Heart Failure NCLEX Review Questions

Heart Failure NCLEX Review Questions Leave the first rating Students also studied Terms in this set (32) Save 15 Cardiac Surgical Questions & 60 ...75 terms R0ckerch1cPreview Heart Failure NCLEX Questions 23 terms dwren47Preview Heart Failure NCLEX Practice 18 terms lmr2333Preview NCLEX 85 terms zor The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are

reviewed with the following findings: sodium 139 mEq/L,

potassium 5.6 mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What should the nurse do next?

• Withhold the daily dose until the following day.
• Withhold the dose and report the potassium level.
• Give the digoxin with a salty snack, such as crackers.
• Give the digoxin with extra fluids to dilute the sodium

level.

• Withhold the dose and report the potassium level.

The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the potassium level. The physician may order the digoxin to be given once the potassium level has been treated and decreases to within normal range.What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure?

• Urine output
• Lung sounds
• Blood pressure
• Respiratory rate
• Blood pressure

Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide.A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)?

• Administer ordered morphine sulfate.
• Position patient in a semi-Fowler's position.
• Position patient on left side with head of bed flat.
• Instruct patient on the use of relaxation techniques.
• Use a calm, reassuring approach while talking to

patient.

A, B, D, E.

Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety.

A male patient with a long-standing history of heart failure has recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient?

• Taper the patient off his current medications.
• Continue education for the patient and his family.
• Pursue experimental therapies or surgical options.
• Choose interventions to promote comfort and prevent

suffering.

• Choose interventions to promote comfort and prevent suffering.

The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount. Medications should be continued unless they are not tolerated.Experimental therapies and surgeries are not commonly used in the care of hospice patients.What should the nurse recognize as an indication for the use of dopamine (Intropin) in the care of a patient with heart failure?

• Acute anxiety
• Hypotension and tachycardia
• Peripheral edema and weight gain
• Paroxysmal nocturnal dyspnea (PND)
• Hypotension and tachycardia

Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine.A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient?

• Reduce preload.
• Decrease afterload.
• Increase contractility.
• Promote vasodilation.
• Reduce preload.

Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone.A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid?

• High-potassium foods
• Drugs to treat erectile dysfunction
• Nonsteroidal antiinflammatory drugs
• Over-the-counter H2-receptor blockers
• Drugs to treat erectile dysfunction

The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. High-potassium foods, NSAIDs, and H2-receptor blockers do not pose a risk in combination with nitrates.A stable patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before positioning the patient on the bedside, what should the nurse assess first?

• Urine output
• Heart rhythm
• Breath sounds
• Blood pressure
• Blood pressure

The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the semi-Fowler's position and use other measures to improve gas exchange.

The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient (select all that apply)?

• Left ventricular function is documented.
• Controlling dysrhythmias will eliminate HF.
• Prescription for digoxin (Lanoxin) at discharge
• Prescription for angiotensin-converting enzyme (ACE)

inhibitor at discharge

• Education materials about activity, medications, weight

monitoring, and what to do if symptoms worsen

A, D, E.

The Joint Commission has identified these three core measures for heart failure patients. Although controlling dysrhythmias will improve CO and workload, it will not eliminate HF. Prescribing digoxin for all HF patients is no longer done because there are newer effective drugs and digoxin toxicity occurs easily related to electrolyte levels and the therapeutic range must be maintained.After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108/minute. What should the nurse suspect is happening?

A. ADHF

• Chronic HF
• Left-sided HF
• Right-sided HF
• Right-sided HF

An MI is a primary cause of heart failure. The jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure.Beyond the first year after a heart transplant, the nurse knows that what is a major cause of death?

• Infection
• Acute rejection
• Immunosuppression
• Cardiac vasculopathy
• Cardiac vasculopathy

Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated CAD) are the major causes of death.During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection.The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to ADHF?

• Take medications as prescribed.
• Use oxygen when feeling short of breath.
• Only ask the physician's office questions.
• Encourage most activity in the morning when rested.
• Take medications as prescribed.

The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies such as alternating activity with rest will help the patient meet this goal.If the patient needs to use oxygen at home, it will probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient.This nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening HF.The home care nurse visits a 73-year-old Hispanic woman with chronic heart failure. Which clinical manifestations, if assessed by the nurse, would indicate acute decompensated heart failure (pulmonary edema)?

• Fatigue, orthopnea, and dependent edema
• Severe dyspnea and blood-streaked, frothy sputum
• Temperature is 100.4o F and pulse is 102 beats/minute
• Respirations 26 breaths/minute despite oxygen by

nasal cannula

• Severe dyspnea and blood-streaked, frothy sputum

Clinical manifestations of pulmonary edema include anxiety, pallor, cyanosis, clammy and cold skin, severe dyspnea, use of accessory muscles of respiration, a respiratory rate > 30 breaths per minute, orthopnea, wheezing, and coughing with the production of frothy, blood-tinged sputum. Auscultation of the lungs may reveal crackles, wheezes, and rhonchi throughout the lungs. The heart rate is rapid, and blood pressure may be elevated or decreased.

A 54-year-old male patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first?

• Perform a bladder scan to assess for urinary retention.
• Restrict the patient's oral fluid intake to 500 mL per day.
• Assist the patient to a sitting position with arms on the

overbed table.

• Instruct the patient to use pursed-lip breathing until

the dyspnea subsides.

• Assist the patient to a sitting position with arms on the overbed table.

The nurse should place the patient with ADHF in a high Fowler's position with the feet horizontal in the bed or dangling at the bedside. This position helps decrease venous return because of the pooling of blood in the extremities. This position also increases the thoracic capacity, allowing for improved ventilation. Pursed-lip breathing helps with obstructive air trapping but not with acute pulmonary edema. Restricting fluids takes considerable time to have an effect.A 70-year-old woman with chronic heart failure and atrial fibrillation asks the nurse why warfarin (Coumadin) has been prescribed for her to continue at home. Which response by the nurse is accurate?

• "The medication prevents blood clots from forming in

your heart."

• "The medication dissolves clots that develop in your

coronary arteries."

• "The medication reduces clotting by decreasing serum

potassium levels."

• "The medication increases your heart rate so that clots

do not form in your heart."

• "The medication prevents blood clots from forming in your heart."

Chronic heart failure causes enlargement of the chambers of the heart and an altered electrical pathway, especially in the atria. When numerous sites in the atria fire spontaneously and rapidly, atrial fibrillation occurs. Atrial fibrillation promotes thrombus formation within the atria with an increased risk of stroke and requires treatment with cardioversion, antidysrhythmics, and/or anticoagulants. Warfarin is an anticoagulant that interferes with hepatic synthesis of vitamin K-dependent clotting factors.Which of the following patients are MOST at risk for

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

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

is recovering from a myocardial infarction.

• A 55 year old female with a health history of asthma

and hypoparathyroidism.

• A 30 year old male with a history of endocarditis and

has severe mitral stenosis.

• A 45 year old female with lung cancer stage 2.
• A 58 year old female with uncontrolled hypertension

and is being treated for influenza.

A, C, E

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." D 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.