Question 1

The nurse is providing home care for a patient with chronic heart failure who says, "I don't think I'm going to go to cardiac rehab anymore, it is too hard to get there. Besides, if I'm going to die, I don't want to die on a treadmill." Which of the following responses by the nurse is best?

Accepted Answer

This response acknowledges the patient's feelings and provides information that may persuade them to continue with the cardiac rehab program. It is important to provide patients with information about the benefits of cardiac rehab to help motivate them and improve their medical outcomes. The other options either dismiss the patient's concerns or suggest giving up, which is not helpful or appropriate.

Question 2

The nurse is caring for a patient who has chronic heart failure and is scheduled for pacemaker placement. The nurse recognizes additional teaching is required by which of the following patient statements?

Accepted Answer

The statement "I won't have to take my cardiac medications after the surgery" is incorrect and requires additional teaching. Pacemaker placement does not eliminate the need for cardiac medications, but rather can help improve the effectiveness of the medications in managing heart failure symptoms. It is important for the patient to continue taking their medications as prescribed.

Question 3

In a patient who has had cardiac surgery, chest tube drainage greater than ________________mL/hr may lead to hypovolemia and a decrease in cardiac output.

Accepted Answer

The answer of In a patient who has had cardiac...

Question 4

The nurse is contributing to a patient's plan of care who is recovering from heart transplant surgery. The patient is shivering and has weak peripheral pulses, mottled skin on the feet, and excessive chest tube drainage. Which nursing diagnosis would be a priority for the nurse to recommend?

Accepted Answer

The patient's weak peripheral pulses, mottled skin on the feet, and excessive chest tube drainage indicate decreased cardiac output due to hypovolemia. This is a life-threatening condition and should be the priority nursing diagnosis. Pain, infection, and impaired skin/tissue integrity are also important nursing diagnoses, but they are not as immediately life-threatening as hypovolemia.

Question 5

For a patient with chronic obstructive pulmonary disease (COPD) who needs oxygen, the oxygen flow should generally be limited to ____________________/min.

Accepted Answer

The answer of For a patient with chronic obstructive pulmonary...

Question 6

The nurse is reinforcing discharge teaching for a patient with a history of right-sided heart failure. Which of the following would be included?

Accepted Answer

It is important for patients with right-sided heart failure to monitor their weight and report any sudden weight gain to their healthcare provider, as it may be a sign of worsening fluid retention.

Question 7

In a patient with heart failure, which of the following occur as compensatory mechanisms to help maintain adequate blood flow out of the heart? (Select all that apply.?

Accepted Answer

In heart failure, compensatory mechanisms include the release of epinephrine and norepinephrine (A) to increase heart rate and contractility. The kidneys activate the renin-angiotensin-aldosterone system (C) to retain sodium and water, increasing volume and preload. The heart muscles stretch (E) to increase the force of myocardial contraction. Muscles mass of the heart decreases (B) in heart failure and urine output increases (D), indicating decreased kidney function in heart failure. The oxygen demand of the heart is increased, not lowered (F), due to the increased workload required to maintain adequate blood flow.

Question 8

The nurse is teaching a patient with heart failure how to avoid activity that results in Valsalva's maneuver. Which of these observations by the nurse would indicate that the teaching has been effective?

Accepted Answer

Valsalva's maneuver involves holding the breath and straining, which can increase intra-thoracic pressure and affect cardiac output. To avoid this, the patient should avoid activities that involve straining, holding the breath or increasing intra-thoracic pressure, such as lifting heavy objects, straining while defecating or urinating, coughing, sneezing forcefully or blowing up balloons. The patient breathing normally when sitting up indicates that they are properly avoiding Valsalva's maneuver.

Question 9

The nurse is reinforcing teaching to a patient prescribed captopril (Capoten). Which of the following should the nurse specifically include in instructions? (Select all that apply.?

Accepted Answer

Captopril (Capoten) is an ACE inhibitor used to treat hypertension. It can cause hypotension, cough, and angioedema. The nurse should instruct the patient to check blood pressure weekly and report changes, report any cough that develops, and report any swelling of the hands, feet, or tongue or difficulty swallowing.

Question 10

The nurse is documenting a patient's report of shortness of breath after lying down, which caused a feeling of suffocation. Which of the following terms would the nurse document?

Accepted Answer

Paroxysmal nocturnal dyspnea is the term used to describe sudden episodes of shortness of breath that occur at night, often causing a feeling of suffocation when lying down.

Question 11

As part of discharge teaching, the nurse is instructing a patient on the use of digoxin. What should be included in the teaching? (Select all that apply.?

Accepted Answer

Patients taking digoxin should be instructed to take their medication exactly as directed at the same time each day, to take their pulse before taking medication and to call the physician if the pulse is below 60 or above 100, and to report any visual changes, such as blurred vision, photophobia, or seeing yellowish green halos. Changing positions quickly may actually increase the risk for orthostatic hypotension, so this should not be included in the teaching. A persistent cough is not a common side effect of digoxin, so it does not need to be included in the teaching.

Question 12

The nurse reinforced teaching for a patient awaiting a heart transplant. Which of these, if stated by a patient, indicates to the nurse correct understanding of the usual criteria used for a potential heart donor? (Select all that apply.?

Accepted Answer

The answer of The nurse reinforced teaching for a patient...

Question 13

The nurse is reinforcing discharge teaching for a patient taking antirejection medication following a heart transplant. Which of the following beverages should the nurse instruct the patient to avoid?

Accepted Answer

Grapefruit juice can increase the level of antirejection medication in the bloodstream, leading to potential toxicity. The other beverages listed do not have this interaction.

Quiz 26: Nursing Care of Patients With Heart Failure