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NUR 170 MED SURG > UNIT 6 HEART FAILURE CHAPTER 32 > Flashcards

UNIT 6 HEART FAILURE CHAPTER 32 Flashcards

1
Q

What is heart failure?

A

Heart failure , also called pump failure, is a general term for the inability of the heart to work effectively as a pump. It results from a number of acute and chronic cardiovascular problems that are discussed in this chapter and within the cardiovascular unit.

Both acute and chronic HF can be life threatening if they are not adequately treated or if the patient does not respond to treatment.

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2
Q

What are the different types of heart failure?

A

left-sided and right sided

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3
Q

What is the purpose of the heart?

A
  • The purpose of the heart is to carry necessary supplies out to the
    tissues.
  • There are components
  • The pump
  • The electrical system
  • The vascular system
  • The blood volume
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4
Q

Right-sided heart failure

A

Right-sided heart (ventricular) failure may be caused by left ventricular failure, right ventricular myocardial infarction (MI), or pulmonary hypertension. In this type of heart failure (HF), the right ventricle cannot empty completely. Increased volume and pressure develop in the venous system, and peripheral edema results.

Signs of systemic congestion occur as the right ventricle fails, fluid is retained, and pressure builds in the venous system. Edema develops in the lower legs and may progress to the thighs and abdominal wall. Patients may notice that their shoes fit more tightly, or their shoes or socks may leave indentations on their swollen feet. They may have removed their rings because of swelling in their fingers and hands. Ask about weight gain. An adult may retain 4 to 7 L of fluid (10 to 15 lb [4.5 to 6.8 kg]) before pi ing edema occurs.

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5
Q

Left-sided heart failure

A

. Typical causes of left-sided heart (ventricular) failure include hypertension, coronary artery disease, and valvular disease. Decreased tissue perfusion from poor cardiac output and pulmonary congestion from increased pressure in the pulmonary vessels indicate left ventricular failure (LVF).

As the amount of blood ejected from the left ventricle diminishes, hydrostatic pressure builds in the pulmonary venous system and results in fluid-filled alveoli and pulmonary congestion, which results in a cough. The patient in early HF describes the cough as irritating, nocturnal (at night), and usually nonproductive. As HF becomes very severe, he or she may begin expectorating frothy, pink-tinged sputum—a sign of life-threatening pulmonary edema.

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6
Q

Risk Factors of Heart Failure? Name 3

A

Heart failure (HF) is caused by systemic hypertension in most cases. Some patients experiencing myocardial infarction (MI, “heart a ack”) also develop HF. T
he next most common cause is structural heart changes, such as valvular dysfunction, particularly pulmonic or aortic stenosis, which leads to pressure or volume overload on the heart.

  • Hypertension
  • Coronary artery disease
  • Cardiomyopathy
  • Substance abuse (alcohol and illicit/prescribed drugs)
  • Valvular disease
  • Congenital defects
  • Cardiac infections and inflammations
  • Dysrhythmias
  • Diabetes mellitus
  • Smoking/tobacco use
  • Family history
  • Obesity
  • Severe lung disease
  • Sleep apnea
  • Hyperkinetic conditions (e.g., hyperthyroidism)
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7
Q

S/S of left sided heart failure

A
  • Weakness
  • Fatigue
  • Dizziness
  • Acute confusion
  • Pulmonary congestion * Breathlessness
  • Oliguria (scant urine output)
    -crackles in both lungs
    -wheezes in lungs
    -tachypnea
    -tachycardia
    -S3 gallop
    -frothy, pink-tinged sputum
    -hacking cough, worse at night
    -pallor
    -pulmonary edema
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8
Q

A client is diagnosed with left-sided heart failure. Which client assessment findings will the nurse anticipate? Select all that apply.
A. Peripheral edema
B. Crackles in both lungs
C. Tachycardia
D. Ascites
E. Tachypnea
F. S3 gallop

A

B. Crackles in both lungs
C. Tachycardia
E. Tachypnea
F. S3 gallop

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9
Q

S/S of right-sided heart failure

A
  • Systemic congestion
  • Jugular (neck vein) distention (JVD_
  • Enlarged liver and spleen (Hepatomegaly) (Splenomegaly)
  • Anorexia and nausea
  • Dependent edema (legs and sacrum)
  • Distended abdomen
  • Swollen hands and fingers
  • Polyuria at night
  • Weight gain
  • Increased blood pressure (from excess volume) or decreased blood pressure (from failure)
    -bounding pulse
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10
Q

What is the best indicator of weight loss or weight gain with a patient with right-sided heart failure?

A. weighing them in the morning with the same clothes before breakfast.
B. assessing the degree of their edema
C. restricting free fluids
D. monitoring intake and output

A

A. weighing them in the morning with the same clothes before breakfast.

Edema is an extremely unreliable sign of HF. Be sure that accurate daily weights are taken to document fluid retention. Assessing weight at the same time of the morning using the same scale is important. Weight is the most reliable indicator of fluid gain and loss!

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11
Q

What are some of patient centered goals for a patient with heart failure?

A
  • Improve Perfusion and Cardiac Output
  • Increased gas exchange in lungs and tissues
  • Decrease complications such as pulmonary edema and peripheral
    edema
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12
Q

The nurse is caring for a client with heart failure who is prescribed spironolactone. Which client statement requires further nursing education?
A. “I may need to take this drug every other day according to lab values.”
B. “I need to take potassium supplements with this medication.”
C. “I will try my best not to use table salt on my food.”
D. “This medication will cause me to urinate more often.”

A

B. “I need to take potassium supplements with this medication.”

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13
Q
  1. The nurse is caring for a client with heart failure who is on oxygen at 2 L per nasal cannula with an oxygen saturation of 90%. The client states, “I feel short of breath.” Which action will the nurse take first?
    A. Contact respiratory therapy.
    B. Increase the oxygen to 4 L.
    C. Place the client in a high-Fowler position.
    D. Draw arterial blood for arterial blood gas analysis.
A

C. Place the client in a high-Fowler position.

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14
Q

Which of the following body systems are correct when a patient is experiencing heart failure?

A. Antidiuretic hormone increased
B. bradycardia
C.bradypnea
D. perfusion is intact

A

A. Antidiuretic hormone increased

COMPENSATORY MECHANISMS OF HEART FAILURE
Sympathetic nervous system stimulation (fight/flight)
* Renin-angiotensin system activation
* Chemical responses (BNP)
* Hypertrophy

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15
Q

Chronic Heart Failure: Clinical
Manifestations

A

F - fatigue
A - limitation of activities
C - chest congestion & cough
E - edema
S - shortness of breathe

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16
Q

Heart Failure Diagnostic/Labs that are needed?

A

Pump – heart failure
* Additional diagnosis:
* Electrolytes (always monitor electrolytes with fluid imbalance)
* Kidney function (always monitor kidneys with fluid imbalance)
* I’s and O’s (always monitor I’s and O’s with fluid imbalance)
* BNP (A BNP is always assessed to rule in/rule out and monitor heart failure) USED TO DETERMINE HEART FAILURE
* Urinalysis
* EKG
* ABG

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17
Q
  1. A client with a history of type 2 diabetes is admitted to the hospital with chest pain and scheduled for a cardiac catheterization. Which medication would need to be withheld for 24 hours before the proce- dure and for 48 hours after the procedure?
  2. Glipizide
  3. Metformin
  4. Repaglinide
  5. Regular insulin
A
  1. Metformin

Rationale: Metformin needs to be withheld 24 hours before and for 48 hours after cardiac catheterization because of the injection of contrast medium during the procedure. If the con- trast medium affects kidney function, with metformin in the system the client would be at increased risk for lactic acidosis. The medications in the remaining options do not need to be withheld before and after cardiac catheterization.

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18
Q
  1. A client with myocardial infarction suddenly be- comes tachycardic, shows signs of air hunger, and begins coughing frothy, pink-tinged sputum. Which finding would the nurse anticipate when auscultating- ing the client’s breath sounds?
  2. Stridor
  3. Crackles
  4. Scattered rhonchi
  5. Diminished breath sounds
A
  1. Crackles

Rationale: Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of frothy, pink-tinged sputum. Auscultation of the lungs reveals crackles. Rhonchi and diminished breath sounds are not asso- ciated with pulmonary edema. Stridor is a crowing sound associated with laryngospasm or edema of the upper airway. Test-Taking Strategy: Focus on the subject, breath sounds characteristic of pulmonary edema. Recalling that fluid pro- duces sounds that are called crackles will assist you in eliminat- ing the incorrect options.

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19
Q
  1. While assessing a client on a cardiac unit, a nurse identifies the presence of an S3 gallop. What action would the nurse take next?
    a. Assess for symptoms of left-sided heart failure.
    b. Document this as a normal finding.
    c. Call the primary health care provider immediately.
    d. Transfer the client to the intensive care unit.
A

a. Assess for symptoms of left-sided heart failure.

ANS: A
The presence of an S3 gallop is an early diastolic filling sound indicative of increasing left ventricular pressure and left ventricular failure. The other actions are not warranted.

20
Q
  1. A nurse cares for a client with right-sided heart failure. The client asks, Why do I need to weigh myself every day? How would the nurse respond?
    a. Weight is the best indication that you are gaining or losing fluid.
    b. Daily weights will help us make sure that you are eating properly.
    c. The hospital requires that all clients be weighed daily.
    d. You need to lose weight to decrease the incidence of heart failure.
A

ANS: A
Daily weights are needed to document fluid retention or fluid loss. One liter of fluid equals 2.2 lb (1 kg). Weight changes are the most reliable indicator of fluid loss or gain. The other responses do not address the importance of monitoring fluid retention or loss.

21
Q
  1. A nurse teaches a client who has a history of heart failure. Which statement would the nurse include in this client’S discharge teaching?
    a. Avoid drinking more than 3 quarts (3 L) of liquids each day.
    b.Eat six small meals daily instead of three larger meals.
    c. When you feel short of breath, take an additional diuretic.
    d. Weigh yourself daily while wearing the same amount of clothing.
A

ANS: D
Clients with heart failure are instructed to weigh themselves daily to detect worsening heart failure early, and thus avoid complications. Other signs of worsening heart failure include increasing dyspnea, exercise intolerance, cold symptoms, and nocturia. Fluid overload increases symptoms of heart failure. The client would be taught to eat a heart-healthy diet, balance intake and output to prevent dehydration and overload, and take medications as prescribed. The most important discharge teaching is daily weights as this provides the best data related to fluid retention.

22
Q

Nursing Intervention for Dyspnea

A

Provide the necessary amount of supplemental oxygen within a range prescribed by the health care provider to maintain oxygen saturation at 90% or greater. If the patient has dyspnea, place in a high-Fowler’s position with pillows under each arm to maximize chest expansion and improve gas exchange. Repositioning and performing coughing and deep- breathing exercises every 2 hours helps to improve gas exchange and prevents atelectasis. Interprofessional collaboration with the respiratory therapist is important to plan the most effective methods for assisting with ventilation.

23
Q

Is weighing a pt that has heart failure essential

A

YES

Weigh the patient daily or delegate this activity to UAP and supervise that it is done. Keep in mind that 1 kg of weight gain or loss equals 1 L of retained or lost fluid. The same scale should be used every morning before breakfast for the most accurate assessment of weight. Monitor for an expected decrease in weight because excess fluid is excreted from the body.

24
Q

A patient who is taking lisinopril for heart failure, has recently been experiencing a nonproductive cough, What drug does the nurse anticipate the doctor to order to replace this medication?

A. Phenelizine
B. Diazepam
C. Clopidrel
D. Valsartan

A

D. Valsartan

ARBs are also effective and can be used as an initial agent for those who do not tolerate ACE inhibitors, usually due to a nagging dry cough. For patients with acute HF, the health care provider may prescribe an IV-push ACE inhibitor such as Vasotec IV.

25
Q
  1. Which of the following is a common side effect of Spironolactone?*
    A. Renal failure
    B. Hyperkalemia
    C. Hypokalemia
    D. Dry cough
A

B. Hyperkalemia

26
Q

what is BNP (B-Type Natriuretic Peptide Hormone) used to indicate?

A

HEART FAILURE

< 100 pg/mL: no heart failure (HF)
>100-300 pg/mL: HF present >
300 pg/mL: mild HF
> 600 pg/mL: moderate HF
> 900 pg/mL: severe HF

27
Q
  1. A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition?
    A. “Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain.”
    B. “It is important to monitor your daily weights, fluid and salt intake.”
    C. “Left-sided heart failure can lead to right-sided heart failure, if left untreated.”
    D. “This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema.”
A

Option D is the answer. This is a description of right-sided heart failure NOT left ventricular systolic dysfunction. Left-sided systolic dysfunction is where the left side of the heart is unable to CONTRACT efficiently which causes blood to back-up into the lungs…leading to pulmonary edema.

28
Q
  1. Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-apply:
    A. Jugular venous distention
    B. Persistent cough
    C. Weight gain
    D. Crackles
    E. Nocturia
    F. Orthopnea
A

The answers are B, D, and F. Persistent cough, crackles (also called rales), and orthopnea are signs and symptoms of LEFT-sided heart failure…not right-sided heart failure.

29
Q
  1. A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention?
    A. Encourage the patient to cough and deep breathe.
    B. Place the patient in Semi-Fowler’s position.
    C. Assist the patient into High Fowler’s position.
    D. Perform chest percussion therapy.
A

The answer is C. Due to the patient being in fluid overload (especially with left-sided heart failure…remember the lungs are majorly affected in this type of heart failure), it is most appropriate to place the patient in High Fowler’s position to help make breathing easie

30
Q
  1. You’re providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching?
    A. “I will limit my sodium intake to 5-6 grams a day.”
    B. “I will be sure to incorporate canned vegetables and fish into my diet.”
    C. “I’m glad I can still eat sandwiches because I love bologna and cheese sandwiches.”
    D. “I will limit my consumption of frozen meals.”
A

The answer is D. Patients with heart failure should limit sodium intake to 2 to 3 grams per day (not 5-6 grams), avoid canned vegetable/fish, and avoid sandwich meats and cheeses because of their high sodium content. Frozen meals are high in sodium, therefore the patient is correct in saying they should limit their consumption of them.

31
Q
  1. Which of the following is a late sign of heart failure?
    A. Shortness of breath
    B. Orthopnea
    C. Edema
    D. Frothy-blood tinged sputum
A

The answer is D. Shortness of breath, orthopnea, and edema are EARLY signs and symptoms. Frothy-blood tinged sputum is a late sign.

32
Q
  1. These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes?
    A. Beta-blockers
    B. Vasodilators
    C. Angiotensin II receptor blockers
    D. Angiotensin-converting-enzyme inhibitors
A

The answer is D. This is a description of ACE inhibitors (option D).

33
Q
  1. A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves. Which of the following lab results confirms these findings?
    A. Na+ 135
    B. BNP 560
    C. K+ 8.0
    D. K+ 1.5
A

The answer is C. Losartan and Spironolactone can both cause an increased potassium level (hyperkalemia). Losartan is an ARB and Spironolactone is a potassium-sparing diuretic. Therefore, the EKG changes are a sign of a high potassium level (normal potassium level is 3.5-5.1).

34
Q
  1. During your morning assessment of a patient with heart failure, the patient complains of sudden vision changes that include seeing yellowish-green halos around the lights. Which of the following medications do you suspect is causing this issue?
    A. Lisinopril
    B. Losartan
    C. Lasix
    D. Digoxin
A

The answer is D. Yellowish-green halos/vision changes are classic signs of Digoxin toxicity.

35
Q
  1. You are assisting a patient up from the bed to the bathroom. The patient has swelling in the feet and legs. The patient is receiving treatment for heart failure and is taking Hydralazine and Isordil. Which of the following is a nursing priority for this patient while assisting them to the bathroom?
    A. Measure and record the urine voided.
    B. Assist the patient up slowing and gradually.
    C. Place the call light in the patient’s reach while in the bathroom.
    D. Provide privacy for the patient.
A

The answer is B. The best answer for this particular question is option B. All the options are important for the nurse to perform. However, Hydralazine (vasodilator) and Isordil (nitrate) can cause orthostatic hypotension. The patient should transfer slowly and gradually to decrease dizziness and the risk of falling.

36
Q
  1. A patient is taking Digoxin. Prior to administration you check the patient’s apical pulse and find it to be 61 bpm. Morning lab values are the following: K+ 3.3 and Digoxin level of 5 ng/mL. Which of the following is the correct nursing action?
    A. Hold this dose and administer the second dose at 1800.
    B. Administer the dose as ordered.
    C. Hold the dose and notify the physician of the digoxin level.
    D. Hold this dose until the patient’s potassium level is normal.
A

The answer is C. The patient is Digoxin toxic. A normal Digoxin level is <2 ng/mL. Therefore, the nurse should not administer the dose but hold it and notify the doctor for further orders.

37
Q
  1. Which of the following is a common side effect of Spironolactone?
    A. Renal failure
    B. Hyperkalemia
    C. Hypokalemia
    D. Dry cough
A

The answer is B. Spironolactone is potassium-sparing. Therefore, it can increase the potassium level (hyperkalemia).

38
Q
  1. The physician’s order says to administered Lasix 40 mg IV twice a day. The patient has the following morning labs: Na+ 148, BNP 900, K+ 2.0, and BUN 10. Which of the following is a nursing priority?
    A. Administer the Lasix as ordered
    B. Notify the physician of the BNP level
    C. Assess the patient for edema
    D. Hold the dose and notify the physician about the potassium level
A

The answer is D. Lasix is a diuretic that wastes potassium. A normal potassium level is 3.5-5.1. The nurse should hold the dose and notify the physician who will order a potassium supplement to replace the potassium deficient.

39
Q

After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of crackles in the lungs?

A. Left-sided heart failure
B. Pulmonic valve malfunction
C. Right-sided heart failure
D. Tricuspid valve malfunction

A

Correct Answer: A. Left-sided heart failure

40
Q

Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation?

A. Beta-adrenergic blockers
B. Calcium channel blockers
C. Narcotics
D. Nitrates

A

A. Beta-adrenergic blockers

41
Q

With which of the following disorders is jugular vein distention most prominent?

A. Abdominal aortic aneurysm
B. Heart failure
C. MI
D. Pneumothorax

A

B. Heart failure

42
Q

Toxicity from which of the following medications may cause a client to see a green-yellow halo around lights?

A. digoxin (Lanoxin)
B. furosemide (Lasix)
C. metoprolol (Lopressor)
D. enalapril (Vasotec)

A

A. digoxin (Lanoxin)

43
Q

Which of the following symptoms is most commonly associated with left-sided heart failure?

A. Crackles
B. Arrhythmias
C. Hepatic engorgement
D. Hypotension

A

A. Crackles

44
Q

In which of the following disorders would the nurse expect to assess sacral edema in a bedridden client?

A. Diabetes
B. Pulmonary emboli
C. Renal failure
D. Right-sided heart failure

A

D. Right-sided heart failure

45
Q

Which of the following symptoms might a client with right-sided heart failure exhibit?

A. Adequate urine output
B. Polyuria
C. Oliguria
D. Polydipsia

A

C. Oliguria

46
Q

Stimulation of the sympathetic nervous system produces which of the following responses?

A. Bradycardia
B. Tachycardia
C. Hypotension
D. Decreased myocardial contractility

A

B. Tachycardia

47
Q

WHAT FOODS ARE HIGH IN POTASSIUM

A

Fish, excluding shellfish; whole grains, nuts, broccoli, cabbage, carrots celery, cucumbers, potatoes with skins, spinach, tomatoes, apricots, bananas, cantaloupe, nectarines, oranges, tangerines

NUR 170 MED SURG (46 decks)

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