CM-EVOLVE. Chapter 35 to 68 QUESTIONS AND 100% CORRECT ANSWERS.
CH 35-CARE OF PT W CARDIAC PROBS
1. The nurse prepares to administer digoxin to a client with heart failure and notes the following information: Temperature: 99.8°F
(37.7°C), Pulse: 48 beats/min and irregular, Respirations: 20 breaths/min, Potassium level: 3.2 mEq/L (3.2 mmol/L). What action does the
nurse take?
A. Give the digoxin; reassess the heart rate in 30 minutes.
B. Give the digoxin; document assessment findings in the medical record.
C. Hold the digoxin, and obtain a prescription for an additional dose of furosemide. Incorrect
D. Hold the digoxin, and obtain a prescription for a potassium supplement. Correct
The nurse needs to hold the digoxin and get a prescription for a potassium supplement. Digoxin causes bradycardia and hypokalemia potentiates
digoxin toxicity. Furosemide decreases circulating blood volume and depletes potassium. There is no indication suggesting that the client has fluid
volume excess at this time.
2. A client with heart failure is taking furosemide (Lasix). Which finding concerns the nurse with this new prescription?
E. Serum sodium level of 135 mEq/L (135 mmol/L)
F. Serum potassium level of 2.8 mEq/L (2.8 mmol/L) Correct
G. Serum creatinine of 1.0 mg/dL (88.4 mcmol/L)
H. Serum magnesium level of 1.9 mEq/L (0.95 mmol/L)
The nurse is concerned with the serum potassium level of 2.8 mEq/L (2.8 mmol/L) in a heart failure client taking furosemide. Furosemide is a
loop diuretic and clients taking this drug must be monitored for potassium deficiency from diuretic therapy.
A serum sodium level of 135 mEq/L (135 mmol/L) is a normal value. Heart failure may cause renal insufficiency, but a serum creatinine of 1.0
mg/dL (88.4 mcmol/L) represents a normal value. A diuretic may deplete magnesium, but a serum magnesium level of 1.9 mEq/L (0.95
mmol/L) represents a normal value. 3.Which diagnostic test result is consistent with a diagnosis of heart failure (HF)?
I. Serum potassium level of 3.2 mEq/L (3.2 mmol/L) Incorrect
J. Ejection fraction of 60%
K. B-type natriuretic peptide (BNP) of 760 pg/mL (760 ng/dL) Correct
L. Chest x-ray report showing right middle lobe consolidation
A BNP of 760 pg/ml (760 ng/dL) is consistent with a diagnosis of heart failure. BNP is produced and released by the ventricles when the client
has fluid overload as a result of HF. A normal BNP value is less than 0–99 picograms per milliliter (pg/mL) or 0–99 nanograms per liter (ng/L).
Hypokalemia (serum potassium level of 3.2 mEq/L [3.2 mmol/L]) may occur in response to diuretic therapy for HF, but may also occur with
other conditions. It is not specific to HF. Ejection fraction of 60% represents a normal value of 50% to 70%. Consolidation on chest x-ray may
indicate pneumonia.
1
,CM-EVOLVE. Chapter 35 to 68 QUESTIONS AND 100% CORRECT ANSWERS.
4.The nurse is caring for an 82-year-old client admitted for exacerbation of heart failure (HF). The nurse questions the client about the use of
which medication because it raises an index of suspicion as to the worsening of the client’s HF?
M. Ibuprofen (Motrin) Correct
N. Hydrochlorothiazide (HydroDIURIL) Incorrect
O. NPH insulin
2
,CM-EVOLVE. Chapter 35 to 68 QUESTIONS AND 100% CORRECT ANSWERS.
P. Levothyroxine (Synthroid)
The nurse questions an 82-year-old client with exacerbation of heart failure if the client is taking ibuprofen. Long-term use of nonsteroidal
antiinflammatory drugs such as ibuprofen (Motrin) causes fluid and sodium retention, which can worsen a client’s HF.
A diuretic may be used in the treatment of HF and hypertension. Although diabetes may be a risk factor for cardiovascular disease, it does not
directly cause HF. In proper doses, Synthroid replaces thyroid hormone for those with hypothyroidism. It does not cause HF.
5.A client begins therapy with lisinopril (Prinivil, Zestril). What does the nurse consider at the start of therapy with this medication?
Q. The client’s ability to understand medication teaching
R. The risk for hypotension Correct
S. The potential for bradycardia
T. Liver function tests Incorrect
At the start of therapy with lisinopril, the nurse needs to consider the risk for hypotension. Angiotensin-converting enzyme (ACE) inhibitors
like lisinopril are associated with first-dose hypotension and orthostatic hypotension, which are more likely in those older than 75 years.
Although desirable, ability to understand teaching is not essential. ACE inhibitors are vasodilators and do not affect heart rate. Renal
function, not liver function, may be altered by ACE inhibitors.
Awarded 0.0 points out of 1.0 possible points.
6. The nurse in the emergency department is caring for a client with acute heart failure who is experiencing severe dyspnea, with pink, frothy
sputum, and crackles throughout the lung fields. The nurse reviews the medical record, which contains the following information:
Physical Assessment Findings Diagnostic Findings
Diagnosis: heart failure
Enalapril 10 mg orally
Crackles in all Ejection fraction 30% daily
fields S3 present BNP 560 Heparin 5000 units
Oliguria Sodium 130 mEq/L (130 mmol/L) subcutaneously Furosemide
40 mg IV daily
U.
Enalapril
V.
Heparin
Incorrect
W.
Furosemide
Correct
3
, CM-EVOLVE. Chapter 35 to 68 QUESTIONS AND 100% CORRECT ANSWERS.
X.
4
CH 35-CARE OF PT W CARDIAC PROBS
1. The nurse prepares to administer digoxin to a client with heart failure and notes the following information: Temperature: 99.8°F
(37.7°C), Pulse: 48 beats/min and irregular, Respirations: 20 breaths/min, Potassium level: 3.2 mEq/L (3.2 mmol/L). What action does the
nurse take?
A. Give the digoxin; reassess the heart rate in 30 minutes.
B. Give the digoxin; document assessment findings in the medical record.
C. Hold the digoxin, and obtain a prescription for an additional dose of furosemide. Incorrect
D. Hold the digoxin, and obtain a prescription for a potassium supplement. Correct
The nurse needs to hold the digoxin and get a prescription for a potassium supplement. Digoxin causes bradycardia and hypokalemia potentiates
digoxin toxicity. Furosemide decreases circulating blood volume and depletes potassium. There is no indication suggesting that the client has fluid
volume excess at this time.
2. A client with heart failure is taking furosemide (Lasix). Which finding concerns the nurse with this new prescription?
E. Serum sodium level of 135 mEq/L (135 mmol/L)
F. Serum potassium level of 2.8 mEq/L (2.8 mmol/L) Correct
G. Serum creatinine of 1.0 mg/dL (88.4 mcmol/L)
H. Serum magnesium level of 1.9 mEq/L (0.95 mmol/L)
The nurse is concerned with the serum potassium level of 2.8 mEq/L (2.8 mmol/L) in a heart failure client taking furosemide. Furosemide is a
loop diuretic and clients taking this drug must be monitored for potassium deficiency from diuretic therapy.
A serum sodium level of 135 mEq/L (135 mmol/L) is a normal value. Heart failure may cause renal insufficiency, but a serum creatinine of 1.0
mg/dL (88.4 mcmol/L) represents a normal value. A diuretic may deplete magnesium, but a serum magnesium level of 1.9 mEq/L (0.95
mmol/L) represents a normal value. 3.Which diagnostic test result is consistent with a diagnosis of heart failure (HF)?
I. Serum potassium level of 3.2 mEq/L (3.2 mmol/L) Incorrect
J. Ejection fraction of 60%
K. B-type natriuretic peptide (BNP) of 760 pg/mL (760 ng/dL) Correct
L. Chest x-ray report showing right middle lobe consolidation
A BNP of 760 pg/ml (760 ng/dL) is consistent with a diagnosis of heart failure. BNP is produced and released by the ventricles when the client
has fluid overload as a result of HF. A normal BNP value is less than 0–99 picograms per milliliter (pg/mL) or 0–99 nanograms per liter (ng/L).
Hypokalemia (serum potassium level of 3.2 mEq/L [3.2 mmol/L]) may occur in response to diuretic therapy for HF, but may also occur with
other conditions. It is not specific to HF. Ejection fraction of 60% represents a normal value of 50% to 70%. Consolidation on chest x-ray may
indicate pneumonia.
1
,CM-EVOLVE. Chapter 35 to 68 QUESTIONS AND 100% CORRECT ANSWERS.
4.The nurse is caring for an 82-year-old client admitted for exacerbation of heart failure (HF). The nurse questions the client about the use of
which medication because it raises an index of suspicion as to the worsening of the client’s HF?
M. Ibuprofen (Motrin) Correct
N. Hydrochlorothiazide (HydroDIURIL) Incorrect
O. NPH insulin
2
,CM-EVOLVE. Chapter 35 to 68 QUESTIONS AND 100% CORRECT ANSWERS.
P. Levothyroxine (Synthroid)
The nurse questions an 82-year-old client with exacerbation of heart failure if the client is taking ibuprofen. Long-term use of nonsteroidal
antiinflammatory drugs such as ibuprofen (Motrin) causes fluid and sodium retention, which can worsen a client’s HF.
A diuretic may be used in the treatment of HF and hypertension. Although diabetes may be a risk factor for cardiovascular disease, it does not
directly cause HF. In proper doses, Synthroid replaces thyroid hormone for those with hypothyroidism. It does not cause HF.
5.A client begins therapy with lisinopril (Prinivil, Zestril). What does the nurse consider at the start of therapy with this medication?
Q. The client’s ability to understand medication teaching
R. The risk for hypotension Correct
S. The potential for bradycardia
T. Liver function tests Incorrect
At the start of therapy with lisinopril, the nurse needs to consider the risk for hypotension. Angiotensin-converting enzyme (ACE) inhibitors
like lisinopril are associated with first-dose hypotension and orthostatic hypotension, which are more likely in those older than 75 years.
Although desirable, ability to understand teaching is not essential. ACE inhibitors are vasodilators and do not affect heart rate. Renal
function, not liver function, may be altered by ACE inhibitors.
Awarded 0.0 points out of 1.0 possible points.
6. The nurse in the emergency department is caring for a client with acute heart failure who is experiencing severe dyspnea, with pink, frothy
sputum, and crackles throughout the lung fields. The nurse reviews the medical record, which contains the following information:
Physical Assessment Findings Diagnostic Findings
Diagnosis: heart failure
Enalapril 10 mg orally
Crackles in all Ejection fraction 30% daily
fields S3 present BNP 560 Heparin 5000 units
Oliguria Sodium 130 mEq/L (130 mmol/L) subcutaneously Furosemide
40 mg IV daily
U.
Enalapril
V.
Heparin
Incorrect
W.
Furosemide
Correct
3
, CM-EVOLVE. Chapter 35 to 68 QUESTIONS AND 100% CORRECT ANSWERS.
X.
4
