Lewis Ch-37: Heart Failure Flashcards
(24 cards)
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
Why the others are wrong:
• a. Dysrhythmias
These can be chronic, but they’re often a complication or result of heart disease—not the root cause.
And some are temporary.
• b. Pulmonary embolus
That’s a sudden, acute event. It can cause acute right-sided heart strain, but it’s not a long-term, chronic condition on its own.
• c. Myocarditis
That’s inflammation of the heart muscle—acute, usually due to infection. It can lead to chronic issues, but it’s not itself a chronic disease unless it progresses to cardiomyopathy
The nurse is caring for a client who is receiving IV furosemide and morphine for the treatment of acute decompensated heart failure 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. Wight 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. Decreased dyspnea with the head of bed at 30 degrees
Now, back to your question:
The patient has orthopnea due to heart failure. You give them IV furosemide (a diuretic) and morphine (to reduce preload and anxiety).
What’s the best sign it’s working?
Answer:
d. Decreased dyspnea with the head of bed at 30 degrees
Because now they don’t have to sit fully upright to breathe. You’re reducing fluid overload, clearing out the lungs, and letting them breathe lying down again—like a human being, not a stressed-out meerkat.
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Why not the other options?
• a. Weight loss = good, but not as immediate or specific
• b. Urine output = nice diuretic effect, but doesn’t directly tell you lungs are better
• c. Chest pain relief = morphine helps that, sure—but this patient’s main issue is breathing, not pain
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TL;DR:
Orthopnea = can’t breathe lying flat.
Treatment works = they can lie back and chill without feeling like they’re drowning in air.
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 enzymes (ACE) inhibitors
d. Benefits and adverse effects of angiotensin-converting enzymes (ACE) inhibitors
With an ejection fraction of 38% (translation: your heart is trying its best but it’s very tired), you’re deep in systolic heart failure territory. ACE inhibitors are first-line meds to reduce afterload, slow disease progression, and hopefully keep that EF from dropping lower than your GPA during finals week.
The other options? Cute, but off-target:
• a. Aerobic exercise? Sure, eventually, but let’s not yeet the heart into overdrive before meds are optimized.
• b. Salt substitutes? Some contain potassium, which can mix very badly with ACE inhibitors. So… maybe don’t.
• c. Yearly appointments? Adorable. But this person needs follow-up like yesterday, not next year.
The nurse is conducting a health hx 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
Anemia reduces the oxygen-carrying capacity of the blood, which makes the heart work harder to deliver enough oxygen to the body. This extra workload can precipitate or worsen heart failure, especially in someone with an already compromised heart
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 to this assessment?
a. Pulsus alternans
b. Two pillow orthopnea
c. Acute bilateral pleural effusion
d. Paroxysmal nocturnal dyspnea
d. Paroxysmal nocturnal dyspnea
Ah, a classic case of “I was fine until my lungs betrayed me at 3 a.m.”—this one practically screams d. Paroxysmal nocturnal dyspnea (PND), the drama queen of heart failure symptoms.
Why it’s the right answer:
Paroxysmal nocturnal dyspnea is exactly what it sounds like—sudden (paroxysmal) shortness of breath at night (nocturnal) that wakes patients up gasping for air like they just lost a fight with a pillow. It’s a hallmark of left-sided heart failure, where fluid backs up into the lungs during sleep when the body is lying flat, and gravity can’t help redistribute that fluid. So basically, they lie down, the lungs start filling up like a clogged sponge, and surprise! Instant midnight suffocation panic.
During a visit to a client with chronic heart failure, the home care nurse finds that the client has ankle edema, a 2kg weight gain, and complaints of “feeling too tired to do anything.” Based on the 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. Activity intolerance related to physical deconditioning
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. Calls the clinic when the weight increases from 56 to 59 kg in 2 days.
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 needs to be restricted?
a. Canned and frozen fruits
b. Fresh or frozen vegetables
c. Milk, yogurt, and other milk products
d. Eggs and other high-cholesterol foods.
c. Milk, yogurt, and other milk products
Let me put it this way:
A single cup of milk? Around 100–130 mg of sodium.
Yogurt (depending on the brand)? Can easily hit 150–200 mg per serving.
Cheese? Cheese is sodium’s party palace. One slice of American cheese can hit 300+ mg like it’s no big deal
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. 40%
Ejection Fraction (EF): The TL;DR Version
It’s basically a percentage of blood that the left ventricle pumps out with each beat. Think of it as your heart’s “test score” for how well it’s doing its main job: launching blood into the body.
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The Normal Range:
• 55% to 70% = “Your heart is doing its job like a responsible adult.”
• 40%–54% = “Meh. Could be better. Probably mildly dysfunctional.”
• Below 40% = “Houston, we have a heart failure.”
• 35% or lower = “Yikes. Hope you like ACE inhibitors.”
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So, what is reduced ejection fraction (HFrEF)?
That’s when your left ventricle is being lazy or weak, and it’s only ejecting a sad little portion of blood each time. So instead of pushing out a strong 60%, it’s down to something like 40% or less, which means your tissues are sitting around like, “Uh, where’s our oxygen?”
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Real-world analogy:
Imagine the left ventricle is a juice box. A healthy heart squeezes most of the juice out with every pump.
A failing heart? It’s like someone with arthritis gently patting the juice box and calling it a day.
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. Referral to a home health care agency
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. Beta-adrenergic agonists
d. Calcium channel blockers
a. Angiotensin-converting enzyme (ACE) inhibitors
Why they’re used after an MI (heart attack)
When your heart muscle is injured (post-MI), the body panics and starts remodeling the heart. And no, not the cool kind of remodeling with granite countertops. More like fibrosis and ventricular dilation. Which leads to heart failure.
ACE inhibitors:
• Reduce afterload (less pressure for the heart to pump against)
• Prevent or slow remodeling (aka the cardiac version of “stop making it worse”)
• Improve survival—Yes, actual real-life longevity. Not just fewer symptoms.
The nurse is caring for a client with class III status heart failure and type 2 diabetes and the client asks the nurse whether heart transplant is 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. “The choice of a client for a heart transplant depends on many different factors.”
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
b. Arterial blood gases
c. B-type natriuretic peptide
d. 12-lead electrocardiogram
c. B-type natriuretic peptide
Which of the following actions is priority when caring for a client admitted with acute decompensated heart failure 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. Monitor blood pressure frequently
A client with heart failure has a new order for captopril 12.5mg 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. “I will call for help when i need to get up to use the bathroom”
Which of the following clients is less likely to enroll in a cardiac rehabilitation program?
a. A 64-year-old male who has diabetes
b. A 51-year-old male who has a same-sex partner
c. A 52-year-old single female
d. A 39-year-old male with two children
c. A 52-year-old single female
Women are 36% less likely to enroll in cardiac rehabilitation programs
A client with a history of chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. Which of the following actions should the nurse take first?
a. Palpate the abdomen
b. Assess the orientation
c. Check the capillary refill
d. Auscultate the lung sounds
d. Auscultate the lung sounds
The home health nurse is visiting a client with chronic heart failure who has prescriptions for a diuretic, an ACE-inhibitor, and a low-sodium diet and tells the nurse about a 2.3 kg weight gain in the last 3 days. Which of the following actions should the nurse do first?
a. Ask the client to recall the dietary intake for the last 3 days
b. Question the client about the use of the prescribed medications
c. Assess the client for clinical manifestations of acute heart failure
d. Teach the client about the importance of dietary sodium restrictions.
c. Assess the client for clinical manifestations of acute heart failure
The nurse is caring for a client in the intensive care unit with acute decompensated heart failure who has symptoms of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been prescribed for the client. Which of the following actions should the nurse implement first?
a. Give IV diazepam 2.5mg
b. Administer IV morphine sulphate 2 mg.
c. Increase nitroglycerin infusion by 5 mcg/min
d. Increase dopamine infusion by 2 mcg/kg/min
b. Administer IV morphine sulphate 2 mg.
After receiving a change of shift report, which of the following clients admitted with heart failure should the nurse assess first?
a. A client who is receiving IV nitroprusside and has a bp of 100/56
b. A client who is cool and clammy, with new-onset confusion and restlessness
c. A client who has dizziness after receiving the first dose of captopril
d. A client who has crackles in both posterior lung bases and is receiving oxygen.
b. A client who is cool and clammy, with new-onset confusion and restlessness
Which assessment finding in a client admitted with chronic heart failure requires the most rapid action by the nurse?
a. Oxygen saturation of 88%
b. Weight gain of 1 kg
c. Apical pulse rate of 106 bpm
d. Urine output of 50 mL over 2 hours
a. Oxygen saturation of 88%
Blue
Blue
An outpatient who has heart failure returns to the clinic after 2 weeks of therapy with an ACE inhibitor. Which of these assessment findings is most important for the nurse to report to the health care provider?
a. Pulse rate of 56
b. 2+ pedal edema
c. BP of 88/42
d. Complaints of fatigue
c. BP of 88/42
The nurse is caring for a client with right-sided heart failure who asks the nurse what caused the heart failure. Which of the following causes is the primary cause of right-sided heart failure?
a. Cor pulmonale
b. Chronic pulmonary hypertension
c. Left-sided heart failure
d. Acute decompensated heart failure
c. Left-sided heart failure
