Chapter 37: Nursing Management: Heart Failure: Lewis’s Medical-
Surgical Nursing, 5th Edition
1. Which of the following diagnostic tests will be most useful to the nurse in
determining whether a patient admitted with acute shortness of breath has heart
failure?
A. Serum creatine kinase (CK)
B. Arterial blood gases (ABGs)
C. B-type natriuretic peptide (BNP)
D. 12-lead electrocardiogram (ECG)
Answer: C
Explanation: BNP is released by the ventricles in response to increased stretch and
volume overload, making it a key diagnostic biomarker for heart failure. The other
tests provide useful but less specific information.
2. The nurse is caring for a patient with heart failure with reduced ejection
fraction. Which of the following values should the nurse expect to assess in the
patient related to ejection fraction?
A. 40%
B. 60%
C. 80%
D. 90%
Answer: A
Explanation: Heart Failure with Reduced Ejection Fraction (HFrEF) is typically
defined as an ejection fraction (EF) of 40% or less. A normal EF is greater than 55%.
3. The nurse is conducting a health history on a patient with heart failure. Which of
the following conditions in the patient's health history is a precipitating cause of
heart failure?
A. Hyperthyroidism
B. Anemia
C. Hypovolemia
D. Diabetes
Answer: B
Explanation: Anemia increases cardiac workload by reducing oxygen-carrying
capacity, forcing the heart to pump more volume, which can precipitate heart failure.
Hypovolemia and hypothyroidism are precipitating causes, while diabetes is a risk
factor but not a direct precipitant.
4. The nurse is caring for a patient with chronic heart failure. Which of the
following conditions is a cause of chronic heart disease?
A. Dysrhythmias
B. Pulmonary embolus
, C. Myocarditis
D. Congenital heart disease
Answer: D
Explanation: Congenital heart disease is a structural issue present from birth, leading
to long-term cardiac stress and chronic heart failure. Dysrhythmias, pulmonary
embolus, and myocarditis are typically acute events causing acute heart failure.
5. A patient with a history of chronic heart failure is admitted to the emergency
department (ED) with severe dyspnea and a dry, hacking cough. Which of the
following actions should the nurse take first?
A. Palpate the abdomen.
B. Assess the orientation.
C. Check the capillary refill.
D. Auscultate the lung sounds.
Answer: D
Explanation: The patient's symptoms suggest acute decompensated heart failure and
potential pulmonary edema. The priority action is to assess the respiratory system
(auscultate lung sounds) to confirm the presence of crackles or wheezing and guide
immediate intervention to ensure adequate oxygenation.
6. The nurse is caring for a patient who is receiving IV furosemide and morphine
for the treatment of acute decompensated heart failure (ADHF) with severe
orthopnea. When evaluating the patient response to the medications, which of
the following is the best indicator that the treatment has been effective?
A. Weight loss of 1 kg overnight
B. Hourly urine output greater than 60 mL
C. Reduction in patient complaints of chest pain
D. Decreased dyspnea with the head of bed at 30 degrees
Answer: D
Explanation: Orthopnea is a key symptom of ADHF due to pulmonary congestion.
Relief of dyspnea when lying flat indicates improved fluid redistribution and
decreased pulmonary edema, directly reflecting the effectiveness of diuretic and
preload-reducing therapy.
7. Which topic will the nurse plan to include in discharge teaching for a patient
with systolic heart failure and an ejection fraction of 38%?
A. Need to participate in an aerobic exercise program several times weekly
B. Use of salt substitutes to replace table salt when cooking and at the table
C. Importance of making a yearly appointment with the primary care provider
D. Benefits and adverse effects of angiotensin-converting enzyme (ACE) inhibitors
Answer: D
Explanation: ACE inhibitors are a cornerstone of therapy for systolic heart failure as
they reduce afterload and decrease disease progression. Aerobic exercise may not be
appropriate, salt substitutes can cause hyperkalemia, and follow-up needs are more
frequent than annually.
,8. A patient who has chronic heart failure tells the nurse, "I felt fine when I went to
bed, but I woke up in the middle of the night feeling like I was suffocating!"
Which of the following information should the nurse document related to this
assessment?
A. Pulsus alternans
B. Two-pillow orthopnea
C. Acute bilateral pleural effusion
D. Paroxysmal nocturnal dyspnea
Answer: D
Explanation: Paroxysmal nocturnal dyspnea (PND) is characterized by sudden
respiratory distress that awakens the patient from sleep, often 1-2 hours after lying
down, due to the reabsorption of dependent edema and increased pulmonary blood
volume.
9. During a visit to a patient with chronic heart failure, the home care nurse finds
that the patient has ankle edema, a 2 kg weight gain, and complains of "feeling
too tired to do anything." Based on these data, which of the following is the best
nursing diagnosis for the patient?
A. Activity intolerance related to physical deconditioning
B. Disturbed body image related to alteration in self-perception
C. Impaired skin integrity related to alteration in fluid volume (peripheral edema)
D. Ineffective breathing pattern related to respiratory muscle fatigue
Answer: A
Explanation: The patient's complaint of fatigue and inability to perform activities,
combined with signs of fluid overload (edema, weight gain), directly support the
diagnosis of Activity Intolerance. The other diagnoses are not supported by the
provided data.
10. The nurse working in the heart failure clinic will know that teaching for a
patient with newly diagnosed heart failure has been effective when the patient
does which of the following actions?
A. Uses an additional pillow to sleep when feeling short of breath at night.
B. Tells the home care nurse that furosemide is taken daily at bedtime.
C. Calls the clinic when the weight increases from 56 to 59 kg in 2 days.
D. Says that the nitroglycerin patch will be used for any chest pain that develops.
Answer: C
Explanation: A weight gain of 3 kg in 2 days significantly exceeds the recommended
2 kg threshold for reporting and indicates potential fluid overload and worsening heart
failure, demonstrating the patient understands key self-monitoring.
11. The nurse is teaching the patient with heart failure about a 2 g sodium diet.
Which of the following foods should the nurse explain to the patient that need to
be restricted?
A. Canned and frozen fruits
B. Fresh or frozen vegetables
, C. Milk, yogurt, and other milk products
D. Eggs and other high-cholesterol foods
Answer: C
Explanation: Milk and yogurt contain significant natural sodium. Many other dairy
products, like processed cheeses, are very high in sodium and must be restricted on a
2-gram sodium diet. The other food groups listed are generally low in sodium.
12. The nurse is caring for an older-adult patient with heart failure and learns that
the patient lives alone and sometimes confuses the "water pill" with the "heart
pill." When planning for the patient's discharge the nurse will facilitate which of
the following actions?
A. Transfer to a dementia care service
B. Referral to a home health care agency
C. Placement in a long-term care facility
D. Arrangements for around-the-clock care
Answer: B
Explanation: A home health care referral is appropriate to assess the home
environment and assist the patient in developing a safe medication management
system. The data do not indicate a need for the more intensive levels of care listed in
the other options.
13. Following an acute myocardial infarction, a previously healthy patient develops
clinical manifestations of heart failure. The nurse anticipates discharge teaching
will include information about which of the following medications?
A. Angiotensin-converting enzyme (ACE) inhibitors
B. Digitalis preparations
C. β-Adrenergic agonists
D. Calcium channel blockers
Answer: A
Explanation: ACE inhibitors are a first-line therapy post-MI to prevent or slow the
progression of heart failure by inhibiting ventricular remodeling. Digoxin is not first-
line, β-agonists are IV-only rescue drugs, and calcium channel blockers are not
generally used for heart failure.
14. The nurse is caring for a patient with Class III status (NYHA) heart failure and
type 2 diabetes and the patient asks the nurse whether heart transplant is a
possible therapy. Which of the following responses by the nurse is best?
A. "Since you have diabetes, you would not be a candidate for a heart transplant."
B. "The choice of a patient for a heart transplant depends on many different factors."
C. "Your heart failure has not reached the stage in which heart transplants are
considered."
D. "People who have heart transplants are at risk for multiple complications after
surgery."
Answer: B
Explanation: Transplant candidacy is multifactorial, including end-stage disease,
Surgical Nursing, 5th Edition
1. Which of the following diagnostic tests will be most useful to the nurse in
determining whether a patient admitted with acute shortness of breath has heart
failure?
A. Serum creatine kinase (CK)
B. Arterial blood gases (ABGs)
C. B-type natriuretic peptide (BNP)
D. 12-lead electrocardiogram (ECG)
Answer: C
Explanation: BNP is released by the ventricles in response to increased stretch and
volume overload, making it a key diagnostic biomarker for heart failure. The other
tests provide useful but less specific information.
2. The nurse is caring for a patient with heart failure with reduced ejection
fraction. Which of the following values should the nurse expect to assess in the
patient related to ejection fraction?
A. 40%
B. 60%
C. 80%
D. 90%
Answer: A
Explanation: Heart Failure with Reduced Ejection Fraction (HFrEF) is typically
defined as an ejection fraction (EF) of 40% or less. A normal EF is greater than 55%.
3. The nurse is conducting a health history on a patient with heart failure. Which of
the following conditions in the patient's health history is a precipitating cause of
heart failure?
A. Hyperthyroidism
B. Anemia
C. Hypovolemia
D. Diabetes
Answer: B
Explanation: Anemia increases cardiac workload by reducing oxygen-carrying
capacity, forcing the heart to pump more volume, which can precipitate heart failure.
Hypovolemia and hypothyroidism are precipitating causes, while diabetes is a risk
factor but not a direct precipitant.
4. The nurse is caring for a patient with chronic heart failure. Which of the
following conditions is a cause of chronic heart disease?
A. Dysrhythmias
B. Pulmonary embolus
, C. Myocarditis
D. Congenital heart disease
Answer: D
Explanation: Congenital heart disease is a structural issue present from birth, leading
to long-term cardiac stress and chronic heart failure. Dysrhythmias, pulmonary
embolus, and myocarditis are typically acute events causing acute heart failure.
5. A patient with a history of chronic heart failure is admitted to the emergency
department (ED) with severe dyspnea and a dry, hacking cough. Which of the
following actions should the nurse take first?
A. Palpate the abdomen.
B. Assess the orientation.
C. Check the capillary refill.
D. Auscultate the lung sounds.
Answer: D
Explanation: The patient's symptoms suggest acute decompensated heart failure and
potential pulmonary edema. The priority action is to assess the respiratory system
(auscultate lung sounds) to confirm the presence of crackles or wheezing and guide
immediate intervention to ensure adequate oxygenation.
6. The nurse is caring for a patient who is receiving IV furosemide and morphine
for the treatment of acute decompensated heart failure (ADHF) with severe
orthopnea. When evaluating the patient response to the medications, which of
the following is the best indicator that the treatment has been effective?
A. Weight loss of 1 kg overnight
B. Hourly urine output greater than 60 mL
C. Reduction in patient complaints of chest pain
D. Decreased dyspnea with the head of bed at 30 degrees
Answer: D
Explanation: Orthopnea is a key symptom of ADHF due to pulmonary congestion.
Relief of dyspnea when lying flat indicates improved fluid redistribution and
decreased pulmonary edema, directly reflecting the effectiveness of diuretic and
preload-reducing therapy.
7. Which topic will the nurse plan to include in discharge teaching for a patient
with systolic heart failure and an ejection fraction of 38%?
A. Need to participate in an aerobic exercise program several times weekly
B. Use of salt substitutes to replace table salt when cooking and at the table
C. Importance of making a yearly appointment with the primary care provider
D. Benefits and adverse effects of angiotensin-converting enzyme (ACE) inhibitors
Answer: D
Explanation: ACE inhibitors are a cornerstone of therapy for systolic heart failure as
they reduce afterload and decrease disease progression. Aerobic exercise may not be
appropriate, salt substitutes can cause hyperkalemia, and follow-up needs are more
frequent than annually.
,8. A patient who has chronic heart failure tells the nurse, "I felt fine when I went to
bed, but I woke up in the middle of the night feeling like I was suffocating!"
Which of the following information should the nurse document related to this
assessment?
A. Pulsus alternans
B. Two-pillow orthopnea
C. Acute bilateral pleural effusion
D. Paroxysmal nocturnal dyspnea
Answer: D
Explanation: Paroxysmal nocturnal dyspnea (PND) is characterized by sudden
respiratory distress that awakens the patient from sleep, often 1-2 hours after lying
down, due to the reabsorption of dependent edema and increased pulmonary blood
volume.
9. During a visit to a patient with chronic heart failure, the home care nurse finds
that the patient has ankle edema, a 2 kg weight gain, and complains of "feeling
too tired to do anything." Based on these data, which of the following is the best
nursing diagnosis for the patient?
A. Activity intolerance related to physical deconditioning
B. Disturbed body image related to alteration in self-perception
C. Impaired skin integrity related to alteration in fluid volume (peripheral edema)
D. Ineffective breathing pattern related to respiratory muscle fatigue
Answer: A
Explanation: The patient's complaint of fatigue and inability to perform activities,
combined with signs of fluid overload (edema, weight gain), directly support the
diagnosis of Activity Intolerance. The other diagnoses are not supported by the
provided data.
10. The nurse working in the heart failure clinic will know that teaching for a
patient with newly diagnosed heart failure has been effective when the patient
does which of the following actions?
A. Uses an additional pillow to sleep when feeling short of breath at night.
B. Tells the home care nurse that furosemide is taken daily at bedtime.
C. Calls the clinic when the weight increases from 56 to 59 kg in 2 days.
D. Says that the nitroglycerin patch will be used for any chest pain that develops.
Answer: C
Explanation: A weight gain of 3 kg in 2 days significantly exceeds the recommended
2 kg threshold for reporting and indicates potential fluid overload and worsening heart
failure, demonstrating the patient understands key self-monitoring.
11. The nurse is teaching the patient with heart failure about a 2 g sodium diet.
Which of the following foods should the nurse explain to the patient that need to
be restricted?
A. Canned and frozen fruits
B. Fresh or frozen vegetables
, C. Milk, yogurt, and other milk products
D. Eggs and other high-cholesterol foods
Answer: C
Explanation: Milk and yogurt contain significant natural sodium. Many other dairy
products, like processed cheeses, are very high in sodium and must be restricted on a
2-gram sodium diet. The other food groups listed are generally low in sodium.
12. The nurse is caring for an older-adult patient with heart failure and learns that
the patient lives alone and sometimes confuses the "water pill" with the "heart
pill." When planning for the patient's discharge the nurse will facilitate which of
the following actions?
A. Transfer to a dementia care service
B. Referral to a home health care agency
C. Placement in a long-term care facility
D. Arrangements for around-the-clock care
Answer: B
Explanation: A home health care referral is appropriate to assess the home
environment and assist the patient in developing a safe medication management
system. The data do not indicate a need for the more intensive levels of care listed in
the other options.
13. Following an acute myocardial infarction, a previously healthy patient develops
clinical manifestations of heart failure. The nurse anticipates discharge teaching
will include information about which of the following medications?
A. Angiotensin-converting enzyme (ACE) inhibitors
B. Digitalis preparations
C. β-Adrenergic agonists
D. Calcium channel blockers
Answer: A
Explanation: ACE inhibitors are a first-line therapy post-MI to prevent or slow the
progression of heart failure by inhibiting ventricular remodeling. Digoxin is not first-
line, β-agonists are IV-only rescue drugs, and calcium channel blockers are not
generally used for heart failure.
14. The nurse is caring for a patient with Class III status (NYHA) heart failure and
type 2 diabetes and the patient asks the nurse whether heart transplant is a
possible therapy. Which of the following responses by the nurse is best?
A. "Since you have diabetes, you would not be a candidate for a heart transplant."
B. "The choice of a patient for a heart transplant depends on many different factors."
C. "Your heart failure has not reached the stage in which heart transplants are
considered."
D. "People who have heart transplants are at risk for multiple complications after
surgery."
Answer: B
Explanation: Transplant candidacy is multifactorial, including end-stage disease,
