Lewis Chapter 37: Heart Failure

Question 1

What are the manifestations of HFrEF that the nurse should recognize?

a. ↓ Afterload and ↓ left ventricular end-diastolic pressure (LVEDP)

b. ↓ Ejection fraction (EF) and ↑ pulmonary artery occlusive pressure (PAOP)

c. ↓ PAOP and ↑ left ventricular EF

d. ↑ Pulmonary hypertension associated with normal EF

Answer 1

B.

Question 2

Which compensatory mechanism leads to inappropriate sodium and fluid retention?

a. Ventricular dilation

b. Ventricular hypertrophy

c. Neurohormonal response

d. Sympathetic nervous system activation

Answer 2

C.

Question 3

Which medication used in the management of a client with acute pulmonary edema will decrease both preload and afterload and provide relief of anxiety?

a. Morphine

b. Amiodarone

c. Dobutamine

d. Aminophylline

Answer 3

A.

Question 4

How can a client with chronic HF best decrease the chances of having an acute decompensation?

a. Resting and not making any exertions except under medical supervision

b. Documenting fluid intake and urinary output each day

c. Monitoring weight daily and reporting changes outside of recommended parameters

d. Taking extra furosemide when shortness of breath occurs

Answer 4

C.

Question 5

Clients with a heart transplant are at risk for which complications in the first year after transplantation? (Select all that apply.)

a. Cancer

b. Infection

c. Rejection

d. Vasculopathy

e. Sudden cardiac death

Answer 5

B, C, E.

Question 6

Which characteristic is associated with heart failure (HF)?

A. Ventricular dysfunction

B. Preload deficits

C. Impaired valve functions

D. Pulmonary embolism

Answer 6

A. Ventricular dysfunction

HF is characterized by ventricular dysfunction. The event may be acute or chronic. Other features of HF include reduced exercise tolerance, decreased quality of life, and shorter life expectancy.

Question 7

Which factor primarily puts an individual at risk for heart failure (HF)?

A. Hyperlipidemia

B. Tobacco smoking

C. Obesity

D. Hypertension

Answer 7

D. Hypertension

Hypertension is a primary risk factor for HF. Other risk factors include smoking, obesity, and high serum cholesterol levels.

Question 8

Which compensatory mechanism is initially triggered in cardiac stress?

A. Sympathetic nervous system activation

B. Ventricular hypertrophy

C. Neurohormonal responses

D. Ventricular dilation

Answer 8

A. Sympathetic nervous system activation

Sympathetic nervous system activation is often the first compensatory mechanism triggered in low cardiac output states.

Question 9

Which condition is considered a causative factor in right-sided heart failure (HF)?

A. Biventricular failure

B. Pulmonary edema

C. Left-sided heart failure

D. Cor pulmonale

Answer 9

C. Left-sided heart failure

The primary cause of right-sided HF is left-sided HF. Left-sided failure results in pulmonary congestion and increased pressure in the blood vessels of the lungs (pulmonary hypertension).

Question 10

Which condition is a common cause of pulmonary edema?

A. Left ventricular failure

B. Right ventricular failure

C. Atrial fibrillation

D. Cyanosis

Answer 10

A. Left ventricular failure

The most common cause of pulmonary edema is acute left ventricular failure, secondary to acute myocardial infarction. There is an abnormal, life-threatening accumulation of fluid in the alveoli and interstitial spaces of the lungs.

Question 11

Which underlying disease is common in heart failure (HF)?

A. Peripheral venous distension

B. Renal failure

C. Coronary artery disease

D. Distal neuropathy

Answer 11

C. Coronary artery disease

Coronary artery disease is one of the primary risk factors for HF.

Question 12

Which term describes the most common form of heart failure (HF)?

A. HF with reduced ejection fraction (HFrEF)

B. HF with preserved ejection fraction (HFpEF)

C. HF with mid-range ejection fraction (HFmEF)

D. Mixed HF

Answer 12

A. HF with reduced ejection fraction (HFrEF)

HFrEF results from an inability of the heart to pump blood effectively and is the most common form of HF.

Question 13

Which characteristic of heart failure is associated with malfunctioning of the left ventricle?

A. Hepatomegaly

B. Peripheral edema

C. Pulmonary edema

D. Jugular venous distension (JVD)

Answer 13

C. Pulmonary edema

Malfunction of the left ventricle leads to increased pulmonary pressure, which causes fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli. This is manifested as pulmonary congestion and edema.

Question 14

Which cause of pulmonary edema accompanies heart failure (HF)?

A. Pulmonary hypertension

B. Acute left ventricular failure

C. Acute myocardial infarction (AMI)

D. Pulmonary embolism

Answer 14

B. Acute left ventricular failure

The most common cause of pulmonary edema is acute left ventricular failure.

Question 15

Which symptom of chronic heart failure (HF) is an early sign of the disease?

A. Dyspnea

B. Ventricular remodelling

C. Cardiac myopathy

D. Biventricular failure

Answer 15

A. Dyspnea

Dyspnea is an early sign of HF; it can occur at rest or with mild exertion and occurs due to ventricles not pumping efficiently.

Question 16

Which effect do diuretics have on left ventricular function?

A. Improve cardiac output (CO)

B. Increase venous return

C. Increase afterload

D. Increase intravascular volume

Answer 16

A. Improve cardiac output (CO)

Diuretics decrease venous return to the left ventricle, reducing preload and improving CO.

Question 17

Which benefit does decreasing afterload have on heart failure?

A. Increases myocardial oxygen

B. Dilates cardiac arteries

C. Reduces pulmonary congestion

D. Increases intravascular fluid

Answer 17

C. Reduces pulmonary congestion

Afterload is the resistance against which the left ventricle must pump. If afterload is reduced, the cardiac output improves and pulmonary congestion thereby decreases.

Question 18

Which class of drugs improves cardiac contractility?

A. Diuretics

B. Inotropics

C. Antihypertensives

D. Vasodilators

Answer 18

B. Inotropics

Inotropic medications (e.g., dobutamine, milrinone) increase myocardial contractility without increasing oxygen consumption.

Question 19

Which teaching point would the nurse include when providing education to a patient with heart failure (HF)?

A. Using oxygen if saturations fall below 80%

B. Monitoring PaCO2 at home

C. Detecting late signs and symptoms

D. Continuing to exercise

Answer 19

D. Continuing to exercise

Regular activity and exercise periods should be prescribed for all patients with stable chronic HF.

Question 20

Which intervention would the nurse initiate when caring for a patient with a PaO2 of 90% who reports fatigue, dyspnea, and difficulty moving around?

A. Ambulation

B. Oxygen therapy

C. Teaching about end-of-life care

D. Teaching on the risk factors for heart failure (HF)

Answer 20

B. Oxygen therapy

Treatment for HF includes oxygen therapy if indicated. A patient experiencing fatigue and dyspnea with a PaO2 of below 90% would require oxygen therapy.

Question 21

Which phrase describes ventricular assist devices (VADs)?

A. Offers mechanical circulatory support

B. Can replace cardiac resynchronization therapy (CRT)

C. Ability to cardiovert and defibrillate the ventricles

D. Used for life-threatening dysrhythmias

Answer 21

A. Offers mechanical circulatory support

VADs are a mechanical circulatory support device. These devices sustain patients with HF in deteriorating conditions, especially those awaiting cardiac transplantation.

Question 22

Which type of diuretic is the first choice for chronic heart failure (HF)?

A. Potassium sparing

B. Loop

C. Thiazide

D. Osmotic

Answer 22

C. Thiazide

Thiazide diuretics may be the first choice for chronic HF because of their convenience, safety, low cost, and effectiveness. They are particularly useful in treating edema secondary to HF and in controlling hypertension.

Question 23

Which type of medication is used as first-line therapy for heart failure (HF)?

A. Angiotensin-converting enzyme (ACE) inhibitors

B. Neprilysin

C. β-Adrenergic blockers

D. Spironolactone

Answer 23

A. Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors are the first-line therapy for the treatment of HF. Because cardiac output (CO) is dependent on afterload in chronic HF, the reduction in systemic vascular resistance seen with the use of ACE inhibitors produces a significant increase in CO.

Question 24

Which statement describes an overall goal for a patient with heart failure (HF)?

A. Eliminate shortness of breath episodes

B. Have no complications related to HF

C. Have no adverse medication effects

D. Live without pain

Answer 24

B. Have no complications related to HF

The overall goal is that the patient with HF will have no complications related to HF.

Question 25

Which response by the nurse is best when a patient questions the necessity of testing for a methicillin-resistant Staphylococcus aureus (MRSA) infection?

A. “This is a preventive measure and part of routine care.”

B. “Any active infection would disqualify you as a donor recipient.”

C. “If positive, you would need treatment for MRSA infection before the procedure.”

D. “There are too many risk factors involved with performing transplantation on a person with an active MRSA infection.”

Answer 25

B. “Any active infection would disqualify you as a donor recipient.”

Because an active infection, including MRSA infection, is an absolute contraindication for heart transplantation, the nurse’s best response is to explain the necessity of MRSA testing prior to heart transplantation.

Question 26

Which nursing action can improve gas exchange, thereby improving cardiac output, in chronic heart failure?

A. Administering IV morphine

B. Reducing oxygen saturation

C. Using supplemental oxygen at all times

D. Increasing respiratory efforts

Answer 26

A. Administering IV morphine

IV morphine reduces preload and afterload and decreases myocardial oxygen demands, thereby improving cardiac output.

Question 27

Administering intravenous Lasix as prescribed has which benefit for a patient with heart failure?

A. Increases venous return

B. Decreases intravascular volume

C. Improves gas exchange

D. Decreases cardiac contractility

Answer 27

B. Decreases intravascular volume

Lasix is a potent diuretic that decreases venous return by decreasing intravascular volume. Decreasing venous return (preload) reduces the amount of volume returned to the left ventricle during diastole, improving cardiac output.

Question 28

Which nursing action is a priority when caring for a patient with heart failure (HF) who becomes significantly tachycardic and tachypneic when discussing their condition?

A. Providing education on HF

B. Teaching relaxation techniques

C. Administering supplemental oxygen

D. Placing the patient on strict bed rest

Answer 28

B. Teaching relaxation techniques

Reduction of anxiety is an important nursing function, especially for a patient who is clearly anxious about the condition.

Question 29

Which intervention would the nurse anticipate being ordered for a patient with heart failure (HF) who is currently in Fowler’s position on mechanical ventilation, experiencing significant volume overload, dyspnea, and pulmonary edema?

A. Treating with ultrafiltration

B. Monitoring

C. Repositioning

D. Administering vasopressors

Answer 29

A. Treating with ultrafiltration

The patient should be treated with ultrafiltration to rapidly remove intravascular fluid volume while maintaining hemodynamic stability.

Question 30

Which statement describes a goal of treating heart failure (HF)?

A. Eliminate symptoms.

B. Prevent adverse effects to treatments.

C. Increase the cardiac workload.

D. Prolong survival.

Answer 30

D. Prolong survival.

The aim of treating HF is to prolong survival.

Question 31

Which group of medications is reserved for patients in cardiogenic shock?

A. Inotropics

B. Angiotensin-converting enzyme (ACE) inhibitors

C. Diuretics

D. Vasodilators

Answer 31

A. Inotropics

Inotropic drugs are reserved to treat unstable patients with reduced ejection fraction. Their use is confined to patients in cardiogenic shock.

Question 32

Which nutritional program are patients with heart failure (HF) generally advised to follow?

A. Weight Watchers diet

B. Diabetic diet

C. Low-fat diet

D. Dietary approach to stop hypertension (DASH)

Answer 32

D. Dietary approach to stop hypertension (DASH)

The DASH diet is effective as first-line nutritional therapy for patients with systolic hypertension. Diet education and weight management are critical in the control of HF.

Question 33

When caring for a patient at a 6-month evaluation following heart transplantation surgery, which assessment finding would require immediate follow-up?

A. Trace pedal edema

B. Enlarged lymph node

C. Occasional coughing

D. Approximated incision

Answer 33

B. Enlarged lymph node

An enlarged lymph node is an abnormal finding and would require immediate follow-up in a heart transplantation patient. Immunosuppressive therapy is prescribed to prevent rejection of the transplanted heart, but it could result in increased risk for cancer or infection.

Question 34

When caring for a patient who is next on the transplantation list and is waiting at the hospital for a donor heart to become available, which statement by the patient indicates the need for additional teaching?

A. “I am so depressed. There’s no telling when a heart will be available.”

B. “My family and I are close enough that we don’t believe we need to go to a heart transplantation support group.”

C. “My wife is nervous about the amount of medication I will have to take after surgery, so she bought me a medication organizer.”

D. “I’m going home to wait since I only live about 2 hours’ drive from the hospital.”

Answer 34

D. “I’m going home to wait since I only live about 2 hours’ drive from the hospital.”

Because the new heart must be transplanted within 4 hours after removal from the donor, the patient’s statement about going home now is concerning, because most transplantation centres require patients to arrive within 2 hours from notification. Although this patient lives about 2 hours from the hospital, this does not take into account the possibility of traffic or another reason that travel time may be extended.