Heart Failure 2024 Updated Exam Questions And Answers

The nurse is caring for a patient with chronic heart failure and atrial fibrillation that takes digoxin and a thiazide diuretic. Which statement made by the patient indicates that the patient is experiencing a complication related to the medication? "My ankles are still slightly swollen." "I have to urinate a lot after I take those pills!" "I'm not really hungry for lunch. I feel so nauseated and tired." "I check my heart rate regularly. It is usually 80-90 beats per minute." - ANSWER- "I'm not really hungry for lunch. I feel so nauseated and tired." EXPLANATION Drug therapy with digoxin and potassium-losing diuretics (thiazides or loop diuretics) may lead to hypokalemia. The presence of hypokalemia while the patient is on digoxin may lead to digoxin toxicity. Signs of early digoxin toxicity include anorexia, nausea and vomiting, fatigue, headache, depression, and visual changes. Slightly swollen ankles are an expected finding with chronic heart failure; frequent urination is an expected effect of the diuretic. The heart rate of 90 beats/minute is normal. p. 748 A patient is admitted to the hospital with a diagnosis of acute decompensated heart failure (ACHF). The primary health care provider prescribes a continuous intravenous infusion of sodium nitroprusside. What is the priority nursing intervention? Monitor urinary output. Monitor blood pressure. Check serum potassium level. Assess the skin surrounding the intravenous (IV) site. - ANSWER- monitors BP A patient newly diagnosed with heart failure is being discharged from the hospital. Which health care team member frequently works with protocols set up with the patient's health care provider to identify problems and start interventions? Physical therapist Home health nurse Occupational therapist Social services provider - ANSWER- Home health nurses EXPLANATION frequently work with protocols set up with the patient's health care provider. The protocols help the patient to identify problems, such as an increase in weight or dyspnea, both of which are symptoms of worsening heart failure. Physical therapy or occupational therapy may not be needed. Social services can assist with obtaining community resources the patient may need. p. 752 The nurse recognizes that a primary goal for a patient with chronic heart failure is what? Maximizing cardiac output Maintaining an ideal body weight Performing daily aerobic exercises Maintaining a steady pulse oximetry reading - ANSWER- An increase in cardiac output helps overcome chronic heart failure, thereby maintaining the blood flow to meet the body's demand. Being overweight is just one risk factor for chronic heart failure; EXPLANATION maintaining ideal body weight may not be a goal for some patients. Performing daily aerobic exercises may be too strenuous on the heart. There are many risk factors to consider when determining treatment goals. Pulse oximetry is used to monitor the effectiveness of oxygen therapy, and achievement of a steady reading is not a practical or primary goal. p. 746 A patient who underwent cardiac transplantation exhibits signs of acute rejection. The nurse recognizes that which medication is often used as post transplantation therapy to prevent this type of response? Ibuprofen Metoprolol Tacrolimus Acetaminophen - ANSWER- Tacrolimus EXPLANATION is a calcineurin that is included in most immunosuppressive regimens. Ibuprofen is a no steroidal anti- inflammatory drug (NSAID) used to treat pain. Metoprolol is a beta-blocker that is used to treat hypertension. Acetaminophen is a no steroidal anti-inflammatory drug (NSAID) that is used to treat pain and fever. p. 754 A patient with cardiac failure is scheduled to receive sodium nitroprusside. The nurse should monitor what parameter while administering the drug to the patient? Blood pressure Body temperature Heart rate and pulse rate Central venous pressure - ANSWER- Symptomatic hypotension is a major adverse effect of sodium nitroprusside; therefore, blood pressure is continuously monitored in patients taking sodium nitroprusside. Body temperature, heart rate, and central venous pressure are not altered due to administration of this drug. p. 745 The nurse reviews the teaching plan that has been created for a patient with chronic heart failure that is being discharged from the hospital. The nurse should question which item that is listed on the plan? Eat small, frequent meals. Obtain the annual flu vaccine. Avoid extremes of heat and cold. Immediately report a weight gain of 5 pounds in 2 days. - ANSWER- The patient should be instructed to immediately report a weight gain of 3 pounds in 2 days, or 3-5 pounds in a week. Eating small, frequent meals is a component of the dietary therapy. The patient should be instructed to receive the annual flu vaccination for health promotion. The patient should be instructed to avoid extremes of heat and cold, to prevent stress on the heart. P. 751 The nurse is caring for a patient with manifestations of acute decompensated heart failure (ADHF). What is the priority nursing assessment? Lung sounds Facial swelling Level of anxiety Intake and output - ANSWER- The priority nursing assessment is auscultation of lung sounds. EXPLANATION Excess fluid volume often leads to pulmonary congestion. ADHF can manifest as pulmonary edema. Facial swelling is a possible side effect with prescribed renin-angiotensin-aldosterone inhibitors for heart failure. It is important to assess the patient's anxiety, but it is not the priority. Assessing intake and output is important for right-sided heart failure. p. 741 The nurse reviews the laboratory results of a patient with heart failure (HF) who receives a prescription for digoxin. The nurse decides to withhold the medication based on abnormal findings of what blood study? Potassium Thyroid function tests White blood cells (WBCs) Blood urea nitrogen (B.U.N.) - ANSWER- Low serum potassium enhances the actions of digitalis, causing a therapeutic dose to reach toxic levels. Similarly, hyperkalemia inhibits the actions of digitalis, resulting in sub therapeutic dose. Monitor serum potassium levels of all patients taking digitalis. The results of a B.U.N., WBCs, or thyroid function tests do not affect the nurse's decision to administer or to withhold digoxin. p. 748 A patient is diagnosed with left-sided heart failure. The nurse expects what assessment finding? Orthopnea Low blood pressure Pulsating neck veins Edema in the lower extremities - ANSWER- Orthopnea, EXPLANATION difficulty breathing except when sitting or standing, is a symptom of advanced heart failure, especially left-sided failure. When the heart fails as a pump, blood backs up into the lungs, causing fluid to leak from the alveolar membrane. As this process continues, pulmonary edema may develop. Patients may experience hypotension or hypertension, depending on the severity of the disease. Pulsating neck veins and edema in the lower extremities are characteristics of right-sided heart failure. A patient is diagnosed with left ventricular hypertrophy that resulted from untreated hypertension. The nurse should monitor the patient for symptoms of what condition? Poor contractility