Question 1

Which IV medication will the nurse expect to administer to a patient who has ADHF,to increase stroke volume?

Accepted Answer

Dobutamine is a beta-1 adrenergic agonist that helps increase cardiac output and stroke volume. It has positive inotropic effects and can improve the contractility of the heart muscle. Milrinone and Nesiritide are also used in ADHF, but they have different mechanisms of action and do not specifically target increasing stroke volume. Nitroprusside is a vasodilator that may be used in ADHF, but it is not primarily used to increase stroke volume.

Question 2

The nurse monitors a patient receiving intravenous (IV)furosemide (Lasix)and enalapril (Vasotec)5 mg orally twice daily for an acute exacerbation of chronic heart failure.Which of the following findings indicates to the nurse that the treatment is effective?

Accepted Answer

Fewer crackles on lung auscultation indicate that there is less fluid in the lungs, which is a sign of efficacy in treating heart failure. While weight loss and increased urinary output may also be positive signs, they can be influenced by factors other than medication effectiveness. Decrease in systolic BP may be expected with medication administration, but it is not the most specific indicator of treatment effectiveness for heart failure.

Question 3

A patient with a history of chronic congestive heart failure is hospitalized with severe dyspnea and a dry,hacking cough.She has pitting edema in both ankles,and her vital signs are blood pressure (BP)170/100 mm Hg,pulse 92 beats/min,and respiration 28 breaths/min.What is the most important assessment for the nurse to conduct next?

Accepted Answer

The patient's symptoms are consistent with exacerbation of congestive heart failure, which can cause pulmonary edema. Therefore, the nurse should auscultate the lung sounds to assess for the presence of crackles or wheezes, which could indicate the severity of the patient's condition and guide further treatment. Assessing orientation, capillary refill, or palpating the abdomen may have some relevance, but they are less critical in this situation, and the information obtained from these assessments would not be as urgent in guiding the patient's care.

Question 4

IV nitroprusside (Nipride)is ordered for a patient with acute pulmonary edema.During the initial administration of the drug,the nurse should monitor the patient for which of the following?

Accepted Answer

IV nitroprusside is a potent vasodilator and can cause significant hypotension. Therefore, the nurse should closely monitor the patient's blood pressure during initial administration. Bradycardia, cyanide toxicity, and ventricular dysrhythmias are not typical adverse effects of nitroprusside.

Question 5

When working in the heart failure clinic,the nurse knows that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient does which of the following?

Accepted Answer

Monitoring weight is crucial for patients with heart failure as weight gain can be a sign of fluid retention. The patient demonstrating an understanding of when to call if their weight increases shows effective teaching. Option A is incorrect because nitroglycerin patches are used to prevent angina, not treat chest pain. Option C is incorrect because furosemide is typically taken in the morning to prevent nocturia. Option D is incorrect because patients with heart failure should see their doctor more frequently, usually every 3-6 months.

Question 6

When teaching the patient with congestive heart failure about a 2-g sodium diet,the nurse explains that which of the following foods must be restricted?

Accepted Answer

Milk and milk products contain high amounts of sodium, especially if they are processed or flavored. Therefore, they must be restricted to maintain a sodium-restricted diet in congestive heart failure patients.

Question 7

Which of the following determinants of health is true in relation to heart failure?

Accepted Answer

Studies have shown that women tend to develop heart failure at an older age than men. The other options are not necessarily true in relation to heart failure.

Question 8

When the nurse is admitting an 80-year-old woman with chronic heart failure to the medical unit,the patient says she lives alone and that she thinks she confuses her "water pill" with her "heart pill." The nurse makes a note that which of the following discharge plans for this patient should be included?

Accepted Answer

The patient's statement that she confuses her medications and lives alone raises concerns about her ability to manage her medication regimen safely. A home care nurse can provide assistance with medication management and monitor the patient's condition, allowing her to remain in her own home. Placement in a skilled nursing care facility or a special unit for individuals with dementia may not be warranted based solely on this information, and arrangements for a family member to be with the patient around the clock may not be feasible or necessary.

Question 9

A patient with acute heart failure has severe dyspnea and is extremely anxious.The nurse anticipates that increased cardiac output and decreased anxiety may be promoted by the IV administration of which of the following medications?

Accepted Answer

Morphine is a narcotic analgesic that can reduce anxiety and also has vasodilating effects that can decrease afterload and improve cardiac output in patients with acute heart failure. Diazepam may decrease anxiety, but has no effect on cardiac output. Dopamine and nitroglycerin are not indicated for relieving anxiety in this situation.

Question 10

An outpatient who has developed heart failure after having an acute myocardial infarction has a new prescription for carvedilol (Coreg).After 2 weeks,the patient returns to the clinic.Which assessment finding causes the nurse the most concern?

Accepted Answer

Carvedilol is a beta blocker that can cause hypotension as a side effect. A blood pressure of 88/42 mm Hg is significantly low and can be a sign of worsening heart failure or a potentially life-threatening complication. The other options, such as a lower heart rate or complaints of fatigue, may be expected side effects of carvedilol and can be managed with medication adjustment or lifestyle modifications. Pedal edema is also a common finding in patients with heart failure and can be managed with diuretics.

Question 11

When the nurse is developing a teaching plan to prevent the development of heart failure in a patient with stage 1 hypertension,what information is most likely to improve compliance with antihypertensive therapy?

Accepted Answer

Hypertension can lead to heart failure by causing the heart to work harder than normal, leading to the heart muscle becoming thickened and less efficient over time. This explanation directly connects the condition (hypertension) with the risk of developing heart failure, making it a relevant point for improving compliance with antihypertensive therapy.

Question 12

The nurse plans discharge teaching for a patient with chronic heart failure who is to be maintained on digoxin (Lanoxin),a diuretic,and a potassium supplement.What would appropriate instructions for the patient include?

Accepted Answer

DC) Patients on digoxin should be instructed to notify their physician if they experience nausea or difficulty breathing, as these can be signs of digoxin toxicity or worsening heart failure. D) Taking the pulse rate before taking digoxin is important because a very low heart rate may indicate that the dose should be skipped or adjusted, and this is a general precaution for medications affecting the heart.

Question 13

Which of the following is a common cause of chronic heart failure?

Accepted Answer

The answer of Which of the following is a common...

Question 14

A patient admitted to the hospital with an exacerbation of her chronic heart failure tells the nurse she was fine when she went to bed but woke up feeling as if she were suffocating.What is the best way for the nurse to document this assessment information?

Accepted Answer

Paroxysmal nocturnal dyspnea is a symptom that happens to patients with chronic heart failure. It is characterized by sudden breathlessness occurring at night that can awaken the patient, and it is a sign of pulmonary congestion. This assessment information is significant for the nurse to document.

Question 15

The nurse identifies the collaborative problem of "potential complication: pulmonary edema for a patient in chronic heart failure." Which assessment will the nurse be most concerned about?

Accepted Answer

A low oxygen saturation of 88% indicates impaired gas exchange, which is a critical concern in pulmonary edema and requires immediate attention.

Question 16

After successful digitalization,a patient is to begin oral maintenance of digoxin and furosemide for control of chronic heart failure.To prevent digitalis toxicity,what does the nurse understand is the most important parameter to monitor in the patient?

Accepted Answer

The most important parameter to monitor in a patient taking digoxin and furosemide is serum potassium levels, as hypokalemia can increase the risk of digoxin toxicity. Therefore, it is necessary to monitor the serum potassium levels to maintain adequate levels and avoid toxicity. Body weight, liver function, and blood pressure are also important factors to monitor, but they are not the most critical in preventing digitalis toxicity.

Question 17

To promote more efficient ventricular emptying by decreasing preload in the patient with chronic heart failure,the nurse should implement which of the following actions?

Accepted Answer

Positioning the patient in a high-Fowler's position with the feet horizontal in the bed helps to decrease venous return to the heart, thereby reducing preload and promoting more efficient ventricular emptying in patients with chronic heart failure.

Question 18

During assessment of a 72-year-old man with swelling in his ankles,the nurse finds jugular venous distension with the head of the bed elevated 45 degrees.What does the nurse know this finding indicates?

Accepted Answer

Jugular venous distension with the head of the bed elevated indicates elevated right atrial pressure. This can be caused by a variety of conditions, including heart failure, pulmonary hypertension, and cor pulmonale.  This finding is not associated with decreased fluid volume, incompetent jugular vein valves, or atherosclerosis of the jugular veins.

Question 19

Following an acute myocardial infarction,a 67-year-old man develops heart failure.What does the nurse anticipate will be the first-line therapy for the patient?

Accepted Answer

First-line therapy for heart failure following myocardial infarction is typically an ACE inhibitor, such as captopril. This medication helps to decrease afterload and improve cardiac output. Digitalis preparations, diuretics, and (F1F1F1S1?F1F1F10)-adrenergic agonists may also be used in the management of heart failure, but they are typically not the first line of therapy.

Question 20

A patient with chronic heart failure tells the nurse at the clinic that he has gained 2.26 kg in the last 3 days,even though he has continued to follow a low-sodium diet.What is the priority nursing action?

Accepted Answer

The sudden weight gain in a patient with chronic heart failure could indicate the onset of acute heart failure or worsening of the chronic condition. The nurse's priority should be to assess the patient for any signs of acute heart failure, such as increased dyspnea, cough, or edema. While the other options could also be appropriate interventions, they should be considered after ruling out acute heart failure.

Quiz 37: Nursing Management: Heart Failure