Congestive Heart Failure
Pulmonary Edema
Chronic Heart Failure
Disorders of Veins and Lymphatics
Peripheral Vascular Disease
100
In which disorder would a nurse expect to assess sacral edema in a bedridden client? a. Right sided heart failure b. Pulmonary emboli c. Diabetes Mellitus d. Renal disease
Answer: a. right sided heart failure Rationale: Sacral, or dependent, edema is secondary to the right sided heart failure. The most accurate area on the body to assess dependent edema in a bedridden client is the sacral area. Diabetes Mellitus, pulmonary emboli, and renal disease aren't directly linked to sacral edema.
100
A hallmark sign of pulmonary edema is? A. Think, green tenacious sputum B. Pink, frothy sputum C. Clear, thin nasal secretions D. Rust-colored pulmonary secretions
B. Pink, frothy sputum A client with pulmonary edema has acute and severe dyspnea, shortness of breath, and anxiety. The skin is cool, clammy, and cyanotic. A productive cough with pink, frothy sputum is also present.
100
What is the earliest signs and symptoms of heart failure? A. fatigue and weakness B. bradycardia C. edema D. cyanosis E. tachycardia
Answer: A-fatigue and weakness Rationale: Fatigue and weakness are the earliest symptoms of heart failure. They occur from the decreased amount of oxygen reaching the tissues. During the day the fatigue can worsen, especially with activity.
100
A patient is placed on compete bed rest. The nurse understands that the patient is at risk for the development of which venous complication? 1. Thrombophlebitis 2. Aneurysm 3. Varicose Vein 4. Thromboangiitis
Rationale: Answer 1; Thrombophlebitis. Immobility is associated with venous stasis, pooling, and coagulability of the blood, all of which increases the potential for the development of thrombophlebitis. Thrombophlebitis is the presence of thrombus in the venous system and the associated inflammatory response in the vessel wall.
100
The nurse is discharging a patient diagnosed with DVT from the hospital. Which discharge instructions should be provided to the patient? A. Have the PTT levels checked weekly until therapeutic range is achieved B. Staying at home is best, but if traveling, airplanes are better than automobiles C. Avoid green leafy vegetables and notify the physician of red or brown urine D. Wear knee stockings with an elastic band around the top
Answer: C Green leafy vegetables contain Vitamin K, which is the antidote for Warfarin. These foods will interfere with the action of Warfarin. Red or brown urine may indicate bleeding. The patient is not restricted to the home. The patient should not take part in any activity that does not allow frequent active passive leg exercises. If in a automobile, the patient should stop to take frequent breaks to walk around. The patient should be instructed to wear stockings that do not constrict any area of the leg
200
A client with left-sided heart failure complains of increasingly shortness of breath and is agitated and coughing up pink tinged, foamy sputum. The nurse should recognize these as signs and symptoms of : a. right-sided heart failure b. acute pulmonary edema c. pneumonia d. cardiogenic shock
Answer: b. acute pulmonary edema Rationale: Because of decreased contractility and increased fluid volume and pressure in clients with heart failure, fluid maybe driven from the pulmonary capillary beds into the alveoli, causing pulmonary edema. In right-sided heart failure, the client exhibit hepatomegaly, jugular vein distention, and peripheral edema. In pneumonia the client would have a temperature spike and sputum that varies in color. Cardiogenic shock would show signs of hypotension and tachycardia.
200
Which of the following would be a priority nursing diagnosis for the client with heart failure and pulmonary edema? A. Risk for infection related to stasis of alveolar secretions B. Impaired skin integrity related to pressure C. Activity intolerance related to pump failure D. Constipation related to immobility
C. Activity intolerance related to pump failure Activity intolerance is a primary problem for clients with heart failure and pulmonary edema. The decreased cardiac output associated with heart failure leads to reduced oxygen and fatigue. Clients frequently complain of dyspnea and fatigue. The client could be at risk for infection related to stasis of secretions or impaired skin integrity related to pressure. However, these are not the priority nursing diagnoses for the client with HF and pulmonary edema, nor is constipation related to immobility.
200
A patient asks the nurse what heart failure is. Which of the following is the nurse's best response? A. "The heart pumps too much blood into the pulmonary veins." B. "The heart is unable to pump enough blood for the body's oxygen needs." C. "Heart failure is a buildup of blood in the aorta from the heart's left ventricle." D. "With a failing heart, the heart stops beating, so blood is not pumped out."
Answer: B Rationale: In heart failure, the heart cannot pump enough blood to meet the body's oxygen needs.
200
A nurse is planning a visit for a client with a deep vein thrombophlebitis who is being managed at home with bedrest and anticoagulant therapy. Which of the following topics will be included in the teaching plan? (Select all that apply) 1. Dietary measures to increase Vitamin K consumption 2. Review of signs and symptoms of when to call the physician or nurse-midwife 3. Instruction on the application of TED stockings 4. Management of childcare
Rationale: Answers 1, 2, and 4 are correct; home care instructions should include a review of when to notify the primary caregiver, how to manage childcare and household activities while on bedrest, and dietary measures to support therapy. Answer 3 is incorrect; instruction on the application of TED stockings should be provided in the acute care setting prior to discharge.
200
A nurse is caring for a patient with peripheral vascular disease (PVD). The patient complains of burning and tingling of the hands and feet and cannot tolerate touch of any kind. Which of the following is the most likely explanation for these symptoms? A.Inadequate tissue perfusion leading to nerve damage. B.Fluid overload leading to compression of nerve tissue. C.Sensation distortion due to psychiatric disturbance. D.Inflammation of the skin on the hands and feet.
Answer: A Patients with peripheral vascular disease often sustain nerve damage as a result of inadequate tissue perfusion. Fluid overload is not characteristic of PVD. There is nothing to indicate psychiatric disturbance in the patient. Skin changes in PVD are secondary to decreased tissue perfusion rather than primary inflammation.
300
In a client with chronic bronchitis, which sign would lead the nurse to suspect right sided heart failure? a. cyanosis b. bilateral crackles c. productive cough d. leg edema
Answer: d. leg edema Rationale: When the left ventricle fails, increased fluid pressure is, in effect, transferred back through the lungs, ultimately damaging the heart's right side. When the right side loses pumping power, blood backs up in the body's veins. This usually causes swelling in the legs and ankles. Right sided heart failure is characterized by signs of circulatory congestion such as leg edema.
300
A 63-year-old female presents to the emergency department in respiratory distress manifested by tachypnea, labored respirations, cyanosis, and crackles and wheezes noted upon auscultation. The client is diagnosed with acute pulmonary edema. The nurse anticipates the administration of which of the following as the drug of choice to treat the client with acute pulmonary edema? A. Dopamine B. Nitroprusside (Nipride) C. Morphine Sulfate D. Furosemide (Lasix)
C. Morphine Sulfate Morphine Sulfate is a drug of choice for treating acute pulmonary edema. Morphine relieves anxiety, improves breathing, and also is a venous vasodilator.
300
Which of the following does the nurse understand is a major cause of left-sided heart failure? A. Hypertension B. Congenital heart defects C. Pulmonary valve stenosis D. Septal defects
Answer: A Rationale: Hypertension contributes to left-sided heart failure because the left ventricle must pump against increased pressure in the aorta from the hypertension.
300
A nurse is caring for a client with a superficial thrombophlebitis. Which of the following is the most appropriate nursing action? 1. Administer anticoagulants per order 2. Elevate the affected limb 3. Apply ice packs to the affected limb 4. Administer antibiotics per order
Rationale: Answer 2 is correct; Elevate the affected limb. Elevation of the limb promotes venous return and helps to reduce edema. Answer 1 is incorrect; anticoagulants are used to treat deep vein thrombosis. Answer 3 is incorrect; ice packs are used for hematomas. Answer 4 is incorrect; antibiotic therapy is not indicated.
300
A nurse is providing discharge information to a patient with peripheral vascular disease. Which of the following information should be included in instructions? A.Walk barefoot whenever possible. B.Use a heating pad to keep feet warm. C.Avoid crossing the legs. D.Use antibacterial ointment to treat skin lesions at risk of infection.
Answer: C Patients with peripheral vascular disease should avoid crossing the legs because this can impede blood flow. Walking barefoot is not advised, as foot protection is important to avoid trauma that may lead to serious infection. Heating pads can cause injury, which can also increase the risk of infection. Skin lesions at risk for infection should be examined and treated by a physician.
400
The nurse is assessing a client with heart failure. The breath sounds commonly auscultated in clients with heart failure are: a. bronchial c. fine crackles b. friction rubs d. tracheal
Answer: c. fine crackles Rationale: Fine crackles are caused by fluid in the alveoli and commonly occur in clients with heart failure. Tracheal breath sounds are auscultated over the trachea. Bronchial breath sounds are heard over the mainstem bronchi. Friction rub occur with pleural inflammation.
400
Signs and symptoms of pulmonary edema include? (Select all that apply) A. Pink, frothy sputum B. Cold, clammy skin C. Anxiety D. Lethargy E. Red colored skin F. Restlessness
A, B, C, D, F. (All except E) Common signs and symptoms of pulmonary edema include pink, frothy sputum, coughing, cold and clammy skin, severe dyspnea, anxiety, restlessness, lethargy, and pale skin color.
400
A patient has been treated for heart failure is being discharged from the hospital on 20 mg furosemide (Lasix) daily. Which of the following statements by the patient would indicate understanding of instructions for this medication? A. "I will take the Lasix in the morning." B. "I will take the Lasix at bedtime." C. "I will drink lots of fluids with the Lasix." D. "I will take it with meals."
Answer: C Rationale: A diuretic should be taken in the morning to prevent interference with sleep at night.
400
A 24-year- old man seeks medical attention for complaints of claudication in the arch of the foot . A nurse also notes superficial thrombophlebitis of the lower leg. For which risk factor should the nurse assess based on these clinical findings? 1 . Smoking history 2 . Recent exposure to allergens 3 . History of recent insect bites 4 . Familial tendency toward peripheral vascular disease
Rationale: Answer 1 is correct; Smoking History. The mixture of arterial and venous manifestations (claudication and phlebitis, respectively) in the young male client suggests thromboangiitis obliterans (Buerger's disease). This is relatively uncommon disorder, characterized by inflammation and thrombosis of smaller arteries and veins. This disorder is typically found in young men who smoke. The cause is unknown but is suspected to have a autoimmune component.
400
Claudication is a well-known effect of peripheral vascular disease. Which of the following facts about claudication is correct? Select all that apply: A. It results when oxygen demand is greater than oxygen supply. B. It is characterized by pain that often occurs duing rest. C. It is a result of tissue hypoxia. D. It is characterized by cramping and weakness.
Answer: A, C, and D Claudication describes the pain experienced by a patient with peripheral vascular disease when oxygen demand in the leg muscles exceeds the oxygen supply. This most often occurs during activity when demand increases in muscle tissue. The tissue becomes hypoxic, causing cramping, weakness, and discomfort.
500
All of the following statements regarding β-blockertherapy in the treatment of heart failure are cor- rect EXCEPT: (A)β-Blockers are classified based on their receptor specificity and are not uniform as a class of drugs (B)β-Blocker therapy results in greater improvements in ejection fractions among those with nonischemic cardiomyopathy compared to ischemic cardiomyopathy C) β-Blocker therapy should be initiated only when the patient is euvolemic (D) β-Blocker therapy should not be initiated in patients with severe class IV CHF
Answer: D) Rationale: β-Blocker therapy should not be initiated in pa- tients with severe class IV CHF. Recent data from the Copernicus trial revealed a significant decrease in mortality with use of carvedilol in patients with class IV heart failure. Subgroup analysis of a much smaller population from the MERIT trial showed mortality benefit from metoprolol tartrate in this patient group. Since β-blockers have different receptor affinities, they cannot be considered interchangeable as a pharmacologic class for the treatment of CHF.
500
A client with acute PE receives furosemide (lasix). What assessment finding indicates that the intervention is working? A. Potassium level decreases from 4.5 to 3.5 mEq/L B. Crackles auscultated in the bases C. Lungs are clear D. Urinary output of 30mL/hr
C. Lungs are clear. Rationale: Furosemide (lasix) is a potent, rapid acting diuretic that would be the drug of choice to treat acute PE. A PE is a type of severe fluid congestion in the alveoli of the lungs. Therefore taking lasix's would be taken to clear the fluid out of the lungs.
500
Which of the following assessments should the nurse teach the patient to perform to monitor fluid status at home? A. Weigh daily B. Weigh weekly C. Weigh biweekly D. Weigh every other day
Answer: A Rationale: Daily weights reflect fluid volume changes as weight gain or loss.
500
A client diagnosed with thrombophlebitis 1 day ago suddenly complains of chest pain and shortness of breath, and the client is visibly anxious. The nurse immediately checks the client for signs and symptoms of: 1. Pneumonia 2. Pulmonary Edema 3. Pulmonary Embolism 4. Myocardial Infarction
Rationale: Answer 3 is correct; Pulmonary embolism. Pulmonary Embolism is life threatening complication of deep vein thrombosis and thrombophlebitis. Chest pain is the most common symptom, which is sudden in onset and may be aggravated by breathing. Other signs and symptoms include dyspnea, cough, diaphoresis, and apprehension.
500
A 23 year old patient in the 27th week of pregnancy has been hospitalized on complete bed rest for 6 days. She experiences sudden shortness of breath, accompanied by chest pain. Which of the following conditions is the most likely cause of her symptoms? A. Myocardial infarction due to a history of atherosclerosis. B. Pulmonary embolism due to deep vein thrombosis (DVT). C. Anxiety attack due to worries about her baby's health. D. Congestive heart failure due to fluid overload.
Answer: B In a hospitalized patient on prolonged bed rest, he most likely cause of sudden onset shortness of breath and chest pain is pulmonary embolism. Pregnancy and prolonged inactivity both increase the risk of clot formation in the deep veins of the legs. These clots can then break loose and travel to the lungs. Myocardial infarction and atherosclerosis are unlikely in a 27-year-old woman, as is congestive heart failure due to fluid overload. There is no reason to suspect an anxiety disorder in this patient. Though anxiety is a possible cause of her symptoms, the seriousness of pulmonary embolism demands that it be considered first.
M
e
n
u