| To the LEFT to the LEFT | RIGHT about now | Under [cardiac] arrest (and other complications) | My heart is so full rn | Teach me, teacher |
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What is A,B,C,D
Which of the following is true about a left sided heart failure patient? (Select all that apply)
A. They may produce a pink, frothy sputum B. Their cough may be confused for a COPD cough C. Crackles will be heard when auscultating the lungs D. Nocturia is a common symptom E. Edema is typically seen in the patient's legs |
What is B. Renal failure
Increased venous pressure leads to jugular venous distention (JVD) and increased capillary hydrostatic pressure throughout the venous system. Systemic clinical manifestations include edema of the lower extremities (dependent edema), hepatomegaly (enlargement of the liver), ascites (accumulation of fluid in the peritoneal cavity), and weight gain due to retention of fluid. (p.823)
Which of the following is not a symptom of right sided heart failure?
A. Jugular vein distention B. Renal failure C. Hepatomegaly D. Ascites |
What is A. to drain fluid from the pericardial sac
If cardiac function becomes seriously impaired, pericardiocentesis (puncture of the pericardial sac to aspirate pericardial fluid) is performed. (p.836)
What is the purpose of a pericardiocentesis?
A. to drain fluid from the pericardial sac B. to remove the pericardial sac C. to reduce the risk of a heart attack D. to get the patient off diuretics |
What is B. a weakened heart muscle
Two major types of HF are identified by assessment of left ventricular function, usually by echocardiogram. The most common type is an alteration in ventricular contraction called systolic heart failure, which is characterized by a weakened heart muscle. A second type is diastolic heart failure, which is characterized by a stiff and noncompliant heart muscle, making it difficult for the ventricle to fill (p.819)
What is systolic heart failure characterized by?
A. A heart muscle not contracting at all B. A heart muscle that has been weakened C. A heart muscle working too quickly D. A heart muscle that is stiff and noncompliant |
What is A. Low sodium
Chart 29-5 p.830 A low sodium daily diet will still contain about 2000 mg of sodium. Fresh fruits and vegetables are low in sodium and should be encouraged.
Which of the following diets would a nurse encourage a patient to follow?
A. Low sodium B. Low fat C. High carbohydrate D. High protein |
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What is D. Edema
The clinical manifestations of pulmonary congestion include dyspnea, cough, pulmonary crackles, and low oxygen saturation levels. An extra heart sound, the S3, or “ventricular gallop,” may be detected on auscultation. (p.822)
Which of the following is NOT a symptom of left sided heart failure?
A. Ventricular gallop B. S3 heart sound C. Dry cough D. Edema |
What is E. A and B are correct
A patient has a history of right heart failure. Which of the following statements by the patient indicates the patient may be experiencing heart failure exacerbation?
A.“I’ve noticed that I’ve gained 6 lbs in one week” B.“While I sleep, I have to prop myself up with a pillow so I can breathe” C.“I haven’t noticed any swelling in my feet or hands lately” D.Options B and C are correct E.A and B are correct F.All options are correct |
What is B,D,E
An increase in pericardial fluid raises the pressure within the pericardial sac and compresses the heart. This has the following effects: -Elevated pressure in all cardiac chambers -Decreased venous return due to atrial compression -Inability of the ventricles to distend and fill adequately (p.836)
Which of the following occur when a patient has an increasing pericardial effusion? (Select all that apply)
A.Decreased pressure in all cardiac chambers B.Elevated pressure in all cardiac chambers C.Destruction of the tricuspid and pulmonary valves D.Decreased venous return due to atrial compression E.Inability of the ventricles to distend and fill adequately |
What is C. 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.
A 54-year-old male patient who had bladder surgery 2 days ago develops acute decompensated heart failure with severe dyspnea. Which action by the nurse would be indicated first?
A. Perform a bladder scan to assess for urinary retention. B. Restrict the patient's oral fluid intake to 500 mL per day. C. Assist the patient to a sitting position with arms on the overbed table. D. Instruct the patient to use pursed-lip breathing until the dyspnea subsides. |
What is D. Going for a short walk every evening, increasing the distance each night
Chart 29-4 (p.826)
A nurse is discussing an exercise plan for a patient with heart failure. Which of the following would be best?
A. Going for a 2 mile walk on a hot, sunny day B. Going to kickboxing class once a week C. Going for a run right after dinner D. Going for a short walk every evening, increasing the distance each night |
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What is A. Place additional pillows under the patient's head.
Patient is probably experiencing orthopnea, and the best treatment for that is to not have the patient lie completely flat (p.822)
A patient with left sided heart failure calls their PCP and states they are having trouble sleeping at night because they can't breathe. What would the nurse recommend for the patient?
A. Place additional pillows under the patient's head B. Place pillows under patient's feet C. Request provider prescribe patient wear 2L oxygen via nasal cannula only when sleeping D. Tell the patient to take a double dose of their diuretic medication before bed |
What is A. Elevate patient's feet with pillows
Edema usually affects the feet and ankles and worsens when the patient stands or sits for a long period. The edema may decrease when the patient elevates the legs.(p.823)
Which nursing intervention would you give a patient with right sided heart?
A. Elevate patient's feet with pillows B. Encourage patient to eat a high carbohydrate diet C. Promote high intensity exercising D. Check patient's weight once a week |
What is C. nitroglycerin
Nitroglycerin would not relieve the chest pain in a patient with a PE. Anticoagulant therapy with unfractionated heparin, low–molecular-weight heparin, fondaparinux (Arixtra) or rivaroxaban (Xarelto) is started when PE is suspected (p.836)
A patient presents to the ED with dyspnea, pleuritic chest pain, and tachypnea. Upon examination of a chest CT angiogram, patient has a pulmonary embolism. Which medication would the nurse NOT administer to treat this?
A. fondaparinux (Arixtra) B. heparin C. nitroglycerin D. rivaroxaban (Xarelto) |
What is C. Stage C
Stage A: Patient is at high risk of developing HF, but shows no symptoms (Symptoms: Htn, diabetes, atherosclerosis) Stage B: Patient with heart dysfunction, but has no symptoms of HF (Symptoms: H/o MI, left ventricular hypertrophy, low ejection fraction) Stage C: Patient with heart dysfunction, but has symptoms of HF (Symptoms: SOB, fatigue, decreased energy) Stage D: Patients with refractory end-stage HF requiring specialized interventions (Symptoms: HF symptoms with use of therapies) (p.820)
Patient presents to the ED with increased shortness of breath and fatigue. Patient was hospitalized 10 days ago for similar symptoms and was diagnosed with heart failure. What stage of heart failure is this patient in?
A. Stage A B. Stage B C. Stage C D. Stage D |
What is A. 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.
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?
A. Take medications as prescribed. B. Use oxygen when feeling short of breath. C. Only ask the physician's office questions. D. Encourage most activity in the morning when rested. |
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What is B. Left ventricle
Pulmonary congestion occurs when the left ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic circulation. The increased left ventricular end-diastolic blood volume increases the left ventricular end-diastolic pressure, which decreases blood flow from the left atrium into the left ventricle during diastole. (p.822)
In patient's with left sided heart failure, which part of the heart is not working effectively?
A. Left atrium B. Left ventricle C. Pulmonic valve D. Right atrium |
What is A,B,C,D,E
chest x-ray and a 12-lead electrocardiogram (ECG) are obtained to assist in the diagnosis. Laboratory studies usually performed during the initial workup include serum electrolytes, blood urea nitrogen (BUN), creatinine, liver function tests, thyroid-stimulating hormone, complete blood count (CBC), BNP, and routine urinalysis. (p.823)
What diagnostic testing with a provider order for a right-sided heart failure patient? (Select all that apply)
A. ECG B. Chest x-ray C. BNP D. Serum electrolytes E. Liver function |
What is D. Cardiogenic shock
Therapeutic modalities for cardiogenic shock include the use of circulatory assist devices, such as the intra-aortic balloon pump (IABP) (Hochman & Reyentovich, 2015). The IABP is a catheter with an inflatable balloon at the end. The catheter is usually inserted through the femoral artery and threaded toward the heart, and the balloon is positioned in the descending thoracic aorta (p.835)
Which of the following complications would an intra-aortic balloon pump (IABP) be used?
A. Cardiac arrest B. Cardiac tamponade C. Pulmonary edema D. Cardiogenic shock |
What is D. Patients who do not respond to routine pharmacologic therapy
IV inotropes (milrinone [Primacor], dobutamine [Dobutrex]) increase the force of myocardial contraction; as such, they may be indicated for hospitalized patients with acute decompensated HF. These agents are used for patients who do not respond to routine pharmacologic therapy and are reserved for patients with severe ventricular dysfunction (p.826)
When would a heart failure patient be given an IV inotrope?
A. Patients who cannot tolerate oral medications B. Patients with Stage B heart failure C. Patients currently on a beta blocker and diuretic D. Patients who do not respond to routine pharmacologic therapy |
What is A. Always check your heart rate before taking digoxin
A key concern associated with digoxin therapy is digitalis toxicity. Clinical manifestations of toxicity include anorexia, nausea, visual disturbances, confusion, and bradycardia (p.825)
A patient was given a digoxin prescription for his heart failure. Which of the following is most important for the nurse to teach him?
A. "Always check your heart rate before taking digoxin" B. "Digoxin must be taken on an empty stomach" C. "Get blood work done every 2 months to monitor calcium levels" D. "With this medication, you can eat whatever you want" |
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What is A,B,D,F
-Ineffective Tissue Perfusion related to ineffective blood flow through left ventricle -Anxiety related to clinical manifestations of HF -Activity intolerance related to decreased cardiac output -Fatigue related to increased energy expended when breathing (p.822 and 829)
Which of the following are appropriate nursing diagnoses for a patient with left-sided heart failure? (Select all that apply)
A. Ineffective Tissue Perfusion B. Anxiety C. Urge Urinary Incontinence D. Activity Intolerance E. Risk for Infection F. Fatigue |
What is C. Adenosine
Table 29-3 p.824
Which of the following medications would NOT be used to treat right-sided heart failure?
A. Digoxin B. Carvedilol C. Adenosine D. Spironolactone |
What is A,B,C
(p.837)
A patient is brought via ambulance in PEA. Which of the following will you do? (Select all that apply)
A. Perform CPR B. Administer epinephrine every 3-5mins C. Attach defibrillator pads to patient's chest D. Give patient a snack E. Administer 2mg adenosine via IVP |
What is B. Urinary retention
Heart failure patients typically do not have issues with urinating, unless there is an underlying condition such as BPH
Which of the following is not a complication of heart failure?
A. Pulmonary edema B. Urinary retention C. Increased fatigue D. Cardiomyopathy |
What is D. Choose interventions to promote comfort and prevent suffering.
The central focus of hospice care is the promotion of comfort and the prevention of suffering.
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?
A. Taper the patient off his current medications. B. Continue education for the patient and his family. C. Pursue experimental therapies or surgical options. D. Choose interventions to promote comfort and prevent suffering. |
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