Case Study For Heart Failure Seminar
Mitral Valve Disease and Shortness of Breath
You are assigned to care for Ms. C., an 81-year-old patient in the cardiac telemetry unit (CTU) who was
admitted today with symptoms of increasing shortness of breath over the last week. You are familiar
with Ms. C., who has a history of mitral valve regurgitation with left ventricular enlargement and has
been admitted multiple times to the CCU and coronary step-down unit. The RN who admitted Ms. C. tells
you that she received furosemide (Lasix) 100 mg IV in the emergency department and her dyspnea has
improved. She is receiving oxygen using a nasal cannula at 3L/minute. She has crackles in both lung
bases and her cardiac monitor shows a sinus rhythm, rate 94-96, with occasional premature ventricular
contractions (PVCs). The only medication currently ordered is morphine sulfate 2-4 mg IV as needed for
chest pain or dyspnea.
Unfortunately, Ms. C.’s condition has deteriorated when you go into the room to assess her. You find that
she is sitting up in bed at a 60-degree angle. She is pale, with circumoral cyanosis, and her respirations
appear labored and rapid. You ask if she feels more short of breath. Because she is unable to catch her
breath enough to speak, she nods her head “yes.”
1. What action should you take first?
a. Listen to her breath sounds
b. Ask when the dyspnea started
c. Increase her oxygen flow rate to 6L/minute
d. Raise the head of the bed to 75 – 85 degrees.
When you assess her, you find that she has crackles audible throughout both lung fields and is coughing
up pink, frothy sputum. Her oxygen saturation is 85% with the oxygen turned up to 6 L/minute. Her
respiratory rate is 38 breaths/minute. She also has 3 – 4+ pitting edema in her feet and to mid-calf. Even
though you have the bed elevated to a 75 – degree angle, you can see her jugular veins distended up to
her jaw line.
2. Which one of these complications are you most concerned about, based on your assessment?
a. Pulmonary edema
b. Cor pulmonale
c. Myocardial infarction
d. Pulmonary embolus
3. Which action will you take next?
a. Call the physician about the patient’s condition
b. Place the patient on a non-rebreather mask with Fio2 at 95%
c. Assist the patient to cough and deep breathe
d. Administer the ordered morphine sulfate 2 mg IV to the patient
This study source was downloaded by 100000866399126 from CourseHero.com on 05-05-2023 05:50:28 GMT -05:00
https://www.coursehero.com/file/68896242/Case-Study-For-Heart-Failure-Seminar-Mitral-Valve-Disease-and-Shortness-of-Breathdoc/
, 4. What additional assessment data are most important to obtain at this time?
a. Skin color and capillary refill
b. Orientation and pupil reaction to light
c. Heart sounds and point of maximum impulse
d. Blood pressure and apical pulse
5. Ms. C.’s BP is 98/52 and her apical pulse is 116 and irregular. The cardiac monitor shows sinus
tachycardia, rate 110 – 120, with frequent multifocal PVCs. You call Ms. C.’s physician and receive
these orders. Which one will you implement first?
a. Obtain serum digoxin level
b. Give furosemide (Lasix) 100 mg IV
c. Check blood potassium level
d. Insert #16 French Foley catheter
6. Which of the orders listed in question5 is best to delegate to the experienced LVN who is
assisting you?
______________________________________
7. While you are waiting for the potassium level to be processed, you administer morphine sulfate
2 mg to Ms. C. A new graduate RN who has just started on the unit asks why you are giving the
morphine. What is the best response?
a. “The morphine will help prevent any chest discomfort from occurring.”
b. “The morphine will decrease Ms. C.’s respiratory rate.”
c. “The morphine will make Ms. C. more comfortable if she has to be intubated.”
d. “The morphine will decrease venous return to the heart.”
8. Ms. C.’s potassium level, faxed to the unit, is 3.1 mEq/L. You call the physician and receive orders
to administer potassium chloride (KCL) 20 mEq IV before administering the furosemide. How will
you administer the KCL?
a. Utilize a syringe pump to infuse the KCL over 10 minutes
b. Dilute the KCL in 100 ml of D5W and infuse over I hour
c. Use a 5-ml syringe and push the KCL over at least 1 minute
d. Add the KCL to 1 liter of D5W and administer over 8 hours
9. After you have infused the KCL, you administer the furosemide to Ms. C. Which of these nursing
actions will be most useful in evaluating whether the furosemide is having the desired effect?
a. Obtain the patient’s daily weight
b. Measure the hourly urine output
c. Monitor the blood pressure
This study source was downloaded by 100000866399126 from CourseHero.com on 05-05-2023 05:50:28 GMT -05:00
https://www.coursehero.com/file/68896242/Case-Study-For-Heart-Failure-Seminar-Mitral-Valve-Disease-and-Shortness-of-Breathdoc/
Mitral Valve Disease and Shortness of Breath
You are assigned to care for Ms. C., an 81-year-old patient in the cardiac telemetry unit (CTU) who was
admitted today with symptoms of increasing shortness of breath over the last week. You are familiar
with Ms. C., who has a history of mitral valve regurgitation with left ventricular enlargement and has
been admitted multiple times to the CCU and coronary step-down unit. The RN who admitted Ms. C. tells
you that she received furosemide (Lasix) 100 mg IV in the emergency department and her dyspnea has
improved. She is receiving oxygen using a nasal cannula at 3L/minute. She has crackles in both lung
bases and her cardiac monitor shows a sinus rhythm, rate 94-96, with occasional premature ventricular
contractions (PVCs). The only medication currently ordered is morphine sulfate 2-4 mg IV as needed for
chest pain or dyspnea.
Unfortunately, Ms. C.’s condition has deteriorated when you go into the room to assess her. You find that
she is sitting up in bed at a 60-degree angle. She is pale, with circumoral cyanosis, and her respirations
appear labored and rapid. You ask if she feels more short of breath. Because she is unable to catch her
breath enough to speak, she nods her head “yes.”
1. What action should you take first?
a. Listen to her breath sounds
b. Ask when the dyspnea started
c. Increase her oxygen flow rate to 6L/minute
d. Raise the head of the bed to 75 – 85 degrees.
When you assess her, you find that she has crackles audible throughout both lung fields and is coughing
up pink, frothy sputum. Her oxygen saturation is 85% with the oxygen turned up to 6 L/minute. Her
respiratory rate is 38 breaths/minute. She also has 3 – 4+ pitting edema in her feet and to mid-calf. Even
though you have the bed elevated to a 75 – degree angle, you can see her jugular veins distended up to
her jaw line.
2. Which one of these complications are you most concerned about, based on your assessment?
a. Pulmonary edema
b. Cor pulmonale
c. Myocardial infarction
d. Pulmonary embolus
3. Which action will you take next?
a. Call the physician about the patient’s condition
b. Place the patient on a non-rebreather mask with Fio2 at 95%
c. Assist the patient to cough and deep breathe
d. Administer the ordered morphine sulfate 2 mg IV to the patient
This study source was downloaded by 100000866399126 from CourseHero.com on 05-05-2023 05:50:28 GMT -05:00
https://www.coursehero.com/file/68896242/Case-Study-For-Heart-Failure-Seminar-Mitral-Valve-Disease-and-Shortness-of-Breathdoc/
, 4. What additional assessment data are most important to obtain at this time?
a. Skin color and capillary refill
b. Orientation and pupil reaction to light
c. Heart sounds and point of maximum impulse
d. Blood pressure and apical pulse
5. Ms. C.’s BP is 98/52 and her apical pulse is 116 and irregular. The cardiac monitor shows sinus
tachycardia, rate 110 – 120, with frequent multifocal PVCs. You call Ms. C.’s physician and receive
these orders. Which one will you implement first?
a. Obtain serum digoxin level
b. Give furosemide (Lasix) 100 mg IV
c. Check blood potassium level
d. Insert #16 French Foley catheter
6. Which of the orders listed in question5 is best to delegate to the experienced LVN who is
assisting you?
______________________________________
7. While you are waiting for the potassium level to be processed, you administer morphine sulfate
2 mg to Ms. C. A new graduate RN who has just started on the unit asks why you are giving the
morphine. What is the best response?
a. “The morphine will help prevent any chest discomfort from occurring.”
b. “The morphine will decrease Ms. C.’s respiratory rate.”
c. “The morphine will make Ms. C. more comfortable if she has to be intubated.”
d. “The morphine will decrease venous return to the heart.”
8. Ms. C.’s potassium level, faxed to the unit, is 3.1 mEq/L. You call the physician and receive orders
to administer potassium chloride (KCL) 20 mEq IV before administering the furosemide. How will
you administer the KCL?
a. Utilize a syringe pump to infuse the KCL over 10 minutes
b. Dilute the KCL in 100 ml of D5W and infuse over I hour
c. Use a 5-ml syringe and push the KCL over at least 1 minute
d. Add the KCL to 1 liter of D5W and administer over 8 hours
9. After you have infused the KCL, you administer the furosemide to Ms. C. Which of these nursing
actions will be most useful in evaluating whether the furosemide is having the desired effect?
a. Obtain the patient’s daily weight
b. Measure the hourly urine output
c. Monitor the blood pressure
This study source was downloaded by 100000866399126 from CourseHero.com on 05-05-2023 05:50:28 GMT -05:00
https://www.coursehero.com/file/68896242/Case-Study-For-Heart-Failure-Seminar-Mitral-Valve-Disease-and-Shortness-of-Breathdoc/
