Deck 37: Nursing Management: Heart Failure

Question 1

Which IV medication will the nurse expect to administer to a patient who has ADHF,to increase stroke volume?

A) Milrinone (Primacor)
B) Nesiritide (Natrecor)
C) Dobutamine (Dobutrex)
D) Nitroprusside (Nipride)

Answer 1

Dobutamine (Dobutrex)

Question 2

The nurse monitors a patient receiving intravenous (IV)furosemide (Lasix)and enalapril (Vasotec)5 mg orally twice daily for an acute exacerbation of chronic heart failure.Which of the following findings indicates to the nurse that the treatment is effective?

A) A weight loss of 0.9 kg
B) An increase in urinary output
C) A decrease in systolic BP
D) Fewer crackles on lung auscultation

Answer 2

Fewer crackles on lung auscultation

Question 3

A patient with a history of chronic congestive heart failure is hospitalized with severe dyspnea and a dry,hacking cough.She has pitting edema in both ankles,and her vital signs are blood pressure (BP)170/100 mm Hg,pulse 92 beats/min,and respiration 28 breaths/min.What is the most important assessment for the nurse to conduct next?

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

Answer 3

Auscultate the lung sounds.

Question 4

IV nitroprusside (Nipride)is ordered for a patient with acute pulmonary edema.During the initial administration of the drug,the nurse should monitor the patient for which of the following?

A) Bradycardia
B) Hypotension
C) Cyanide toxicity
D) Ventricular dysrhythmias

Question 5

When working in the heart failure clinic,the nurse knows that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient does which of the following?

A) Says that the nitroglycerin patch will be used for any chest pain that develops
B) Calls when the weight increases from 56 to 59 kg in 2 days
C) Tells the home care nurse that furosemide is taken daily at bedtime
D) Makes an appointment to see the doctor at least once yearly

Question 6

When teaching the patient with congestive heart failure about a 2-g sodium diet,the nurse explains that which of the following foods must be restricted?

A) Eggs
B) Canned fruit
C) Frozen vegetables
D) Milk and milk products

Question 7

Which of the following determinants of health is true in relation to heart failure?

A) Men compose more new cases of heart failure than women.
B) Women tend to be diagnosed with heart failure at an older age as compared to men.
C) Men are more likely to be diabetic as compared to women.
D) Women are less likely to have high BP than men.

Question 8

When the nurse is admitting an 80-year-old woman with chronic heart failure to the medical unit,the patient says she lives alone and that she thinks she confuses her "water pill" with her "heart pill." The nurse makes a note that which of the following discharge plans for this patient should be included?

A) A referral for a home care nurse
B) Placement in a skilled nursing care facility
C) Transfer to a special unit for individuals with dementia
D) Arrangements for a family member to be with the patient around the clock

Question 9

A patient with acute heart failure has severe dyspnea and is extremely anxious.The nurse anticipates that increased cardiac output and decreased anxiety may be promoted by the IV administration of which of the following medications?

A) Morphine
B) Diazepam (Valium)
C) Dopamine (Intropin)
D) Nitroglycerin (Tridil)

Question 10

An outpatient who has developed heart failure after having an acute myocardial infarction has a new prescription for carvedilol (Coreg).After 2 weeks,the patient returns to the clinic.Which assessment finding causes the nurse the most concern?

A) The patient has a BP of 88/42 mm Hg.
B) The patient has an apical pulse rate of 56 beats/min.
C) The patient complains of feeling tired.
D) The patient has 2+ pedal edema.

Question 11

When the nurse is developing a teaching plan to prevent the development of heart failure in a patient with stage 1 hypertension,what information is most likely to improve compliance with antihypertensive therapy?

A) Hypertensive crisis may lead to development of acute heart failure in some patients.
B) Hypertension eventually will lead to heart failure by overworking the heart muscle.
C) High BP increases the risk for rheumatic heart disease.
D) High systemic pressure precipitates papillary muscle rupture.

Question 12

The nurse plans discharge teaching for a patient with chronic heart failure who is to be maintained on digoxin (Lanoxin),a diuretic,and a potassium supplement.What would appropriate instructions for the patient include?

A) Avoid dietary sources of potassium because too much can cause digitalis toxicity.
B) Take the diuretic before bedtime to prevent drowsiness during the day.
C) Notify the physician immediately if nausea or difficulty breathing occurs.
D) Take the pulse rate before taking all medications.

Question 13

Which of the following is a common cause of chronic heart failure?

A) Anemia
B) Dysrhythmias
C) Myocarditis
D) Hypertensive crisis

Question 14

A patient admitted to the hospital with an exacerbation of her chronic heart failure tells the nurse she was fine when she went to bed but woke up feeling as if she were suffocating.What is the best way for the nurse to document this assessment information?

A) Pulsus alternans
B) Paroxysmal nocturnal dyspnea
C) Two-pillow orthopnea
D) Acute bilateral pleural effusion

Question 15

The nurse identifies the collaborative problem of "potential complication: pulmonary edema for a patient in chronic heart failure." Which assessment will the nurse be most concerned about?

A) Apical pulse 106 beats/min
B) Weight gain of 1 kg over 24 hours
C) Oxygen saturation of 88% on room air
D) Decreased hourly urinary output

Question 16

After successful digitalization,a patient is to begin oral maintenance of digoxin and furosemide for control of chronic heart failure.To prevent digitalis toxicity,what does the nurse understand is the most important parameter to monitor in the patient?

A) Body weight
B) Liver function
C) Blood pressure
D) Serum potassium

Question 17

To promote more efficient ventricular emptying by decreasing preload in the patient with chronic heart failure,the nurse should implement which of the following actions?

A) Administer oxygen per mask.
B) Encourage active leg exercises to increase venous return.
C) Administer sedatives to promote rest and decrease myocardial oxygen demand.
D) Position the patient in a high-Fowler's position with the feet horizontal in the bed.

Question 18

During assessment of a 72-year-old man with swelling in his ankles,the nurse finds jugular venous distension with the head of the bed elevated 45 degrees.What does the nurse know this finding indicates?

A) Decreased fluid volume
B) Elevated right atrial pressure
C) Incompetent jugular vein valves
D) Atherosclerosis of the jugular veins

Question 19

Following an acute myocardial infarction,a 67-year-old man develops heart failure.What does the nurse anticipate will be the first-line therapy for the patient?

A) Digitalis preparation,such as digoxin
B) Diuretic,such as hydrochlorothiazide (HydroDIURIL)
C) (?)-Adrenergic agonist,such as dobutamine
D) Angiotensin-converting enzyme (ACE)inhibitor,such as captopril (Capoten)

Question 20

A patient with chronic heart failure tells the nurse at the clinic that he has gained 2.26 kg in the last 3 days,even though he has continued to follow a low-sodium diet.What is the priority nursing action?

A) Ask the patient to recall the dietary intake for the last 3 days because the patient's diet contains hidden sources of sodium.
B) Instruct the patient in a low-calorie,low-fat diet because the weight gain has likely been caused by excessive intake of inappropriate foods.
C) Assess the patient for clinical manifestations of acute heart failure because an exacerbation of the chronic heart failure may be occurring.
D) Educate the patient about the use of diuretic therapy because it is likely that the patient will need medications to reduce the hypervolemia.

Question 21

What is the most common form of initial heart failure?

A) Left-sided
B) Right-sided
C) Biventricular
D) All types occur equally;there is no one common form of heart failure.

Question 22

Which of the following symptoms would the nurse expect to observe in a patient with left-sided heart failure?

A) Nausea
B) Dyspnea
C) Anorexia
D) Dependent edema