Unit 9 - Class Activities

Question 1

Which of the following sets of conditions is an indication that the client with a history of left-sided heart failure is developing pulmonary edema?

a. Distended jugular veins and wheezing
b. Dependent edema and anorexia
c. Coarse crackles and tachycardia
d. Hypotension and tachycardia

Answer 1

c. Coarse crackles and tachycardia
* Signs of pulmonary edema are identical to those of acute heart failure. Signs and symptoms are generally apparent in the respiratory system and include coarse crackles, severe dyspnea, and tachypnea. Severe tachycardia may occur due to sympathetic stimulation in the presence of hypoxemia. Blood pressure may be decreased or elevated depending on the severity of the edema.

Jugular vein distention, dependent edema, and anorexia are symptoms of right sided heart failure.

a way to remember symptoms L eft stands for Lungs

Question 2

The major goal of therapy for a client with heart failure and pulmonary edema should be to

a. Increase cardiac output
b. Improve respiratory status
c. Decrease peripheral edema
d. Enhance comfort

Answer 2

a. Increase cardiac output
* Increasing cardiac output is the main goal of therapy for the client with heart failure or pulmonary edema. Pulmonary edema is an acute medical emergency requiring immediate intervention. Respiratory status and comfort will be improved when cardiac output increases to an acceptable level. Peripheral edema is not typically associated with pulmonary edema

Question 3

help regulate BP/fluid -levels of BNP in the blood increases as the ventricular walls expand from increased pressure, making it a helpful diagnostic, monitoring, and prognostic tool in the setting of HF.
: also called B-type natriuretic peptide & N-terminal-pro-BNP (NT-pro-BNP)

• higher the number = more severe Heart Failure

Answer 3

Brain Natriuretic Peptide (BNP)( neuro- hormone )

Question 4

Left sided Heart Failure Symptoms:

FORCED

Answer 4

F=Fatigue
O=orthopnea
R=Rales/Restlessness
C=Cyanosis/confusion
E=Extreme weakness
D=Dyspnea

Question 5

Right sided heart failure

BACONED

Answer 5

B=Bloating/ weight gain/ enlarged liver & spleen
A=Anorexia/ GI distress
C=Cyanosis/Cool legs
O=Oliguria
N=Nausea
E=Edema/ dependent
D=Distended neck veins

Question 6

A nurse is assessing a client with heart failure. The nurse should asses the client based on which compensatory mechanisms that are activated in the presence of heart failure? Select all that apply.

a. Ventricular hypertrophy
b. Parasympathetic nervous stimulation
c. Renin-angiotensin-aldosterone system
d. Jugular venous distention
e. Sympathetic nervous stimulation

Answer 6

a. Ventricular hypertrophy
c. Renin-angiotensin-aldosterone system
e. Sympathetic nervous stimulation

*When the heart begins to fail, the body activates three major compensatory systems: ventricular hypertrophy, the renin-angiotensin-aldosterone system, and sympathetic nervous stimulation.
Parasympathetic stimulation and jugular venous distention are not compensatory mechanisms associated with heart failure.

Question 7

The nursing instructor is teaching their clinical group how to assess a client for congestive heart failure. How would the instructor teach the students to assess a client with congestive heart failure for nocturnal dyspnea?

a. By collecting the client’s urine output
b. By observing the client’s diet during the day
c. By measuring the client’s abdominal girth
d. By questioning how many pillows the client normally uses for sleep

Answer 7

d. By questioning how many pillows the client normally uses for sleep

Question 8

occurs at the same time each day, typically at rest, unrelated to activity , many times at night., caused by coronary spasm , cause is unknown

Answer 8

Atypical angina (prinzmetal angina)

Question 9

most common and predictable form common manifestation of C.A.D

Answer 9

Stable angina

Question 10

First Line Therapy:

Answer 10

Beta Blockers

Change positions slowly/ orthostatic BP may be an issue, check for fatigue, dizziness, light headed )
Take every day
Take own BP and chart/ demo/ return demonstrate may lower H.R.
Hold if H.R low
Can cause hypoglycemia in DM patients
Given to patients with cardiomyopathy and cardiac dysrhythmia as well as HTN

Question 11

MONA

Answer 11

morphine
oxygen
nitrate
aspirin (ASA)

Question 12

occurs when edema fluid that has accumulated during the day and is reabsorbed into the circulation at night.

This causes fluid overload and pulmonary congestion. The client awakens at night short of breath and frightened.

Answer 12

Paroxysmal nocturnal dyspnea

Question 13

The nursing instructor is teaching their clinical group how to assess a client for congestive heart failure. How would the instructor teach the students to assess a client with congestive heart failure for nocturnal dyspnea?

a. By collecting the client’s urine output
b. By observing the client’s diet during the day
c. By measuring the client’s abdominal girth
d. By questioning how many pillows the client normally uses for sleep

Answer 13

d. By questioning how many pillows the client normally uses for sleep

Question 14

A 69 year old female has a history of heart failure. She is admitted to the emergency department with heart failure complicated by pulmonary edema. On admission of this client, which of the following should the nurse assess first?

a. Blood pressure
b. Skin breakdown
c. Serum potassium level
d. Urine output

Answer 14

a. Blood pressure
* It is a priority to assess blood pressure first because people with pulmonary edema typically experience severe hypertension that requires early intervention.. Potassium levels are not the first priority. The nurse should monitor urine output after the client is stable.

Question 15

Which of the following nursing diagnoses would be appropriate for a client with heart failure? Select all that apply.

a. Ineffective tissue perfusion related to decreased peripheral blood flow secondary to decreased cardiac output
b. Activity intolerance related to increased cardiac output
c. Decreased cardiac output related to structural and functional changes
d. Impaired gas exchange related to decreased sympathetic nervous system activity.

Answer 15

a. Ineffective tissue perfusion related to decreased peripheral blood flow secondary to decreased cardiac output
c. Decreased cardiac output related to structural and functional changes
* Heart Failure is a result of structural and functional abnormalities of the heart tissue muscle. The heart muscle becomes weak and does not adequately pump the blood out of the chambers. As a result, blood pools in the left ventricle and backs up into the left atrium and eventually into the lungs. Therefore, greater amounts of blood remain in the ventricle after contraction thereby decreasing cardiac output. In addition this pooling leads to thrombus formation and ineffective tissue perfusion because of the decrease in blood flow to the other organs and tissues of the body. Typically, these clients shave an ejection fraction of less than 50% and poorly tolerated activity. Activity intolerance is related to the decrease not increase in cardiac output. Gas exchange is impaired. However, the decrease in cardiac output triggers compensatory mechanisms, such as an increase in sympathetic nervous system activity.

Question 16

In which of the following positions should the nurse place a client with suspected heart failure?

a. Semi-sitting (low fowlers position)
b. Lying on the right side (Sims position)
c. Sitting almost upright (high fowlers positon)
d. Lying on the back with the head lowered (Trendelenburg’s positon)

Answer 16

c. Sitting almost upright (high fowlers positon)

*Sitting almost upright in bed with the feet and legs resting on the mattress decreases venous return to the heart, thus reducing myocardial workload. Also, the sitting position allows maximum space for lung expansion. A recliner works for at home clients with legs up.
Low fowlers position would be used if the client could not tolerate high fowler’s position for some reason.
Lying on the right side would not be a good position for the client in heart failure, the client in heart failure would not tolerate the Trendelenburg position.

Question 17

The nurse’s discharge teaching plan for the client with heart failure should stress the significance of which of the following?

a. Maintaining a high fiber diet
b. Walking 2 miles every day
c. Obtaining daily weights at the same time each day
d. Remaining sedentary for most of the day

Answer 17

c. Obtaining daily weights at the same time each day
* Education should focus on health promotion and preventive care in the home environment. Signs and symptoms can be monitored by the client. Instructing the client to obtain daily weights at the same time each day is very important. The client should be told to call the physician if there has been a weight gain of 2 lb. or more. This may indicate fluid overload, and treatment can be prescribed early and on an outpatient basis, rather than waiting until the symptoms become life-threatening. Following high fiber diet is beneficial, but it is not relevant to the teaching needs of the client with heart failure. Prescribing an exercise program would need to be planned in consultation with the physician and based on the history and the physical condition of the client. The client may require exercise tolerance testing before an exercise plan is laid out. Although the nurse does not prescribe an exercise program for the client a sedentary lifestyle should not be recommended

Question 18

When teaching a client with heart failure about preventing complications and future hospitalizations, which problems stated by the client as reasons to call the physician would indicate to the nurse that the client has understood the teaching? Select all that apply

a. Becoming increasingly short of breath at rest
b. Weight gain of 3 lb. or more in 1 day
c. High intake of sodium for breakfast
d. Having to sleep sitting up in a reclining chair
e. Weight loss of 2lb. in 1 day

Answer 18

a. Becoming increasingly short of breath at rest
b. Weight gain of 3 lb. or more in 1 day
d. Having to sleep sitting up in a reclining chair

Question 19

Which of the following foods should the nurse teach a client with heart failure to avoid or limit when following 2 g. sodium diet?

a. Apples
b. Tomato juice
c. Whole wheat bread
d. Beef tenderloin

Answer 19

b. Tomato juice

8Canned foods and juices such as tomato juice are typically high in sodium and should be avoided in a sodium restricted diet. Canned foods and juices in which sodium has been removed or limited are available. The client should be taught to read labels carefully. Apples and whole wheat breads are not high in sodium. Beef tenderloin would have less sodium than canned foods or tomato juice.

Question 20

A client is prescribed metoprolol for a heart disorder. What should the nurse teach the client about this medication?

a. Change positions slowly.
b. Reduce protein intake.
c. Increase fluids.
d. Expect a rapid heart rate.

Answer 20

a. Change positions slowly.
* Metoprolol is a beta blocker. The client should be instructed to use care when ambulating and to change positions slowly since this medication causes orthostatic hypotension. This medication does not cause a rapid heart rate. The client should not be instructed to increase fluids. Protein restriction is not indicated with this medication.

Question 21

A child with Congenital Heart Defects should receive _____ before any dental or invasive procedures to reduce risk of endocarditis / given as a prophylaxis.

Answer 21

antibiotics

Question 22

Tetralogy of Fallot consists of four defects

Answer 22

• pulmonic stenosis,
• right ventricular hypertrophy,
• ventricular septal defect,
• overriding aorta. ….This disease is also characterized by decreased pulmonary blood flow, and polycythemia (increased red blood cells due to hypoxia).

Question 23

During an assessment of neonate born at 33 weeks gestation, a nurse finds and reports a heart murmur. An echocardiogram reveals patent ductus arteriosus, for which the neonate received indomethacin, an expected outcome after the administration of indomethacin to neonate with patent ductus arteriosus is:

a. Closure of a patent ductus arteriosus
b. Decreased bleeding time
c. Increased Gastrointestinal function
d. Increased renal output

Answer 23

a. Closure of a patent ductus arteriosus
* The indication for the use of indomethacin is to close the patent ductus arteriosus. Adverse effects include decreased renal blood flow, platelet dysfunction with coagulation defects, decreased GI motility and an increase in necrotizing enterocolitis. Thus, increased bleeding time, decreased GI function and decreased renal output would be expected after the administration of indomethacin

Question 24

The nurse is caring for a term neonate who is diagnosed with patent ductus arteriosus. While performing a physical assessment of the neonate, the nurse anticipates that the neonate will exhibit which of the following?

a. Decreased cardiac output with faint peripheral pulses
b. Profound cyanosis over most of the body
c. Loud cardiac murmurs through systole and diastole
d. Harsh systolic murmurs with a palpable thrill

Answer 24

c. Loud cardiac murmurs through systole and diastole
* A cardiac defect marked by a failure of the patent ductus arteriosus to close completely at birth, blood from the aorta flow into the pulmonary arteries to be deoxygenated in the lungs and returned to the left atrium and ventricle. : It includes increased workload on the left side of the heart and increased pulmonary vascular congestion. Term infants are commonly asymptomatic but loud machinery like murmur may be hard throughout systole and diastole. It may be accompanied by a suprasternal thrill and the heart may be enlarged

Question 25

Cardiac catheterization has shown that the infant has a malformation of the mitral valve. The nurse specifically monitors the client for the development of problems associated with delivery of which of the following?

a. Oxygenated blood to the body
b. Deoxygenated blood to the lung
c. Oxygenated blood to the right atrium
d. Deoxygenated blood to the left ventricle

Answer 25

a. Oxygenated blood to the body
* The mitral valve separates the left ventricle from the left atrium. Problems with this valve will impede flow of oxygenated blood from the left atrium into the left ventricle for delivery to the body. The pulmonic valve separates the right ventricle from the pulmonary artery. Problems with this valve would impede delivery of deoxygenated blood back to the lung. The blood that returns to the right atrium is deoxygenated. The blood delivered to the left ventricle is oxygenated

Question 26

After the physician explains the prognosis and medical management for atrial septal ( ASD) defect to a primipara client whose 2 day old female neonate was diagnosed with this condition, the nurse determines that the mother needs further instructions when she says which of the following?

a. “As my child grow, she may have increased fatigue and difficulty breathing.”
b. “My child may need to have antibiotics only if she develops an infection.”
c. “This condition occurs more commonly in females than in males “
d. “About half of the children born with this defect heal
spontaneously”

Answer 26

b. “My child may need to have antibiotics only if she develops an infection.”
* A child with atrial septal defect will be monitored by a cardiologist. Nonsurgical closure may be attempted via cardiac catheterization. Surgical closure, using either a prosthetic patch or sutures is performed on elective basis early in childhood. This account for approximately 10% or more of all congenital heart disease and is seen in more female than male neonates. As the child grows they may experience fatigue and dyspnea on exertion. A large defect may result in congestive heart failure if the lesion is unrepaired

Question 27

The nurse is planning care for a pediatric client recovering from surgery to repair a congenital heart defect. Which intervention should the nurse include to support the client’s fluid status?

a. Maintain intravenous therapy until day before discharge.
b. Limit fluids.
c. Monitor output.
d. Encourage fluids.

Answer 27

d. Encourage fluids.
* The child should be encouraged to begin oral fluids and nutrition when permitted. Although oral fluids are rarely limited, intake and output should be carefully assessed. Fluids and antibiotics should be provided as ordered until the child’s oral intake is normal. Once normal, the line can be converted to a heparin or saline lock. Both intake and output should be monitored.

Question 28

An infant is being prepared for surgical repair of a ventricular septal defect (VSD. Which of the following problems will be prevented by closing the defect?

a. Failure to Thrive
b. Ventricular dysrhythmias
c. Heart Block
d. Respiratory Alkalosis

Answer 28

a. Failure to Thrive

*Ventricular septal defect is one of the most common congenital (present from birth) heart defects. It may occur by itself or with other congenital diseases. The most common symptoms include: Shortness of breath, Fast/ difficult breathing, Paleness, Fast heart rate, Sweating while feeding, Frequent respiratory infections and Failure to Thrive ( GAIN Weight).
Antibiotics may be recommended for life when dental work is given With VSD and other congenital heart conditions as well as adult related issues of: Mitral valve prolapse, Rheumatic heart disease, Bicuspid valve disease, Calcified aortic stenosis: But these recommendation may be changing soon