alerts the nurse to further assess the client for this complication?

A) Confusion
B) Dysphagia
C) Sacral edema
D) Irregular heart rate

Answer 3

Confusion

Question 4

A client has been admitted to the intensive care unit with worsening pulmonary manifestations of heart failure.What is the nurse's best action?

A) Place the client in a high Fowler's position.
B) Begin cardiopulmonary resuscitation (CPR).
C) Promote rest and minimize activities.
D) Administer loop diuretics as prescribed.

Question 5

The nurse is assessing a client admitted to the cardiac unit.What statement made by the client alerts the nurse to the possibility of right-sided heart failure?

A) "I sleep with four pillows at night."
B) "My shoes fit really tight lately."
C) "I wake up coughing every night."
D) "I have trouble catching my breath."

Question 6

The nurse notes that the client's apical pulse is displaced to the left.What conclusion can be drawn from this assessment?

A) This is a normal finding.
B) The heart is hypertrophied.
C) The left ventricle is contracted.
D) The client has pulsus alternans.

Question 7

A client is taking triamterene-hydrochlorothiazide (Dyazide)and furosemide (Lasix).What assessment finding requires action by the nurse?

A) Cough
B) Headache
C) Pulse of 62 beats/min
D) Potassium of 2.9 mEq/L

Question 8

The nurse is administering captopril (Capoten)to a client with heart failure.What is the priority intervention for this client?

A) Administer this medication before meals to aid absorption.
B) Instruct the client to ask for assistance when arising from bed.
C) Give the medication with milk to prevent stomach upset.
D) Monitor the potassium level and check for symptoms of hypokalemia.

Question 9

The nurse is starting a client on digoxin (Lanoxin)therapy.What intervention is essential to teach this client?

A) "Avoid taking aspirin or aspirin-containing products."
B) "Increase your intake of foods high in potassium."
C) "Hold this medication if your pulse rate is below 80 beats/min."
D) "Do not take this medication within 1 hour of taking an antacid."

Question 10

The nurse is assessing a client in an outpatient clinic.Which client statement alerts the nurse to possible left-sided heart failure?

A) "I have been drinking more water than usual."
B) "I have been awakened by the need to urinate at night."
C) "I have to stop halfway up the stairs to catch my breath."
D) "I have experienced blurred vision on several occasions."

Question 11

The client who just started taking isosorbide dinitrate (Imdur)reports a headache.What is the nurse's best action?

A) Titrate oxygen to relieve headache.
B) Hold the next dose of Imdur.
C) Instruct the client to drink water.
D) Administer PRN acetaminophen.

Question 12

A client with a history of heart failure is being discharged.Which priority instruction will assist the client in the prevention of complications associated with heart failure?

A) "Avoid drinking more than 3 quarts of liquids each day."
B) "Eat six small meals daily instead of three larger meals."
C) "When you feel short of breath, take an additional diuretic."
D) "Weigh yourself daily while wearing the same amount of clothing."

Question 13

A client with heart failure is prescribed enalapril (Vasotec).What is the nurse's priority teaching for this client?

A) "Avoid using salt substitutes."
B) "Take your medication with food."
C) "Avoid using aspirin-containing products."
D) "Check your pulse daily."

Question 14

A client with a history of myocardial infarction calls the clinic to report the onset of a cough that is troublesome only at night.What direction does the nurse give to the client?

A) "Please come into the clinic for an evaluation."
B) "Increase your fluid intake during waking hours."
C) "Use an over-the-counter cough suppressant."
D) "Sleep on two pillows to facilitate postnasal drainage."

Question 15

A client with systolic dysfunction has an ejection fraction of 38%.The nurse assesses for which physiologic change?

A) Increase in stroke volume
B) Decrease in tissue perfusion
C) Increase in oxygen saturation
D) Decrease in arterial vasoconstriction

Question 16

The nurse assesses a client and notes the presence of an S₃ gallop.What is the nurse's best intervention?

A) Assess for symptoms of left-sided heart failure.
B) Document this as a normal finding.
C) Call the health care provider immediately.
D) Transfer the client to the intensive care unit.

Question 17

The rehabilitation nurse is assisting a client with heart failure to increase activity tolerance.During ambulation of the client,identification of what symptom causes the nurse to stop the client's activity?

A) Decrease in oxygen saturation from 98% to 95%
B) Respiratory rate change from 22 to 28 breaths/min
C) Systolic blood pressure change from 136 to 96 mm Hg
D) Increase in heart rate from 86 to 100 beats/min

Question 18

A client is admitted with early-stage heart failure.Which assessment finding does the nurse expect?

A) A decrease in blood pressure and urine output
B) An increase in creatinine and extremity edema
C) An increase in heart rate and respiratory rate
D) A decrease in respirations and oxygen saturation

Question 19

The client with heart failure has been prescribed intravenous nitroglycerin and furosemide (Lasix)for pulmonary edema.Which is the priority nursing intervention?

A) Insert an indwelling urinary catheter.
B) Monitor the client's blood pressure.
C) Place the nitroglycerin under the client's tongue.
D) Monitor the client's serum glucose level.

Question 20

The nurse is assessing clients on a cardiac unit.Which client does the nurse assess most carefully for developing left-sided heart failure?

A) Middle-aged woman with aortic stenosis
B) Middle-aged man with pulmonary hypertension
C) Older woman who smokes cigarettes daily
D) Older man who has had a myocardial infarction

Question 21

An older adult client with heart failure states,"I don't know what to do.I don't want to be a burden to my daughter,but I can't do it alone.Maybe I should die." What is the nurse's best response?

A) "Would you like to talk about this more?"
B) "You're lucky to have such a devoted daughter."
C) "You must feel as though you are a burden."
D) "Would you like an antidepressant medication?"

Question 22

The nurse is assessing a client with left-sided heart failure.What conditions does the nurse assess for?

A) Pulmonary crackles
B) Confusion, restlessness
C) Pulmonary hypertension
D) Dependent edema
E) S₃/S₄ summation gallop
F) Cough worsens at night

Question 23

The nurse is providing care to a client with infective endocarditis.What infection control precautions does the nurse use?

A) Standard Precautions
B) Bleeding Precautions
C) Reverse isolation
D) Contact isolation

Question 24

A client is being discharged home after a heart transplant with a prescription for cyclosporine (Sandimmune).What priority education does the nurse provide with the client's discharge instructions?

A) "Use a soft-bristled toothbrush and avoid flossing."
B) "Avoid large crowds and people who are sick."
C) "Change positions slowly to avoid hypotension."
D) "Check your heart rate before taking the medication."

Question 25

The nurse is providing discharge education to a client with hypertrophic cardiomyopathy (HCM).What priority instruction will the nurse include?

A) "Take your digoxin at the same time every day."
B) "You should begin an aerobic exercise program."
C) "You should report episodes of dizziness or fainting."
D) "You may have only two alcoholic drinks daily."

Question 26

An older adult client is admitted with fluid volume excess.Which diagnostic study does the nurse facilitate as a priority?

A) Echocardiography
B) Chest x-ray
C) T₄ and thyroid-stimulating hormone (TSH)
D) Arterial blood gas

Question 27

A client in severe heart failure has a heparin drip infusing.The health care provider prescribes nesiritide (Natrecor)to be given intravenously.Which intervention is essential before administration of this medication?

A) Insert a separate IV access.
B) Prepare a test bolus dose.
C) Prepare the piggyback line.
D) Administer furosemide (Lasix) first.

Question 28

A client with pericarditis is admitted to the cardiac unit.What assessment finding does the nurse expect in this client?

A) Heart rate that speeds up and slows down
B) Friction rub at the left lower sternal border
C) Presence of a regularly gallop rhythm
D) Coarse crackles in bilateral lung bases

Question 29

The nurse is caring for a client diagnosed with aortic stenosis.What assessment finding does the nurse expect in this client?

A) Bounding arterial pulse
B) Slow, faint arterial pulse
C) Narrowed pulse pressure
D) Elevated systolic pressure

Question 30

A client with end-stage heart failure is awaiting a transplant.The client appears depressed and states,"I know a transplant is my last chance,but I don't want to become a vegetable." What is the nurse's best response?

A) "Would you like to speak with a priest or chaplain?"
B) "I will consult a psychiatrist to speak with you."
C) "Do you want to come off the transplant list?"
D) "Would you like information about advance directives?"

Question 31

The nurse reminds the client who has received a heart transplant to change positions slowly.Why is this instruction a priority?

A) Rapid position changes can create shear and friction forces, which can tear out internal vascular sutures.
B) The new vascular connections are more sensitive to position changes, leading to increased intravascular pressure.
C) The new heart is denervated and is unable to respond to decreases in blood pressure caused by position changes.
D) The recovering heart diverts blood flow away from the brain when the client stands, increasing the risk for stroke.

Question 32

The nurse is caring for a client with severe heart failure.What is the best position in which to place this client?

A) High Fowler's, pillows under arms
B) Semi-Fowler's, with legs elevated
C) High Fowler's, with legs elevated
D) Semi-Fowler's, on the left side

Question 33

The nurse is assessing a client with a history of heart failure.What priority question assists the nurse to assess the client's activity level?

A) "Do you have trouble breathing or chest pain?"
B) "Are you able to walk upstairs without fatigue?"
C) "Do you awake with breathlessness during the night?"
D) "Do you have new-onset heaviness in your legs?"

Question 34

The nurse is caring for a client with mitral valve stenosis.What clinical manifestation alerts the nurse to the possibility that the client's stenosis has progressed?

A) Oxygen saturation of 92%
B) Dyspnea on exertion
C) Muted systolic murmur
D) Upper extremity weakness

Question 35

A client who has had a prosthetic valve replacement asks the nurse why he must take anticoagulants for the rest of his life.What is the nurse's best response?

A) "The prosthetic valve places you at greater risk for a heart attack."
B) "Blood clots form more easily in artificial replacement valves."
C) "The vein taken from your leg reduces circulation in the leg."
D) "The surgery left a lot of small clots in your heart and lungs."

Question 36

A client has been admitted to the acute care unit for an exacerbation of heart failure.Which is the nurse's priority intervention?

A) Assess respiratory status.
B) Monitor electrolyte levels.
C) Administer intravenous fluids.
D) Insert a Foley catheter.

Question 37

A client with heart failure is due to receive enalapril (Vasotec)and has a blood pressure of 98/50 mm Hg.What is the nurse's best action?

A) Administer the Vasotec.
B) Recheck the blood pressure.
C) Hold the Vasotec.
D) Notify the health care provider.

Question 38

The nurse is instructing a client with heart failure about energy conservation.Which is the best instruction?

A) "Walk until you become short of breath and then walk back home."
B) "Gather everything you need for a chore before you begin."
C) "Pull rather than push or carry items heavier than 5 pounds."
D) "Take a walk after dinner every day to build up your strength."

Question 39

The nurse is obtaining the admission health history for a young adult who presents with fever,dyspnea,and a murmur.What priority data does the nurse inquire about?

A) Family history of coronary artery disease
B) Recent travel to Third World countries
C) Pet ownership, especially cats with litter boxes
D) History of a systemic infection within the past month

Question 40

The nurse is discharging a client home following mitral valve replacement.What statement indicates that the client requires further education?

A) "I will be able to carry heavy loads after 6 months of rest."
B) "I will have my teeth cleaned by the dentist in 2 weeks."
C) "I will avoid eating foods high in vitamin K, like spinach."
D) "I will use an electric razor instead of a straight razor to shave."

Question 41

The nurse is evaluating the laboratory results for a client with heart failure.What results does the nurse expect?

A) Hematocrit (Hct), 32.8%
B) Serum sodium, 130 mEq/L
C) Serum potassium, 4.0 mEq/L
D) Serum creatinine, 1.0 mg/dL
E) Proteinuria
F) Microalbuminuria