Heart Failure
A patient with a history of chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. The patient has pitting edema in both ankles, blood pressure (BP) of 170/100, an apical pulse rate of 92, and respirations 28. The most important assessment for the nurse to accomplish next is to
a. auscultate the lung sounds.
b. assess the orientation.
c. check the capillary refill.
d. palpate the abdomen.
a. auscultate the lung sounds.
The nurse is caring for the patient with unstable angina. She is administering Cardizem as ordered to this client. The nurse knows that this medication is mainly used for the following reason: (Select all that Apply)
A) This medication will help increase myocardial contraction
B) This medication will relax the heart and decrease the strength of the heart contractions
C) This medication will increase the heart rate and therefore increase perfusion to the heart
D) This medication will vasodilate blood vessels reducing preload and opening up coronary arteries
E) This medication will protects the heart cells by preventing remodeling
B) This medication will relax the heart and decrease the strength of the heart contractions
D) This medication will vasodilate blood vessels reducing preload and opening up coronary arteries
The nurse would assess a patient with complaints of chest pain for which clinical manifestations associated with a myocardial infarction (MI)? (select all that apply)
a) Flushing
b) Ashen skin
c) Diaphoresis
d) Nausea and vomiting
e) S3 or S4 heart sounds
b) Ashen skin
c) Diaphoresis
d) Nausea and vomiting
e) S3 or S4 heart sounds
Which individuals would the nurse identify as having the highest risk for CAD?
A. A 45-year-old depressed male with a high-stress job
B. A 60-year-old male with below normal homocysteine levels
C. A 54-year-old female vegetarian with elevated high-density lipoprotein (HDL) levels
D. A 62-year-old female who has a sedentary lifestyle and body mass index (BMI) of 23 kg/m2
A. A 45-year-old depressed male with a high-stress job
While caring for a patient with an acute myocardial infarction, the nurse monitors the patient closely, knowing that the most common complication of myocardial infarction is
a Pericarditis
b Arrhythmias
c Cardiogenic shock
d Congestive heart failure
b Arrhythmias
A patient admitted to the hospital with an exacerbation of chronic heart failure tells the nurse, "I felt fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse can best document this assessment information as
a. pulsus alternans.
b. paroxysmal nocturnal dyspnea.
c. two-pillow orthopnea.
d. acute bilateral pleural effusion.
b. paroxysmal nocturnal dyspnea.
A patient in the intensive care unit with ADHF complains of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been ordered for the patient. The first action by the nurse will be to:
a. administer IV morphine sulfate 2 mg.
b. give IV diazepam (Valium) 2.5 mg.
c. increase dopamine (Intropin) infusion by 2 mcg/kg/min.
d. increase nitroglycerin (Tridil) infusion by 5 mcg/min.
a. administer IV morphine sulfate 2 mg.
In caring for the patient with angina, the patient said, "I walked to the bathroom. While I was having a bowel movement, I started having the worst chest pain ever, like before I was admitted. I called for a nurse, but the pain is gone now." What further assessment data should the nurse obtain from the patient?
a) "What precipitated the pain?"
b) "Has the pain changed this time?"
c) "In what areas did you feel this pain?"
d) "Rate the pain on a scale from 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine."
c) "In what areas did you feel this pain?"
When providing nutritional counseling for patients at risk for CAD, which foods would the nurse encourage patients to include in their diet? (select all that apply)
A. Tofu
B. Walnuts
C. Tuna fish
D. Whole milk
E. Orange juice
A. Tofu
B. Walnuts
C. Tuna fish
What is the clinical significance of atrial flutter?
A. Myocardial Infarction
B. Cardiac Arrest
C. Decreased CO
D. Orthostatic HTN
C. Decreased CO
The nurse working in the heart failure clinic will know that teaching for a 74-year-old patient with newly diagnosed heart failure has been effective when the patient
a. says that the nitroglycerin patch will be used for any chest pain that develops.
b. calls when the weight increases from 124 to 130 pounds in a week.
c. tells the home care nurse that furosemide (Lasix) is taken daily at bedtime.
d. makes an appointment to see the doctor at least once yearly.
b. calls when the weight increases from 124 to 130 pounds in a week.
A home health care patient has recently started taking oral digoxin (Lanoxin) and furosemide (Lasix) for control of heart failure. The patient data that will require the most immediate action by the nurse is if the patient's
a. weight increases from 120 pounds to 122 pounds over 3 days.
b. liver is palpable 2 cm below the ribs on the right side.
c. serum potassium level is 3.0 mEq/L after 1 week of therapy.
d. has 1 to 2+ edema in the feet and ankles in the morning.
c. serum potassium level is 3.0 mEq/L after 1 week of therapy.
When planning emergent care for a patient with a suspected MI, what should the nurse anticipate administrating?
a) Oxygen, nitroglycerin, aspirin, and morphine
b) Oxygen, furosemide (Lasix), nitroglycerin, and meperidine
c) Aspirin, nitroprusside (Nipride), dopamine (Intropin), and oxygen
d) Nitroglycerin, lorazepam (Ativan), oxygen, and warfarin (Coumadin)
a) Oxygen, nitroglycerin, aspirin, and morphine
The nurse prepares a discharge teaching plan for a 44-year-old male patient who has recently been diagnosed with coronary artery disease. Which risk factor should the nurse plan to focus on during the teaching session?
A. Type A personality
B. Elevated serum lipids
C. Family cardiac history
D. Hyperhomocysteinemia
B. Elevated serum lipids
Which of the following is NOT an appropriate treatment for atrial fibrillation?
A. diltiazem, digitalis, metoprolol
B. amiodarone or synchronized cardioversion
C. anticoagulants: warfarin
D. dopamine
D. dopamine
You have a patient with heart failure who is constipated. What would the nurse recommend?
A) Walking
B) Increase fiber
C) Stool softener
D) Drink extra water
A) Walking
B) Increase fiber
C) Stool softener
The nurse is assessing the client for possible evidence of digitalis toxicity. The nurse acknowledges that which is included in the signs and symptoms for digitalis toxicity?
a. Pulse (heart) rate of 100 beats/min
b. Pulse of 72 with an irregular rate
c. Pulse greater than 60 beats/min and irregular rate
d. Pulse below 60 beats/min and irregular rate
d. Pulse below 60 beats/min and irregular rate
The nurse is caring for a client diagnosed with a myocardial infarction who is experiencing chest pain. Which interventions should the nurse implement first? Select All that Apply
1. Administer morphine sulfate Intramuscularly
2. Administer an aspirin orally
3. Apply oxygen via nasal cannula
4. Place the client in a supine position
5. Administer nitroglycerin subcutaneously
2. Administer an aspirin orally
3. Apply oxygen via nasal cannula
A 74-year-old man with a history of prostate cancer and hypertension is admitted to the emergency department with substernal chest pain. Which action will the nurse complete before administering sublingual nitroglycerin?
A. Administer morphine sulfate IV.
B. Auscultate heart and lung sounds.
C. Obtain a 12-lead electrocardiogram (ECG).
D. Assess for coronary artery disease risk factors.
C. Obtain a 12-lead electrocardiogram (ECG).
What are shockable heart rhythms? (Select all that apply)
A. ventricular fibrillation
B. asystole
C. pulseless ventricular tachycardia
D. atrial flutter
A. ventricular fibrillation
C. pulseless ventricular tachycardia
Which food item should the heart failure patient avoid? (Select all that apply)
A) Chips
B) Fruits
C) Veggies
D) Grilled chicken & fries
E) Canned beans
F) Bread
A) Chips
D) Grilled chicken & fries
E) Canned beans
The nurse acknowledges that beta blockers are as effective as antianginals because they do what?
a. Increase oxygen to the systemic circulation.
b. Maintain heart rate and blood pressure.
c. Decrease heart rate and decrease myocardial contractility.
d. Decrease heart rate and increase myocardial contractility.
d. Decrease heart rate and increase myocardial contractility.
The nurse is administering a calcium channel blocker to the client diagnosed with a myocardial infarction. Which assessment data would cause the nurse to question administering this medication?
1. The client's apical pulse is 64
2. The client's calcium level is elevated
3. The client's telemetry shows occasional PVCs
4. The client's blood pressure is 90/62
4. The client's blood pressure is 90/62
In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder include (select all that apply):
a. diffuse involvement of plaque formation in coronary veins
b. abnormal levels of cholesterol, especially low-density lipoproteins
c. accumulation of lipid and fibrous tissue within the coronary arteries
d. development of angina due to a decreased blood supply to the heart muscle
e. chronic vasoconstriction of coronary arteries leading to permanent vasospasm
b. abnormal levels of cholesterol, especially low-density lipoproteins
c. accumulation of lipid and fibrous tissue within the coronary arteries
d. development of angina due to a decreased blood supply to the heart muscle
The nurse administers amiodarone (Cordarone) to a client with ventricular tachycardia. Which monitoring by the nurse is necessary with this drug? Select all that apply.
a. Respiratory rate
b. QT interval
c. Heart rate and rhythm
d. Magnesium level
e. Urine output
b. QT interval
c. Heart rate and rhythm
d. Magnesium level