Chapter 26 Flashcards
_____ ____ is the acute inability of the heart to pump enough blood to meet the body’s oxygen and nutrient needs
Pulmonary edema (acute heart failure)
___ _____ occurs when the right side of the heart fails because of an increased workload caused by pulmonary disease
Cor pulmonale
Organ enlargement that may occur with right-sided heart failure is known as _____ and ______
splenomegaly and hepatomegaly
The goal of treatment for heart failure is to improve the heart’s pumping ability and decrease the heart’s workload by reducing ______ ______ ______
peripheral vascular resistance
______ ______ ______ causes supine patients to awake suddenly with a feeling of suffocation
Paroxysmal nocturnal dyspnea
The end-diastole stretch in the ventricles produced by the ventricular volume is _____
preload
The tension in the ventricular wall during systole necessary to overcome vascular resistance is _____
afterload
______ is dyspnea that occurs when the patient lies down
Orthopnea
Chose right or left sided heart failure \_\_\_ Dry cough \_\_\_ Peripheral edema \_\_\_ Crackles \_\_\_ Hepatomegaly \_\_\_ Jugular venous distention \_\_\_ Dyspnea \_\_\_ Splenomegaly \_\_\_ Orthopnea
L - Dry cough R - Peripheral edema L - Crackles R - Hepatomegaly R - Jugular venous distention L - Dyspnea R - Splenomegaly L - Orthopnea
A patient is being given digoxin (Lanoxin) to treat heart failure. Which of the following is a usual adult daily dosage of digoxin (Lanoxin?)
a) 0.005 mg
b) 0.025 mg
c) 0.25 mg
d) 2.5 mg
c) 0.25 mg
When the nurse is reviewing a patient’s daily laboratory test results, which of the following electrolyte imbalances should the nurse recognize as predisposing the patient to digoxin toxicity?
a) Hypokalemia
b) Hyperkalemia
c) Hyponatremia
d) Hypernatremia
a) Hypokalemia
If a patient has an elevated pulmonary vascular pressures, the nurse understands that the patient is most likely to develop which of the following physiological cardiac changes?
a) Left atrial atrophy
b) Right atrial atrophy
c) Left ventricular hypertrophy
d) Right ventricular hypertrophy
d) Right ventricular hypertrophy
A patient is admitted to a medical unit with a diagnosis of heart failure. The patient reports increasing fatigue during the past two weeks. Which of the following is the most likely cause of this fatigue?
a) Dyspnea
b) Decreased cardiac output
c) Dry cough
d) Orthopnea
b) Decreased cardiac output
A patient asks the nurse what a diagnosis of heart failure means. Which of the following is the nurse’s best response?
a) Your heart briefly stops
b) Your heart has an area of muscle that is dead
c) Your heart is pumping too much blood
d) Your heart is not an efficient pump
d) Your heart is not an efficient pump
A patient’s chest x-ray examination indicates fluid in both lung bases. Which of the following signs or symptoms present during the nurse’s data collection most reflects these x-ray examination findings?
a) Fatigue
b) Peripheral edema
c) Bilateral crackles
d) Jugular venous distention
c) Bilateral crackles
To monitor the severity of a patient’s heart failure, which of the following data is the most appropriate for the nurse to gather daily?
a) Weight
b) Calorie count
c) Appetite
d) Abdominal girth
a) Weight
Which of the following signs indicates to the nurse that digoxin (Lanoxin) has been effective for a patient?
a) Urine output decreases
b) Urine output increases
c) Heart rate higher than 95 beats per minute
d) Heart rate lower than 50 beats per minute
b) Urine output increases
For a patient who is being discharged on digoxin, the nurse should include which of the following in an explanation to the patient on the signs and symptoms of digoxin toxicity?
a) Poor appetite
b) Constipation
c) Halos around lights
d) Tachycardia
a) Poor appetite
The patient is being discharged on furosemide (Lasix). The nurse evaluates the patient as understanding medication teaching if the patient states that which of the following laboratory tests will be monitored as ordered?
a) I will have my urine sodium checked
b) I will have my calcium level checked
c) I will have my prothrombin time checked
d) I will have my potassium level checked
d) I will have my potassium level checked
Which of the following does the nurse understand are the reasons a patient with pulmonary edema is given morphine sulfate? (Select all that apply)
a) To reduce anxiety
b) To relieve chest pain
c) To strengthen heart contractions
d) To increase blood pressure
e) To reduce preload and afterload
f) To induce amnesia
a) To reduce anxiety
e) To reduce preload and afterload
The nurse evaluates that bumetanide (Bumex) IV is effective in treating pulmonary edema if which of the following patient sins or symptoms is resolved?
a) Pedal edema
b) Jugular venous distention
c) Pink, frothy sputum
d) Bradycardia
c) Pink, frothy sputum
A patient is being taught the action of digoxin, which is an inotropic agent. The nurse defines an inotropic agent as a medication that has which of the following actions?
a) Decreases heart rate
b) Increases heart rate
c) Increases conduction time
d) Strengthens heart contractions
d) Strengthens heart contractions
For a person receiving furosemide (Lasix), the nurse evaluates the medication as being effective if which of the following effects occurs?
a) Bilateral crackles diminish
b) Serum potassium decreases
c) Heart rate increases
d) Pulse pressure increases
a) Bilateral crackles diminish
When caring for an anxious patient with dyspnea, which of the following nursing actions is most helpful to include in the plan of care to relieve anxiety?
a) Increase activity levels
b) Stay at patient’s bedside
c) Pull the privacy curtain
d) Close the patient’s door
b) Stay at patient’s bedside
______ ____ _____ is an older term for heart failure
Congestive heart failure
______ _____ is a clinical syndrome that occurs as a result of the inability of the ventricle(s) to fill or pump enough blood to meet the body’s oxygen and nutrient needs. It may cause dyspnea, fatigue and fluid volume overload in the intravascular and interstitial spaces, resulting in reduced quality and length of life.
Heart failure (HF)
Causes of heart failure are varied and may include:
coronary artery disease (most often) myocardial infarction cardiomyopathy heart valve problems hypertension
In the elderly, the most common cause of heart failure is _____ _____
cardiac ischemia
According to the AHA, _____ million people have heart failure with more than ________ new cases each year
5.7; 670,000
A certain amount of force must be generated by the left ventricle during a contraction to eject blood into the aorta through the aortic valve. This force is referred to as _____
afterload
The pressure within the aorta and arteries influence the force needed to open the aortic valve to pump blood into the aorta. This pressure is called ____ _____ _____
peripheral vascular resistance (PVR)
______ is one of the major causes of left sided heart failure because it increases the pressure within arteries
Hypertension
The major cause of right-sided heart failure is ______
left-sided heart failure
When the right ventricle hypertrophies or fails because of increased pulmonary pressures, it is referred to as __ _____
cor pulmonale
When the _____ _____ fails, it does not empty normally and there is a backward buildup of blood in the systemic blood vessels
right ventricle
As the failure progresses, blood pools into the hepatic veins and the liver becomes congested known as _______. Pain in the right upper quadrant of the abdomen and impaired liver function are caused by this liver congestion
hepatomegaly
Systemic venous congestion also leads to engorgement of the spleen, known as ______
splenomegaly
Any signs and symptoms not related to the lungs are caused by ______
right-sided heart failure
Left-sided heart failure signs and symptoms are found I the _____
lungs
_______ ________ help ensure that an adequate amount of blood is being pumped out of the heart
Compensatory mechanisms
When the sympathetic nervous system detects low cardiac output, it speeds up the heart rate by releasing _______ and _______
epinephrine and norepinephrine
Enlarging the chambers in the heart
dilation
Increasing the muscle mass in the heart
hypertrophy
In dilation, the heart muscle fibers stretch to increase the force of myocardial contractions, which is known as the ____-_____ phenomenon
Frank-Starling
_____ _____, also known as acute heart failure, is sudden severe fluid congestion in the alveoli of the lungs and is life-threatening
Pulmonary edema
_____ _____ occurs with an acute event as an MI or when the heart is severely stressed, causing the left ventricle to fail
Pulmonary edema
___, ____ sputum is a classic symptom of pulmonary edema caused by the increased lung congestion and pressures that allow leaking of fluid into the alveoli
pink, frothy
Placing the patient in ____ position allows the lungs to expand more easily
Fowler’s
The _____ ____ _____ shows elevated pulmonary pressures and a decreased cardiac output
pulmonary artery catheter
____ and _____ are the earliest symptoms of heart failure. They occur from the decreased amount of oxygen reaching the tissues.
Fatigue, weakness
_____ is a common symptom of left-sided heart failure. It is a result of the pulmonary congestion that impairs gas exchange between the alveoli and capillaries
Dyspnea
____ _____ is shortness of breath that increases with activity
Extertional dyspnea
_____ is dyspnea that increases when lying flat
Orthopnea
______ _____ ______ is sudden shortness of breath that occurs after lying flat for a time
Paroxysmal nocturnal dyspnea (PND)
a ____, ___ ____ is common in heart failure
chronic, dry cough
_____ _____ causes abnormal breath sounds such as crackles and wheezes
Pulmonary congestion
_____ are produced from fluid buildup in the alveoli resulting from increased pressure in the pulmonary capillaries
Crackles
____ occur from bronchiolar constriction caused by the increased fluid
Wheezes
______ increased the oxygen needs of the heart
tachycardia
A breathing pattern of shallow respirations building to deep breaths followed by a period of apnea characterizes ____-____ breathing
Cheyne-Stokes
Many patients with heart failure are anemic due to decreased ______-______ _____ ____
angiotension-converting enzyme (ACE) action
_____ is a late sign of heart failure. It is associated primarily with left-sided heart failure
Cyanosis
_____ is an increase in urine output at night during sleep
Nocturia
____ _____, a leakage of fluid from the capillaries of the lung into the pleural space, can occur
Pleural effusion
_______ and ____ can occur as a result of poor emptying of the ventricles which leads to stasis of blood
Thrombosis, emboli
______ _____, often caused by an MI that damages the left ventricle, occurs when the left ventricle is unable to supply the tissues with enough oxygen and nutrients to meet their needs. It is a life-threatening condition that requires immediate treatment
Cardiogenic shock
A ____ ____ examination shows the size, shape, and enlargement of the heart and congestion in the pulmonary vessels
chest x-ray
_______ may measure ventricular size, wall thickness, motion and ejection fraction and assess valvular function
Echocardiography
Cardiac _____ ____ ____ shows both moving and still pictures of the heart and major blood vessels. Cardiac structure and function are analyzed to determine treatment for cardiac disease
magnetic resonance imaging (MRI)
______ ______ and angiography are used to detect underlying heart disease that may be the cause of heart failure
Cardiac catheterization
Measurement of the pressure in the heart and lungs is done with _____ _____ to guide medical therapy
hemodynamic monitoring
An enlarged heart
cardiomegaly
The overall goal of medical treatment for chronic heart failure is:
to improve the heart’s pumping ability and decrease the heart’s oxygen demands
One of the major problems caused by heart failure is a ____ __ ____ delivered to the tissues
reduction in oxygen
Dietary ____ is usually restricted to decrease fluid retention
sodium
First-line therapy to decrease afterload.
Decrease cardiac hypertrophy
Examples - captopril (Capoten), benazepril (Lotensin), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univase), quinapril (Accupril), perindopril (Aceon), ramipril (Altace), trandolapril (Mavik)
(Remember the -pril ending)
ACE Inhibitors
Block angiotensin II receptor blockers to prevent hypertension. May be used if ACE inhibitor not tolerated
Examples - candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), valsartan (Diovan)
(Remember the -sartan ending)
Angiotension II Receptor Inhibitors (ARBs)
Decrease fluid overload
Potassium wasting
Examples - bumetanide (Bumex), furosemide (Lasix), torsemide (Demadex)
(Remember the -ide ending)
Loop diuretics
Potassium sparing
Example - spironolactone (Aldactone)
Loop diuretic
Decrease fluid overload
Potassium wasting
Examples - chlorothiazide (Diuril), hydrochlorothiazide (Hydro DIURIL, HCTZ, Microzide), metolazone (Zaroxolyn)
Thiazide diuretics
Decrease afterload, which increases cardiac output and reduces cardiac workload. Used for patients who cannot take ACE inhibitors
Examples - isosorbide dinitrate (Isorbid, Isordil), hydralazine (Apresoline), nitroglycerin
Vasodilators
_______ _____ ______ restores normal contraction timing of the ventricles
Cardiac resynchronization therapy (CRT)
_____ _____ _____ can provide temporary supports to patients in cardiogenic shock and acct as a bridge to transplantation, destination therapy (long-term solution when other options are not available for the failing heart), or heart replacement
Mechanical assistive devices
For acute care, an ____-____ ___ ____ (IABP) increases circulation to the coronary arteries and reduces the work of the heart. The IABP catheter is inserted into the femoral artery and positioned in the descending aortic arch
intra-aortic balloon pump
______ ___ ___ (VADs) are implanted mechanical devices that assist cardiac pumping. These devices maintain cardiac output and allow the failing ventricle to rest.
Ventricular assist devices
For chronic heart failure, oxygen is administered at __ to __ L/min via nasal cannula
2 to 6
____ or ____ position makes breathing easier. In upright positions, the lungs are able to expand more fully and gravity decreases the amount of fluid returned to the heart, thereby reducing the heart’s workload.
Semi-Fowler’s or high-Fowler’s
Monitoring ___ _____ for weight gain is important in detecting fluid retention
daily weights
Activities should be alternated with periods of ____
rest
_____ require monitoring of blood pressure and potassium levels
diuretics
Before administration of a _____ drug, which slows the heart rate, the patient’s apical pulse should be counted for 1 minute. If the pulse is below ___ bpm, notify the physician to determine if the drug should be given
digitalis
60
____, ____, and ____ ____ may be suggested to flavor unsalted foods
Spices, herbs, lemon juice
Blood pressure is monitored when administering _______
vasodilators
______ ______ is reserved for patients with end-stage cardiac disease
Cardiac transplanation
Two types of cardiac transplant procedures are performed : _____ and _____
orthotopic, heterotopic
In the ____ procedure, one the patient is on cardiopulmonary bypass (CPB), the recipient’s diseased heart is removed, leaving the posterior wall of the atria, superior vena cava and inferior vena cava, and pulmonary artery are cut. The donor’s atria, aorta, and pulmonary artery are then anastomosed to the recipient’s atria, aorta, and pulmonary artery
orthotopic
The _____ procedure joins the donor heart and vessels to the recipient’s heart and vessels without removing the recipient’s heart. The donor heart rests in the right side of the chest
heterotopic
________ therapy is required to prevent rejection of the transplanted heart
Immunosuppresive
After a cardiac transplant, the patient is connected to a cardiac monitor and a mechanical ventilator for __ to ___ hours
4, 24
Air in the subcutaneous tissue from opening the chest
crepitus
After the initial transfer assessment, vital signs, oxygen saturation, and cardiac pressures are monitored every __ to ___ minutes, with decreasing frequency as the patient stabilizes
15 to 30
A patient asks the nurse what heart failure is. Which of the following is the nurse’s best response?
a) The heart pumps too much blood into the pulmonary veins
b) The heart is unable to pump enough blood for the body’s oxygen needs
c) Heart failure is a buildup of blood in the aorta from the heart’s left ventricle
d) With a failing heart, the heart stops beating, so blood is not pumped out
b) The heart is unable to pump enough blood for the body’s oxygen needs
Which of the following does the nurse understand is a major cause of left-sided heart failure?
a) Hypertension
b) Congenital heart defects
c) Pulmonary valve stenosis
d) Septal defects
a) Hypertension
A patient who has been treated for heart failure is being discharged from the hospital on 20 mg furosemide (Lasix) daily. Which of the following statements by the patient would indicate understanding of instructions for this medication?
a) I will take the Lasix in the morning
b) I will take the Lasix at bedtime
c) I will drink lots of fluids with the Lasix
d) I will take it with meals
a) I will take the Lasix in the morning
The nurse is caring for a patient receiving bumetanide (Bumex) to reduce preload for heart failure. While assessing the patient the nurse notes the patient has less ankle edema and jugular venous distention than earlier. The next dose of bumetanide is scheduled in 1 hour. Which of the following actions should the nurse take next?
a) Notify the physician
b) Hold the bumetanide
c) Give the bumetanide as scheduled
d) Give the bumetanide early
c) Give the bumetanide as scheduled
Which of the following assessments should the nurse teach the patient to perform to monitor fluid status at home?
a) Weigh daily
b) Weigh weekly
c) Weigh biweekly
d) Weigh monthly
a) Weigh daily
A 160-lb patient is to receive cyclosporine (Neoral) 12.5 mg/kg daily in two divided doses. How many milligrams will the patient receive with each dose?
454.5 mg per dose
A nurse is reinforcing discharge teaching with a client recently diagnosed with heart failure. Which of the following statements should the nurse include in the teaching?
a) Exercise at least three times per week
b) Take diuretics in the early morning and before bedtime
c) Notify the provider of a weight gain of 1 lb in 24 hr
d) Count pulse for 30 seconds and multiply by 2 before taking digoxin
a) Exercise at least three times per week
A nurse is giving a presentation about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia?
a) Furosemide (Lasix)
b) Hydrochlorothiazide (HCTZ)
c) Mannitol (Osmitrol)
d) Spironolactone (Aldactone)
d) Spironolactone (Aldactone)
A nurse is caring for a client admitted to the hospital with congestive heart failure (CHF) who has been taking digoxin (Lanoxin) 0.25 mg daily. The client refuses breakfast and reports nausea. Which of the following actions should the nurse perform first?
a) Suggest that the client rests before eating the meal
b) Request a dietitian consult
c) Check the client’s vital signs
d) Request an order for an antiemetic
c) Check the client’s vital signs
A nurse is caring for a client with right-sided heart failure. The nurse knows that a primary manifestation is:
a) frothy sputum
b) dyspnea
c) orthopnea
d) peripheral edema
d) peripheral edema
A nurse is preparing to administer digoxin (Lanoxin) to a client who has heart failure. Which of the following actions is appropriate?
a) Withholding the medication if the heart rate is above 100/min
b) Instructing the client to eat foods that are low in potassium
c) Measuring apical pulse rate for 30 seconds before administration
d) Evaluating the client for nausea, vomiting and anorexia
d) Evaluating the client for nausea, vomiting and anorexia
A nurse is caring for an older adult client who has left-sided heart failure. Which of the following findings should the nurse expect?
a) Frothy sputum
b) Dependent edema
c) Nocturnal polyuria
d) Jugular distention
a) Frothy sputum
A nurse is collecting data from a client who has left-sided heart failure. Which of the following findings should the nurse expect?
a) Jugular venous distention
b) Right upper quadrant pain
c) Pitting edema of the lower legs
d) Shortness of breath while lying down
d) Shortness of breath while lying down
A nurse is making a home visit to a client who receives diuretics daily for heart failure. Which of the following signs would the client manifest with hypokalemia?
a) Pitting edema
b) Fatigue
c) Dyspnea
d) Oliguria
b) Fatigue
A nurse is admitting a client who has acute heart failure following myocardial infarction (MI) and is reviewing provider’s orders. Which of the following prescriptions by the provider requires clarification?
a) Morphine sulfate 2 mg IV bolus every 2 hr PRN pain
b) Laboratory testing of serum potassium upon admission
c) 0.9% normal saline IV at 50 mL/hr continuous
d) Bumetanide (Bumex) 1 mg IV bolus every 12 hr
c) 0.9% normal saline IV at 50 mL/hr continous
A client with valvular heart disease is at risk for developing left-sided heart failure. The nurse knows to monitor which of the following parameters to determine if the client has developed this disorder?
a) Appetite
b) Body weight
c) Breath sounds
d) Blood pressure
c) Breath sounds
