JoAnn Smith, 72 years old Heart Failure Case study
latest 2024 Update Graded A+ (SOLVED)
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."
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: monitor 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 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; 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 posttransplantation
therapy to prevent this type of response?
Ibuprofen
Metoprolol
Tacrolimus
Acetaminophen - ANSWER: Tacrolimus is a calcineurin that is included in most
immunosuppressive regimens. Ibuprofen is a nonsteroidal antiinflammatory drug
(NSAID) used to treat pain. Metoprolol is a beta-blocker that is used to treat
hypertension. Acetaminophen is a nonsteroidal antiinflammatory 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 prioritynursing assessment?
, Lung sounds
Facial swelling
Level of anxiety
Intake and output - ANSWER: The priority nursing assessment is auscultation of lung
sounds. 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 subtherapeutic 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, 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
Less O 2 requirement
Decreased ventricular irritability
Rich coronary arterial circulation - ANSWER: Poor contractility is a complication seen
in patients who have hypertrophy of the cardiac walls. The heart muscle, which
, undergoes hypertrophy, increases in muscle mass and cardiac wall thickness, due to
overwork and strain. As a result, the hypertrophic heart muscle exhibits poor
contractility over time. Hypertrophic heart muscle is more irritable and, thus, prone
to dysrhythmias. A hypertrophic heart requires more oxygen (O 2) to perform work.
Because the tissue in a hypertrophic heart becomes ischemic more easily, there is
poor coronary artery circulation.
p. 740
The nurse recalls that symptoms of right-sided heart failure are caused by what
condition?
Decreased preload
Increased cardiac output
Fluid congestion in the lungs
Systemic venous congestion - ANSWER: Systemic venous congestion
The symptoms of right-sided heart failure are caused by the backup of blood into the
venous system. Fluid congestion in the lungs is a symptom of left-sided heart failure.
Decreased preload is not correct; preload in right-sided heart failure is increased.
Increased cardiac output is not correct; cardiac output is decreased in right-sided
heart failure
An echocardiogram for a patient indicates enlarged ventricles of the heart. The nurse
caring for the patient understands that this condition has occurred as a result of a
chronic condition. What could be the cause of the cardiac dilation?
Increased heart rate
Increased muscle thickness
Elevated pressure in the ventricles
Increased release of catecholamine - ANSWER: Elevated pressure in the ventricles
Cardiac dilation is an enlargement of the heart chambers, usually the ventricles; it
occurs when pressure in the heart chambers is elevated over time. Hypertrophy is an
increase in the muscle mass and thickness of the cardiac wall in response to
overwork and strain. When the sympathetic nervous system activation is increased,
there is an increased release of catecholamines, which results in an increased heart
rate.
p. 740
The nurse encourages the patient diagnosed with chronic heart failure to obtain
physical and emotional rest. What is the rationale that is offered by the nurse to the
patient?
To relieve dyspnea and fatigue
To increase oxygen saturation of blood
To involve the patient in cardiac rehabilitation
To decrease the need for additional oxygen - ANSWER: To decrease the need for
additional oxygen
latest 2024 Update Graded A+ (SOLVED)
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."
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: monitor 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 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; 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 posttransplantation
therapy to prevent this type of response?
Ibuprofen
Metoprolol
Tacrolimus
Acetaminophen - ANSWER: Tacrolimus is a calcineurin that is included in most
immunosuppressive regimens. Ibuprofen is a nonsteroidal antiinflammatory drug
(NSAID) used to treat pain. Metoprolol is a beta-blocker that is used to treat
hypertension. Acetaminophen is a nonsteroidal antiinflammatory 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 prioritynursing assessment?
, Lung sounds
Facial swelling
Level of anxiety
Intake and output - ANSWER: The priority nursing assessment is auscultation of lung
sounds. 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 subtherapeutic 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, 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
Less O 2 requirement
Decreased ventricular irritability
Rich coronary arterial circulation - ANSWER: Poor contractility is a complication seen
in patients who have hypertrophy of the cardiac walls. The heart muscle, which
, undergoes hypertrophy, increases in muscle mass and cardiac wall thickness, due to
overwork and strain. As a result, the hypertrophic heart muscle exhibits poor
contractility over time. Hypertrophic heart muscle is more irritable and, thus, prone
to dysrhythmias. A hypertrophic heart requires more oxygen (O 2) to perform work.
Because the tissue in a hypertrophic heart becomes ischemic more easily, there is
poor coronary artery circulation.
p. 740
The nurse recalls that symptoms of right-sided heart failure are caused by what
condition?
Decreased preload
Increased cardiac output
Fluid congestion in the lungs
Systemic venous congestion - ANSWER: Systemic venous congestion
The symptoms of right-sided heart failure are caused by the backup of blood into the
venous system. Fluid congestion in the lungs is a symptom of left-sided heart failure.
Decreased preload is not correct; preload in right-sided heart failure is increased.
Increased cardiac output is not correct; cardiac output is decreased in right-sided
heart failure
An echocardiogram for a patient indicates enlarged ventricles of the heart. The nurse
caring for the patient understands that this condition has occurred as a result of a
chronic condition. What could be the cause of the cardiac dilation?
Increased heart rate
Increased muscle thickness
Elevated pressure in the ventricles
Increased release of catecholamine - ANSWER: Elevated pressure in the ventricles
Cardiac dilation is an enlargement of the heart chambers, usually the ventricles; it
occurs when pressure in the heart chambers is elevated over time. Hypertrophy is an
increase in the muscle mass and thickness of the cardiac wall in response to
overwork and strain. When the sympathetic nervous system activation is increased,
there is an increased release of catecholamines, which results in an increased heart
rate.
p. 740
The nurse encourages the patient diagnosed with chronic heart failure to obtain
physical and emotional rest. What is the rationale that is offered by the nurse to the
patient?
To relieve dyspnea and fatigue
To increase oxygen saturation of blood
To involve the patient in cardiac rehabilitation
To decrease the need for additional oxygen - ANSWER: To decrease the need for
additional oxygen
