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Questions for Heart Failure 1. A patient admitted from the emergency department with a diagnosis of heart failure has edema in his lower extremities of +4. Which nursing intervention would aid in decreasing this edema? o Ambulate in the hallway o Elevate lower extremities o Keep the extremities in a dependent position o Stand at the bedside 2. A patient has heart failure. His physician’s orders include complete bed rest. The nurse knows that this order means he o Is encouraged to rest as much as possible o Is confined to bed but may assume responsibility for all of his personal care o Is confined to bed but is allowed to go to the bathroom as needed o Must remain as quiet as possible, with any task requiring physical effort done for him 3. The patient achieves comfort in breathing only when he assumes a sitting posture. During the charting of this position, the nurse can describe this as o Dyspnea o Orthophrenia o Orthopnea o Orthuria 4. The patient has been hospitalized for congestive heart failure three times in the last 4 months. While preparing the discharge teaching plan, the nurse assesses that he does not comply with his medication regimen. The nurse’s immediate course of action would be to o Reteach him about his medications o Have a serious talk with him and his family about compliance o Arrange for home visits after discharge o Collect more information to identify his reasons for noncompliance 5. Dependent edema of the extremities, enlargement of the liver, oliguria, jugular vein distention, and abdominal distention are signs and symptoms of o Right-sided heart failure o Left-sided heart failure o Cardiac dysrhythmias o Valvular heart disease 6. Restlessness, diaphoresis, severe dyspnea, tachypnea, hemoptysis, audible wheezing, and crackles are signs and symptoms of o Heart failure o Respiratory failure o Pulmonary edema o Peripheral edema 7. The nurse identifies the problem of a potential complication - pulmonary edema-for a patient in acute congestive heart failure. For which symptom of this problem does the nurse assess? o Pink, frothy sputum o Lethargy and faintness o Decreased urinary output o Bradycardia 8. During the nursing history and physical assessment of a patient with left-sided heart failure, which finding might the nurse expect related to the patient’s diagnosis? o Orthopnea with bubbling crackles throughout the lungs o Anorexia with weight loss of 3 pounds in 1 week o Increased urinary output, especially during waking hours o Periorbital and facial edema 9. A patient has a diagnosis of heart failure. When the nurse walks into his room, he is orthopneic. The patient is o Sitting or standing in order to breathe deeply and comfortably o Complaining of sudden awakenings from sleep because of shortness of breath o Complaining of pain in lower extremities o Unable to respond to simple questions 10. Edema and pulmonary congestion are treated with o Unlimited activity, high protein diet, weights weekly o Bed rest, normal diet, weights four times daily o Increase in fluids, no activity restrictions o Diuretics, restriction of sodium, restriction of fluid intake 11. ACE inhibitors help the congestive heart failure patient by o Blocking angiotensin o Blocking aldosterone o Blocking creatine o Increasing angiotensin 12. One contraindication to starting the heart failure on beta blockers would be o Allergy to sulfa o Symptomatic bradycardia o Hypertension o Ejection fraction of 25% 13. Spironolactone is an example of a/an o Potassium wasting diuretic o ACE inhibitor o Aldosterone antagonist o Beta blocker o Calcium channel blocker 14. The emotional response most likely to coincide with acute heart failure is o Anger o Stoicism o Anxiety o Depression 15. Before administering digoxin (Lanoxin) to the client in heart failure, the nurse should assess the client’s o Temperature o Blood pressure o Heart rate o Breath sounds 16. Which value should the nurse report immediately to the physician for the cardiac patient in heart failure? o Sodium 139 o Potassium 3.o o Chloride 99 o Glucose 144 17. The client in heart failure who is frightened due to severe dyspnea would benefit most from which of the following nursing interventions? o Tell the patient to relax o Allow the patient to walk the halls o Stay with the client and provide reassurance o Explain to the patient the strain on his heart 18. Epinephrine and norepinephrine are released in response to o Rapid heart rate o Increased work of breathing o Decreased cardiac output o Conservation of water by the kidneys 19. The body uses this process to help compensate for changes in order that our body won’t suffer devastating effects on a daily basis. o Renin-angiotensin-aldosterone system o Compensatory mechanisms o Suppression of cardiac output o Parasympathetic responses 20. This will result in less oxygen being exchanged due to heart failure. o Edema of bronchi o Fluid entering the alveoli o Ischemia to the atria o Bradycardia 21. An appropriate nursing diagnosis due to decreased cardiac output would be o Alteration in skin integrity o Ineffective tissue perfusion o Activity intolerance o Self-health maintenance, impaired 22. The major goal of treatment for heart failure is to o Reduce the heart rate o Increase UOP o Increase cardiac output o Weekly weights 23. Digitalis preparations are given primarily to o Increase myocardial contractility o Release epinephrine and norepinephrine o Raise the heart’s oxygen supply o Ease the contractions of the left ventricle 24. Decreased urine output, tachycardia, tachypnea, and crackles would signify o Ejection fraction above 70% o Left-sided heart failure o Pulmonary edema o Right-sided heart failure 25. Pressure in the aorta and arteries that tells the left ventricle how much force is needed to eject blood is called o Ejection fraction o Absolute LV value o Peripheral vascular resistance o Vascular flow rate 26. An intra-aortic balloon pump would be inflated during o Contraction o Systole o Ejection of blood from the left ventricle o Diastole 27. Nocturia would occur due to o Increase in blood flow in the periphery o Decrease in heart rate at night o Venous return as legs are elevated o Rise in pulmonary pressures 28. The only feasible way to monitor left-sided heart pressures several times a day would be to o Place a PICC with pressure monitoring devices o Monitor right-sided heart pressures with a Swan-Ganz catheter o Leave a cardiac cath in place to measure the pressures o Place the patient on an IABP and admit them to ICU 29. Discharge instructions for the heart failure patient should include o Returning for digoxin levels every other day until the value is between 2-3 o Daily weights with reports of 2 or more pounds gained in a 24 hour period o Consumption of a consistent carbohydrate diet with adequate potassium intake o Follow-up appointment with PCP within the next 6 months 30. This classification of meds, of which digoxin is a member, increases force of contraction which increases cardiac output and slows the heart rate to reduce the workload of the heart. o Inotropes o Beta-blockers o ACE inhibitors o Aldosterone antagonists 31. The most short term device for the patient awaiting a heart transplant that will completely bypass the left ventricle would be the o Intra-aortic balloon pump o Swan-Ganz o Ventricular assist device o Pacemaker insertion 32. Severe pulmonary fluid overload in a relatively short period of time is termed o Tachypnea o Flash pulmonary edema o Severe pulmonary congestion o Right-sided heart failure 33. Be cautious with this medication if your patient has a low potassium level. o Inderol o Capoten o Metoprolol o Digoxin 34. A pacer spike is seen just prior to the QRS complex. You know this is what type of pacer? o Mono pacer o Ventricular pacer o Atrial pacer o Defibrillator pacer 35. Transplanted skeletal muscle around the heart is termed a o Cardioectomy o Cardiomyoplasty o Cardioventriculogram o Cardioversion 36. The most common cause of right sided heart failure is o Pulmonary artery disease o Increased pulmonary pressures o Pulmonary congestion o Left-sided heart failure 37. Right-sided heart failure due to pulmonary disease is termed o Right-sided heart failure o Cardiopulmonali o Cor pulmonale o Cordon pulmonalie 38. The body’s compensatory mechanisms will o Correct cardiac output issues in heart failure o Decrease the hearts need for extra oxygen o Create a negative pulmonary pressure rise o Add to the problems of heart failure 39. Altered mental status, cyanosis, chest pain, crackles, wheezes, and tachypnea are all signs of o Pulmonary vascular resistance o Left-sided heart failure o Right-sided heart failure o Jugular vein distention 40. How do aldosterone antagonists help heart failure patients? o By decreasing sodium and potassium reabsorption o By reabsorption of sodium o By blocking the reabsorption of sodium o By eliminating greater amounts of potassium 41. Heart failure patients are most prone to this dysrhythmia. o Heart block o SVT o A-fib o V-fib 42. EKG changes in the heart failure patient could be from o Overload and ischemia o Dysfunction of the atria o SA node malfunction o Cardiac anomalies 43. Right-sided heart failure symptoms are typically more o Severe o Systemic o Pulmonary o Resistant to treatment 44. A patient on furosemide (Lasix) will need which of the following assessments? o Lung sounds and CBC o Blood pressure and potassium o Blood sugar and sodium o Complete assessment including past 24 hour output 45. Decreased activity intolerance would be a nursing diagnosis most likely related to what in the heart failure patient? o Discomfort in legs while ambulating o Dyspnea during stair climbing o Pump failure o Noticeable shortness of breath with any exertion