HF Flashcards
A 45-year-old man is in the clinic for a routine physical examination. During the recording of his health history, the patient states that he has been having difficulty sleeping. Ill be sleeping great, and then I wake up and feel like I cant get my breath. The nurses best response to this would be:
a. When was your last electrocardiogram?
b. Its probably because its been so hot at night.
c. Do you have any history of problems with your heart?
d. Have you had a recent sinus infection or upper respiratory infection?
ANS: C
Paroxysmal nocturnal dyspnea (shortness of breath generally occurring at night) occurs with heart failure. Lying down increases the volume of intrathoracic blood, and the weakened heart cannot accommodate the increased load. Classically, the person awakens after 2 hours of sleep, arises, and flings open a window with the perception of needing fresh air
During a cardiac assessment on a 38-year-old patient in the hospital for chest pain, the nurse finds the following: jugular vein pulsations 4 cm above the sternal angle when the patient is elevated at 45 degrees, blood pressure 98/60 mm Hg, heart rate 130 beats per minute, ankle edema, difficulty breathing when supine, and an S3 on auscultation. Which of these conditions best explains the cause of these findings?
a. Fluid overload
b. Atrial septal defect
c. MI
d. Heart failure
ANS: D
Heart failure causes decreased cardiac output when the heart fails as a pump and the circulation becomes backed up and congested. Signs and symptoms include dyspnea, orthopnea, paroxysmal nocturnal dyspnea, decreased blood pressure, dependent and pitting edema; anxiety; confusion; jugular vein distention; and fatigue. The S3 is associated with heart failure and is always abnormal after 35 years of age. The S3 may be the earliest sign of heart failure.
Clinical manifestations of right-sided heart failure include
a. elevated central venous pressure and sacral edema.
b. pulmonary congestion and jugular venous distention.
c. hypertension and chest pain.
d. liver tenderness and pulmonary edema.
ANS: A
The common manifestations of right ventricular failure are the following: jugular venous distention, elevated central venous pressure, weakness, peripheral or sacral edema, hepatomegaly (enlarged liver), jaundice, and liver tenderness. Gastrointestinal symptoms include poor appetite, anorexia, nausea, and an uncomfortable feeling of fullness.
An essential aspect of teaching that may prevent recurrence of heart failure is
a. notifying the physician if a 2-lb weight gain occurs in 24 hours.
b. compliance with diuretic therapy.
c. taking nitroglycerin if chest pain occurs.
d. assessment of an apical pulse.
ANS: B
Primary topics of education include (1) the importance of a daily weight, (2) fluid restrictions, and (3) written information about the multiple medications used to control the symptoms of heart failure. Reduction or cessation of diuretics usually results in sodium and water retention, which may precipitate heart failure.
Which of the following assessment findings is most specific for acute onset of pulmonary edema?
a. Pulmonary crackles
b. Peripheral edema
c. Pink, frothy sputum
d. Elevated central venous pressure
ANS: C
Patients experiencing heart failure and pulmonary edema are extremely breathless and anxious and have a sensation of suffocation. They expectorate pink, frothy sputum and feel as if they are drowning. They may sit bolt upright, gasp for breath, or thrash about. The respiratory rate is elevated, and accessory muscles of ventilation are used, with nasal flaring and bulging neck muscles. Respirations are characterized by loud inspiratory and expiratory gurgling sounds.
Which of the following clinical manifestations are indicative of left ventricular failure? (Select all that apply.)
a. Cool, pale extremities
b. Jugular venous distention
c. Liver tenderness
d. Weak peripheral pulses
e. Rales
ANS: A, D, E
Patients presenting with left ventricular failure have one of the following: (1) decreased exercise tolerance, (2) fluid retention, or (3) discovery during examination of noncardiac problems. Clinical manifestations of left ventricular failure include decreased peripheral perfusion with weak or diminished pulses; cool, pale extremities; and, in later stages, peripheral cyanosis.
