chapter 37 Flashcards
The nurse is caring for a client with chronic heart failure. Which of the following
conditions is a cause of chronic heart disease?
a. Dysrhythmias
b. Pulmonary embolus
c. Myocarditis
d. Congenital heart disease
D
Congenital heart disease is a cause of chronic heart failure. Dysrhythmias, pulmonary
embolus, and myocarditis are causes of acute heart failure.
The nurse is caring for a client who is receiving IV furosemide and morphine for the
treatment of acute decompensated heart failure (ADHF) with severe orthopnea. When
evaluating the client response to the medications, which of the following is the best
indicator that the treatment has been effective?
a. Weight loss of 1 kg overnight
b. Hourly urine output greater than 60 mL
c. Reduction in client complaints of chest pain
d. Decreased dyspnea with the head of bed at 30 degrees
D
Because the client’s major clinical manifestation of ADHF is orthopnea (caused by the
presence of fluid in the alveoli), the best indicator that the medications are effective is a
decrease in dyspnea with the head of the bed at 30 degrees. The other assessment data also
may indicate that diuresis or improvement in cardiac output has occurred but are not as
specific to evaluating this client’s response.
Which topic will the nurse plan to include in discharge teaching for a client with systolic
heart failure and an ejection fraction of 38%?
a. Need to participate in an aerobic exercise program several times weekly
b. Use of salt substitutes to replace table salt when cooking and at the table
c. Importance of making a yearly appointment with the primary care provider
d. Benefits and adverse effects of angiotensin-converting enzyme (ACE) inhibitors
D
The core measure for the treatment of heart failure in clients with a low ejection fraction is
to receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise
may not be appropriate for a client with this level of heart failure, salt substitutes are not
usually recommended because of the risk of hyperkalemia, and the client will need to see
the primary care provider more frequently than annually.
The nurse is conducting a health history on a client with heart failure. Which of the
following conditions in the client’s health history is a precipitating cause of heart failure?
a. Hyperthyroidism
b. Anemia
c. Hypovolemia
d. Diabetes
B
Anemia is a precipitating cause of heart failure. Also, hypovolemia and hypothyroidism
are precipitating causes. Diabetes is not a precipitating cause of heart failure.
A client who has chronic heart failure tells the nurse, “I felt fine when I went to bed, but I
woke up in the middle of the night feeling like I was suffocating!” Which of the following
information should the nurse document related to this assessment?
a. Pulsus alternans
b. Two-pillow orthopnea
c. Acute bilateral pleural effusion
d. Paroxysmal nocturnal dyspnea
D
Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body
areas when the client is sleeping and is characterized by waking up suddenly with the
feeling of suffocation. Pulsus alternans is the alternation of strong and weak peripheral
pulses during palpation. Orthopnea indicates that the client is unable to lie flat because of
dyspnea. Pleural effusions develop over a longer time period.
During a visit to a client with chronic heart failure, the home care nurse finds that the
client has ankle edema, a 2 kg weight gain, and complains of “feeling too tired to do
anything.” Based on these data, which of the following is the best nursing diagnosis for the
client?
a. Activity intolerance related to physical deconditioning
b. Disturbed body image related to alteration in self-perception
c. Impaired skin integrity related to alteration in fluid volume (peripheral edema)
d. Ineffective breathing pattern related to respiratory muscle fatigue
A
The client’s statement supports the diagnosis of activity intolerance. There are no data to
support the other diagnoses, although the nurse will need to assess for other client
problems.
The nurse working in the heart failure clinic will know that teaching for a client with
newly diagnosed heart failure has been effective when the client does which of the
following actions?
a. Uses an additional pillow to sleep when feeling short of breath at night.
b. Tells the home care nurse that furosemide is taken daily at bedtime.
c. Calls the clinic when the weight increases from 56 to 59 kg in 2 days.
d. Says that the nitroglycerin patch will be used for any chest pain that develops.
C
Teaching for a client with heart failure includes information about the need to weigh daily
and notify the health care provider about an increase of more than 2 kg in a 2 day period.
Nitroglycerin patches are used primarily to reduce preload (not to prevent chest pain) in
clients with heart failure and should be used daily, not on an “as necessary” basis.
Diuretics should be taken earlier in the day to avoid nocturia and sleep disturbance. The
client should call the clinic if increased orthopnea develops, rather than just compensating
by elevating the head of the bed further.
The nurse is teaching the client with heart failure about a 2 g sodium diet. Which of the
following foods should the nurse explain to the client that need to be restricted?
a. Canned and frozen fruits
b. Fresh or frozen vegetables
c. Milk, yogourt, and other milk products.
d. Eggs and other high-cholesterol foods.
C
Milk and yogourt naturally contain a significant amount of sodium, and intake of these
should be limited for clients on a diet that limits sodium to 2 g daily. Other milk products,
such as processed cheeses, have very high levels of sodium and are not appropriate for a 2
g sodium diet. The other foods listed have minimal levels of sodium and can be eaten
without restriction.
The nurse is caring for a client with heart failure with reduced ejection fraction. Which of
the following laboratory values should the nurse expect to assess in the client related to
ejection fraction?
a. 40%
b. 60%
c. 80%
d. 90%
A
Normal EF is greater than 55% of the ventricular volume. Patients with HF-REF requiring
specialist intervention generally have an EF less than or equal to 40%.
The nurse is caring for an older-adult client with heart failure and learns that the client
lives alone and sometimes confuses the “water pill” with the “heart pill.” When planning
for the client’s discharge the nurse will facilitate which of the following actions?
a. Transfer to a dementia care service
b. Referral to a home health care agency
c. Placement in a long-term care facility
d. Arrangements for around-the-clock care
B
The data about the client suggest that assistance in developing a system for taking
medications correctly at home is needed. A home health nurse will assess the client’s
home situation and help the client develop a method for taking the two medications as
directed. There is no evidence that the client requires services such as dementia care,
long-term care, or around-the-clock home care.
Following an acute myocardial infarction, a previously healthy client develops clinical
manifestations of heart failure. The nurse anticipates discharge teaching will include
information about which of the following medications?
a. Angiotensin-converting enzyme (ACE) inhibitors
b. Digitalis preparations
c. b-adrenergic agonists
d. Calcium channel blockers
A
ACE inhibitor therapy is currently recommended to prevent the development of heart
failure in clients who have had a myocardial infarction and as a first-line therapy for
clients with chronic heart failure. Digoxin therapy for heart failure is no longer considered
a first-line measure. Calcium channel blockers are not generally used in the treatment of
heart failure. The b-adrenergic agonists such as dobutamine are administered through the
IV route and are not used as initial therapy for heart failure.
The nurse is caring for a client with Class III status (NYHA) heart failure and type 2
diabetes and the client asks the nurse whether heart transplant is a possible therapy. Which
of the following responses by the nurse is best?
a. “Since you have diabetes, you would not be a candidate for a heart transplant.”
b. “The choice of a client for a heart transplant depends on many different factors.”
c. “Your heart failure has not reached the stage in which heart transplants are
considered.”
d. “People who have heart transplants are at risk for multiple complications after
surgery.”
B
Indications for a heart transplant include end-stage heart failure, but other factors such as
coping skills, family support, and client motivation to follow the rigorous post-transplant
regimen are also considered. Clients with diabetes who have well-controlled blood glucose
levels may be candidates for heart transplant. Although heart transplants can be associated
with many complications, this response does not address the client’s question.
Which of the following diagnostic tests will be most useful to the nurse in determining
whether a client admitted with acute shortness of breath has heart failure?
a. Serum creatine kinase (CK)
b. Arterial blood gases (ABGs)
c. B-type natriuretic peptide (BNP)
d. 12-lead electrocardiogram (ECG)
C
BNP is secreted when ventricular pressures increase, as with heart failure, and elevated
BNP indicates a probable or very probable diagnosis of heart failure. 12-lead ECGs, ABGs,
and CK also may be used in determining the causes or effects of heart failure but are not as
clearly diagnostic of heart failure as BNP.
Which of the following actions is priority when caring for a client admitted with acute
decompensated heart failure (ADHF) who is receiving a nitrate?
a. Monitor blood pressure frequently.
b. Encourage client to ambulate in room.
c. Titrate nitrate rate slowly before discontinuing.
d. Teach client about safe home use of the medication.
A
Nitrates cause vasodilation therefore BP should be frequently monitored. Since the client
is likely to have orthostatic hypotension, the client should not be encouraged to ambulate.
Nitrate does not require titration and the priority is not to teach about safe use at home.
A client with heart failure has a new order for captopril 12.5 mg PO. After administering
the first dose and teaching the client about captopril, which statement by the client
indicates that teaching has been effective?
a. “I will call for help when I need to get up to use the bathroom.”
b. “I will be sure to take the medication after eating something.”
c. “I will need to include more high-potassium foods in my diet.”
d. “I will expect to feel more short of breath for the next few days.”
A
Captopril can cause hypotension, especially after the initial dose, so it is important that the
client not get up out of bed without assistance until the nurse has had a chance to evaluate
the effect of the first dose. The ACE inhibitors are potassium sparing, and the nurse should
not teach the client to increase sources of dietary potassium. Increased shortness of breath
is expected with initiation of b-blocker therapy for heart failure, not for ACE inhibitor
therapy. ACE inhibitors are best absorbed when taken an hour before eating.
