Chapter 35: Nursing Management: Heart Failure 9th edition

Question 1

1. While assessing a 68-year-old with ascites, the nurse also notes jugular venous distention (JVD) with the head of the patients bed elevated 45 degrees. The nurse knows this finding indicates
   a. decreased fluid volume.
   b. jugular vein atherosclerosis.
   c. increased right atrial pressure.
   d. incompetent jugular vein valves.

Answer 1

increased right atrial pressure.

Question 2

2. 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. Which clinical finding is the best indicator that the treatment has been effective?
   a. Weight loss of 2 pounds in 24 hours
   b. Hourly urine output greater than 60 mL
   c. Reduction in patient complaints of chest pain
   d. Reduced dyspnea with the head of bed at 30 degrees

Answer 2

d.Reduced dyspnea with the head of bed at 30 degrees

Question 3

3. Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 33%?
   a. Need to begin an aerobic exercise program several times weekly
   b. Use of salt substitutes to replace table salt when cooking and at the table
   c. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
   d. Importance of making an annual appointment with the primary care provider

Answer 3

c.Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors

Question 4

4. IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to titrate the nitroprusside rate if the patient develops
   a. ventricular ectopy.
   b. a dry, hacking cough.
   c. a systolic BP <90 mm Hg.
   d. a heart rate <50 beats/minute.

Answer 4

a systolic BP <90 mm Hg.

Question 5

5. A patient who has chronic heart failure tells the nurse, I was 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 finding as
   a. orthopnea.
   b. pulsus alternans.
   c. paroxysmal nocturnal dyspnea.
   d. acute bilateral pleural effusion.

Answer 5

c.paroxysmal nocturnal dyspnea.

Question 6

6. During a visit to a 78-year-old with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain over the past 2 days, and complains of feeling too tired to get out of bed. Based on these data, the best nursing diagnosis for the patient is
   a. activity intolerance related to fatigue.
   b. disturbed body image related to weight gain.
   c. impaired skin integrity related to ankle edema.
   d. impaired gas exchange related to dyspnea on exertion

Answer 6

a.activity intolerance related to fatigue.

Question 7

7. The nurse working on the heart failure unit knows that teaching an older female patient with newly diagnosed heart failure is effective when the patient states that
   a. she will take furosemide (Lasix) every day at bedtime.
   b. the nitroglycerin patch is applied when any chest pain develops.
   c. she will call the clinic if her weight goes from 124 to 128 pounds in a week.
   d. an additional pillow can help her sleep if she is feeling short of breath at night.

Answer 7

she will call the clinic if her weight goes from 124 to 128 pounds in a week.

Question 8

8. When teaching the patient with newly diagnosed 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. eggs and other high-protein foods.
   d. milk, yogurt, and other milk products.

Answer 8

milk, yogurt, and other milk products.

Question 9

9. 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. limit dietary sources of potassium.
   b. take the hydrochlorothiazide before bedtime.
   c. notify the health care provider if nausea develops.
   d. skip the digoxin if the pulse is below 60 beats/minute.

Answer 9

notify the health care provider if nausea develops.

Question 10

10. While admitting an 82-year-old with acute decompensated 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 patients discharge the nurse will facilitate a
    a. consult with a psychologist.
    b. transfer to a long-term care facility.
    c. referral to a home health care agency.
    d. arrangements for around-the-clock care.

Answer 10

referral to a home health care agency.

Question 11

11. Following an acute myocardial infarction, a previously healthy 63-year-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about
    a. digitalis preparations.
    b. b-adrenergic blockers.
    c. calcium channel blockers.
    d. angiotensin-converting enzyme (ACE) inhibitors.

Answer 11

angiotensin-converting enzyme (ACE) inhibitors.

Question 12

12. A 53-year-old patient 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 most appropriate?
    a. Because you have diabetes, 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 needed.
    d. People who have heart transplants are at risk for multiple complications after surgery.

Answer 12

The choice of a patient for a heart transplant depends on many different factors.

Question 13

13. 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 troponin
    b. Arterial blood gases
    c. B-type natriuretic peptide
    d. 12-lead electrocardiogram

Answer 13

B-type natriuretic peptide

Question 14

14. Which action should 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 slowly before stopping.
    d. Teach patient about home use of the drug.

Answer 14

Monitor blood pressure frequently.

Question 15

15. 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 the drug, which statement by the patient indicates that teaching has been effective?
    a. I will be sure to take the medication with food.
    b. I will need to eat more potassium-rich foods in my diet.
    c. I will call for help when I need to get up to use the bathroom.
    d. I will expect to feel more short of breath for the next few days.

Answer 15

c.I will call for help when I need to get up to use the bathroom.

Question 16

16. A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving?
    a. Furosemide (Lasix) 60 mg
    b. Captopril (Capoten) 25 mg
    c. Digoxin (Lanoxin) 0.125 mg
    d. Carvedilol (Coreg) 3.125 mg

Answer 16

Carvedilol (Coreg) 3.125 mg

Question 17

17. 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 do first?
    a. Auscultate the abdomen.
    b. Check the capillary refill.
    c. Auscultate the breath sounds.
    d. Assess the level of orientation.

Answer 17

c.Auscultate the breath sounds.

Question 18

18. A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days. The nurses priority action will be to
    a. have the patient recall the dietary intake for the last 3 days.
    b. ask 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 restricting dietary sodium

Answer 18

assess the patient for clinical manifestations of acute heart failure.

Question 19

19. A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All of the following medications have been ordered for the patient. The nurses priority action will be to
    a. give IV morphine sulfate 4 mg.
    b. give IV diazepam (Valium) 2.5 mg.
    c. increase nitroglycerin (Tridil) infusion by 5 mcg/min.
    d. increase dopamine (Intropin) infusion by 2 mcg/kg/min.

Answer 19

give IV morphine sulfate 4 mg.

Question 20

20. After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first?
    a. A patient who is cool and clammy, with new-onset confusion and restlessness
    b. A patient who has crackles bilaterally in the lung bases and is receiving oxygen.
    c. A patient who had dizziness after receiving the first dose of captopril (Capoten)
    d. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure of 100/62

Answer 20

A patient who is cool and clammy, with new-onset confusion and restlessness

Question 21

21. Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse?
    a. Oxygen saturation of 88%
    b. Weight gain of 1 kg (2.2 lb)
    c. Heart rate of 106 beats/minute
    d. Urine output of 50 mL over 2 hours

Answer 21

a.Oxygen saturation of 88%

Question 22

22. A patient has recently started on digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for the management of heart failure. Which assessment finding by the home health nurse is a priority to communicate to the health care provider?
    a. Presence of 1 to 2+ edema in the feet and ankles
    b. Palpable liver edge 2 cm below the ribs on the right side
    c. Serum potassium level 3.0 mEq/L after 1 week of therapy
    d. Weight increase from 120 pounds to 122 pounds over 3 days

Answer 22

Serum potassium level 3.0 mEq/L after 1 week of therapy

Question 23

23. An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider?
    a. 2+ pedal edema
    b. Heart rate of 56 beats/minute
    c. Blood pressure (BP) of 88/42 mm Hg
    d. Complaints of fatigue

Answer 23

Blood pressure (BP) of 88/42 mm Hg

Question 24

24. A patient who is receiving dobutamine (Dobutrex) for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
    a. Assess the IV insertion site for signs of extravasation.
    b. Teach the patient the reasons for remaining on bed rest.
    c. Monitor the patients blood pressure and heart rate every hour.
    d. Titrate the rate to keep the systolic blood pressure >90 mm Hg.

Answer 24

Titrate the rate to keep the systolic blood pressure >90 mm Hg.

Question 25

25. After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first?
    a. Patient who is taking carvedilol (Coreg) and has a heart rate of 58
    b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L
    c. Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headache
    d. Patient who is taking captopril (Capoten) and has a frequent nonproductive cough

Answer 25

b.Patient who is taking digoxin and has a potassium level of 3.1 mEq/L

Question 26

1. Based on the Joint Commission Core Measures for patients with heart failure, which topics should the nurse include in the discharge teaching plan for a patient who has been hospitalized with chronic heart failure (select all that apply)?
   a. How to take and record daily weight
   b. Importance of limiting aerobic exercise
   c. Date and time of follow-up appointment
   d. Symptoms indicating worsening heart failure
   e. Actions and side effects of prescribed medication

Answer 26

a. How to take and record daily weight
c. Date and time of follow-up appointment

d. Symptoms indicating worsening heart failure
e. Actions and side effects of prescribed medication