Heart Failure NCLEX Questions

Heart Failure NCLEX Questions 5.0 (2 reviews) Students also studied Terms in this set (23) Broward College NUR 2222 Save Heart Failure NCLEX Questions 23 terms florahill10Preview Angina/MI NCLEX style questions 21 terms penny_meisenzahl Preview Heart Failure NCLEX Review Questi...16 terms Dominique_Comeaux Preview Heart F 32 terms tho Which of the following patients is MOST at risk for

developing heart failure? Select-all-that-apply:*

a) A 69-year-old male with a history of alcohol abuse and

is recovering from a myocardial infarction.

b) A 55-year-old female with a health history of asthma

and hypoparathyroidism.

c) A 30-year-old male with a history of endocarditis and

has severe mitral stenosis.

d) A 45-year-old female with lung cancer stage 2.

e) A 58-year-old female with uncontrolled hypertension

and is being treated for influenza.

a) A 69-year-old male with a history of alcohol abuse and is recovering from a

myocardial infarction.

c) A 30-year-old male with a history of endocarditis and has severe mitral

stenosis.

e) A 58-year-old female with uncontrolled hypertension and is being treated

for influenza.

• The answers to this question are options: A, C, E. These patients are at most risk

for heart failure. Remember risks factor for developing heart failure include:

remember the mnemonic FAILURE: Faulty heart valves ( Option C mitral stenosis in this case), Arrhythmias, Infarction (Option A), Lineage, Uncontrolled hypertension (Option E), Recreational drug usage, Evaders (Option E with influenza) A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition

• "Signs and symptoms of this type of heart failure can

include: dyspnea, persistent cough, difficulty breathing

while lying down, and weight gain."

• "It is important to monitor your daily weights, fluid, and

salt intake.

• "Left-sided heart failure can lead to right-sided heart

failure if left untreated."

• "This type of heart failure can build up pressure in the

hepatic veins and cause them to become congested with fluid which leads to peripheral edema."

• "This type of heart failure can build up pressure in the hepatic veins and

cause them to become congested with fluid which leads to peripheral edema."

• Option D is the answer. This is a description of right-sided heart failure NOT left

ventricular systolic dysfunction. Left-sided systolic dysfunction is where the left side of the heart is unable to CONTRACT efficiently which causes blood to back- up into the lungs...leading to pulmonary edema.

Which of the following are NOT typical signs and symptoms of right-sided heart failure? Select-all-that-

apply:

a) Jugular venous distention

b) Persistent cough

c) Weight gain

d) Crackles

e) Nocturia

f) Orthopnea

b) Persistent cough

d) Crackles

f) Orthopnea

• The answers are B, D, and F. Persistent cough, crackles (also called rales), and

orthopnea are signs and symptoms of LEFT-sided heart failure...not right-sided heart failure.A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition?

a) Echocardiogram shows an ejection fraction of 38%.

b) Heart catheterization shows an ejection fraction of

65%.

c) Patient has frequent episodes of nocturnal paroxysmal

dyspnea.

d) Options A and C are both expected findings with left-

sided systolic dysfunction heart failure

d) Options A and C are both expected findings with left-sided systolic

dysfunction heart failure

• The answer is D. Both Options A and C are correct. Option B is a finding

expected in left-sided DIASTOLIC dysfunction heart failure because the issue is with the ability of the ventricle to FILL properly...therefore a patient usually has a normal ejection fraction. Remember a normal EF is >60% in a healthy heart.

True or False: Patients with left-sided diastolic

dysfunction heart failure usually have a normal ejection fraction.

a) True

b) False

a) True

• The answer is TRUE. Patient with left-sided DIASTOLIC dysfunction heart failure

normally have a normal ejection fraction. However, patients with left-sided SYSTOLIC dysfunction heart failure usually do not because the heart is unable to CONTRACT efficiently rather than fill properly as with diastolic dysfunction.A patient has a history of heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation?

• "I've noticed that I've gained 6 lbs in one week."
• "While I sleep I have to prop myself up with a pillow so

I can breathe."

• "I haven't noticed any swelling in my feet or hands

lately."

d) Options B and C are correct.

e) Options A and B are correct.

f) Options A, B, and C are all correct.

e) Options A and B are correct.

• The answer is E. Options A and B are classic signs and symptoms a patient may

experience with heart failure exacerbation.Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation?

a) A 55-year-old female who limits sodium and fluid

intake regularly.

b) A 73-year-old male who reports not taking

Amiodarone for one month and is experiencing atrial fibrillation.

c) A 67-year-old female who is being discharged home

from heart valve replacement surgery.

d) A 78-year-old male who has a health history of eczema

and cystic fibrosis.

• A 73 year old male who reports not taking Amiodarone for one month and is

experiencing atrial fibrillation.

• Option B is the correct answer. Patients who are in an arrhythmia (especially a-

fib) are at risk for developing heart failure because the heart is not contracting properly and blood is pooling in the chambers.

A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air.Which of the following lab results confirm your suspicions of heart failure?

a) K+ 5.6

b) BNP 820

c) BUN 9

d) Troponin < 0.02

b) BNP 820

• The answer is option B. BNP (b-type natriuretic peptide) is a biomarker released

by the ventricles when there is excessive pressure in the heart due to heart failure.<100 no failure, 100-300 present, >300 pg/mL mild, >600 pg/mL >moderate, 900 pg/mL severe Which of the following tests/procedures are NOT used to diagnose heart failure?

a) Echocardiogram

b) Brain natriuretic peptide blood test

c) Nuclear stress test

d) Holter monitor

d) Holter monitor

• The answer is D. Options A, B, and C are all used to diagnose heart

failure...however a holter monitor is not. A holter monitor is used to monitor a patient's heart rate and rhythm.What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath.

a) Left ventricular systolic dysfunction

b) Left ventricular ride-sided dysfunction

c) Right ventricular diastolic dysfunction

d) Left ventricular diastolic dysfunction

d) Left ventricular diastolic dysfunction

• The answer is D. This statement describes left ventricular DIASTOLIC dysfunction.

A patient with left-sided heart failure is having difficulty breathing. Which of the following is the most appropriate nursing intervention?

a) Encourage the patient to cough and deep breathe

b) Place the patient in Semi-Fowler's position

c) Assist patient into High-Fowler's position

d) Perform chest percussion therapy

c) Assist the patient into High-Fowler's position

• The answer is C. Due to the patient being in fluid overload (especially with left-

sided heart failure...remember the lungs are majorly affected in this type of heart failure), it is most appropriate to place the patient in High Fowler's position to help make breathing easier.You're providing diet discharge teaching to a patient with a history of heart failure. Which of the following statements made by the patient represents they understood the diet teaching?

• "I will limit my sodium intake to 5 - 6 grams a day."
• " I will be sure to incorporate canned vegetables and

fish into my diet."

• "I'm glad I can still eat sandwiches b/c I love bologna

and cheese sandwiches."

• "I will limit my consumption of frozen meals."
• "I will limit my consumption of frozen meals."
• The answer is D. Patients with heart failure should limit sodium intake to 2 to 3

grams per day (not 5-6 grams), avoid canned vegetable/fish, and avoid sandwich meats and cheeses because of their high sodium content. Frozen meals are high in sodium, therefore the patient is correct in saying they should limit their consumption of them.

Select all the correct statements about educating the

patient with heart failure:

a) It is important patients with heart failure notify their

physician if they gain more than 6 pounds in a day or 10 pounds in a week.

b) Patients with heart failure should receive an annual

influenza vaccine and be up-to-date with the pneumonia vaccine.

c) Heart failure patients should limit sodium intake to 2-

• grams per day

d) Heart failure is exacerbated by illness, too much fluid

or sodium intake, and arrhythmias.

e) Patients with heart failure should limit exercise because

of the risks.

b) Patients with heart failure should receive an annual influenza vaccine and be

up-to-date with the pneumonia vaccine.

c) Heart failure patients should limit sodium intake to 2-3 grams per day

d) Heart failure is exacerbated by illness, too much fluid or sodium intake, and

arrhythmias.

• The answers are B, C, and D. Option A is wrong because heart failure patients

should notify their doctor if they gain 2-3 pounds in a day or 5 pounds in a week, and option E is wrong because exercise is important for heart failure patients to help strengthen the heart muscle...so they should exercise as tolerated.A patient taking Digoxin is experiencing severe bradycardia, nausea, and vomiting. A lab draw shows that their Digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient?

a) Narcan

b) Aminophylline

c) Digibind

d) No medication b/c this is a normal Digoxin level

c) Digibind

• The answer is C. The patient is experiencing Digoxin toxicity...therefore the

physician will order the antidote for Digoxin which is Digibind.Which of the following is a late sign of heart failure?

a) SOB

b) Orthopnea

c) Edema

d) Frothy-blood tinged sputum

d) Frothy-blood tinged sputum

• The answer is D. Shortness of breath, orthopnea, and edema are EARLY signs

and symptoms. Frothy-blood tinged sputum is a late sign.These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs. This description describes?

a) Beta-blockers

b) Vasodilators

c) Angiotensin II receptor blockers

d) Angiotensin-converting enzyme inhibitors

d) Angiotensin-converting-enzyme inhibitors

A patient with heart failure is taking Losartan and Spironolactone. The patient is having EKG changes that presents with tall peaked T-waves and flat p-waves.Which of the following lab results confirms these findings?

a) Na+ 135

b) BNP 560

c) K+ 8.0

d) K+ 1.5

c) K+ 8.0

• The answer is C. Losartan and Spironolactone can both cause an increased

potassium level (hyperkalemia). Losartan is an ARB and Spironolactone is a potassium-sparing diuretic. Therefore, the EKG changes are a sign of a high potassium level (normal potassium level is 3.5-5.1).