Pathophysiology
and causes
and causes
A nurse is assessing a client who has late-stage heart failure and is experiencing fluid volume overload. Which of the following findings should the nurse expect?
A. Weight gain 1kg (2.2lb) in 1 day
B. Pitting edema +1
C. Client report of nocturnal cough
D. B-Type Natriuretic Peptide (BNP) level of 100 pg/mL
Rationale: A. Weight gain of 1kg (2.2lb) in 1 day alerts the nurse that the client is retaining fluid. This is an indication that the client’s heart failure is worsening.
When assessing your patient with heart failure, which of the following are necessary interventions? SELECT ALL THAT APPLY
A. Monitor blood pressure
B. Increase fluid intake
C. Set low sodium diet
D. Check blood sugar Q6h
E. Assess for edema
Rationale: A, C, E. High blood pressure can make heart failure worse by putting more strain on the heart. High BP or HR means the heart is working overtime. Patients with HF tend to experience fluid overload causing edema and sodium retention. We want to limit fluid intake and decrease sodium excess to prevent overflow of fluid and bloating. Excessive sodium can also increase BP making HF worse. Accucheck is not directly indicated for HF.
A nurse is assessing a client who has fluid volume overload from a cardiovascular disorder. Which of the following manifestations should the nurse expect? (Select all that apply)
A. Jugular vein distension
B. Moist crackles
C. Postural hypotension
D. Increased heart rate
E. Fever
Rationale: A, B, D: Jugular vein distension – the increase in venous pressure due to excessive circulating blood volume results in neck vein distension. Moist crackles – an indicator of pulmonary edema that can quickly lead to death. Increased heart rate – fluid volume excess (hypervolemia), an expansion of fluid volume in the extracellular fluid compartment. This results in increased heart rate and bounding pulses.
A nurse is providing education to a client prescribed furosemide (Lasix) for heart failure management. Which instruction should the nurse include in the teaching plan?
a. "Take furosemide with antacids to reduce gastric irritation."
b. "Monitor your potassium levels regularly while taking furosemide."
c. "Increase your intake of foods high in sodium while on furosemide."
d. "Take furosemide in the morning to minimize nocturia."
The correct answer is (b). Furosemide is a loop diuretic that can cause potassium depletion. Monitoring potassium levels regularly is essential to prevent hypokalemia, a potential adverse effect of furosemide. Options (a), (c), and (d) are incorrect as they promote behaviors or instructions that are not recommended for clients taking furosemide.
When giving a report, the nurse preceptor states “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.”
As a quality nursing student, you know that this describes which of the following?
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
Rationale: When there is a filling problem, this is a diastolic issue. Since blood is backing up into the lungs, this indicates left side dysfunction. If it were right side dysfunction, the blood would backup into the body causing edema. A systolic issue involves a pumping problem.
A client with heart failure is prescribed with metoprolol (Lopressor). The nurse should instruct the client to report which side effect immediately to the healthcare provider?
A. Dry mouth
B. Bradycardia
C. Headache
D. Muscle cramps
Rationale: The correct answer is (b) Bradycardia. Metoprolol is a beta-blocker that can cause bradycardia as a side effect due to its negative chronotropic effect on the heart. Bradycardia can lead to symptoms such as dizziness, fatigue, and syncope, and severe bradycardia may require immediate medical attention.
A female presents to the ER with fatigue, trouble breathing, hypertension and hypervolemia. Upon assessment it is noted that she has decreased urine output and gained 8 pounds this week.
Based on this information, what side of the patients heart is failing?
A. Left side: Deoxygenated blood is not getting to the body
B. Right side: Oxygenated blood is not getting to the lungs
C. Left side: Oxygenated blood is not getting to the body
D. Right side: Deoxygenated blood is not getting to the body
C. Left side: Oxygenated blood is not getting to the body
Rationale: When the L side of the heart fails, the body is not getting oxygenated blood with contractions. This causes fatigue, weakness, and decreased oxygenation. When the body feels it is not getting enough oxygen, it will attempt to raise blood pressure by holding onto fluid and increasing blood volume. This in turn causes decreased urine output and weight gain.
Which medication is most likely to be prescribed for a patient experiencing systolic heart failure to improve cardiac output by increasing myocardial contractility?
A) Beta-blockers
B) Diuretics
C) Angiotensin-converting enzyme (ACE) inhibitors
D) Digoxin
Rationale: D. Digoxin increases myocardial contractility, directly addressing the reduced ejection fraction characteristic of systolic heart failure.
A 60yoM presents with dyspnea upon exertion with an echocardiogram showing a preserved ejection fraction with Left ventricular hypertrophy. What type of heart failure does this indicate?
A. Right-sided heart failure
B. Systolic heart failure (HFrEF)
C. Diastolic heart failure (HFpEF)
Rationale: Diastolic heart failure (HFpEF) is failure of the Left side of the heart. When the left side of the heart begins to fail, it thickens to try and work harder. It is trying to "preserve"
A client with heart failure is prescribed a low-sodium diet. Which food item should the nurse instruct the client to avoid?
A. Cream of Chicken soup
B. Fruits
C. Whole grains
D. Lean proteins
Rationale: The correct answer is Canned soup. Canned soups often contain high amounts of sodium.
A patient presents with signs of increased jugular venous distension, hepatomegaly, and lower extremity edema. These manifestations are most consistent with:
A. Left-sided heart failure
B. Right-sided heart failure
C. Acute myocardial infarction
D. Valvular heart disease
Rationale: B. Right-sided heart failure leads to systemic venous congestion, resulting in increased jugular venous pressure, hepatomegaly, and peripheral edema.
A nurse is caring for a client with heart failure who is prescribed with carvedilol (Coreg). Which statement by the client indicates understanding of the therapeutic effects of carvedilol?
a. "I will take my medication with meals to reduce stomach upset."
b. "I will monitor my blood pressure regularly to ensure it remains stable."
c. "I will avoid sudden changes in position to prevent dizziness."
d. "I will increase my fluid intake to prevent dehydration."
Rationale: The correct answer is (b). Carvedilol, a beta-blocker, helps in reducing blood pressure and improving cardiac function in heart failure. Monitoring blood pressure regularly allows the client to assess the medication's effectiveness in controlling blood pressure and managing heart failure symptoms. Options (a), (c), and (d) are incorrect as they do not specifically address the therapeutic effects of carvedilol.