Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition - Caring for Clients With Heart Failure

Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition - Caring for Clients With Heart Failure Related

Review Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition - Caring for Clients With Heart Failure related questions and content

A client has a myocardial infarction in the left ventricle and develops crackles bilaterally; 3-pillow orthopnea; an S3 heart sound; and a cough with pink, frothy sputum. The nurse obtains a pulse oximetry reading of 88%. What do these signs and symptoms indicate for this client?

  • A. The development of chronic obstructive pulmonary disease (COPD)
  • B. The development of left-sided heart failure
  • C. The development of right-sided heart failure
  • D. The development of cor pulmonale
Correct Answer: B

Rationale: When the left ventricle fails, the heart muscle cannot contract forcefully enough to expel blood into the systemic circulation. Blood subsequently becomes congested in the left ventricle, left atrium, and finally the pulmonary vasculature. Symptoms of/left-sided failure include fatigue; paroxysmal nocturnal dyspnea; orthopnea; hypoxia; crackles; cyanosis; S3 heart sound; cough with pink, frothy sputum; and elevated pulmonary capillary wedge pressure. COPD develops over many years and does not develop after a myocardial infarction. The development of right-sided heart failure would generally occur after a right ventricle myocardial infarction or after the development of left-sided heart failure. Cor pulmonale is a condition in which the heart is affected secondarily by lung damage.

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The nurse is preparing to administer furosemide to a client with severe heart failure. What lab study should be of most concern for this client while taking furosemide?

  • A. BNP of 100
  • B. Sodium level of 135
  • C. Hemoglobin of 12
  • D. Potassium level of 3.1
Correct Answer: D

Rationale: Severe heart failure usually requires a loop diuretic such as furosemide (Lasix). These drugs increase sodium and therefore water excretion, but they also increase potassium excretion. If a client becomes hypokalemic, digitalis toxicity is more likely. The BNP does not demonstrate a severe heart failure. Sodium level of 135 is within normal range, as is the hemoglobin level.

A client with heart failure is having a decrease in cardiac output. What indication does the nurse have that this is occurring?

  • A. Heart rate of 72 beats/minute
  • B. Respiratory rate of 20 breaths/minute
  • C. Blood pressure 80/46 mm Hg
  • D. Oxygen saturation 94%
Correct Answer: C

Rationale: The body can compensate for changes in heart function that occur over time. When cardiac output falls, the body uses certain compensatory mechanisms designed to increase stroke volume and maintain blood pressure. These compensatory mechanisms can temporarily improve the client's cardiac output but ultimately fail when contractility is further compromised. A heart rate of 72 beats/minute is within normal range as well as the respiratory rate and oxygen saturation.

A client is taking furosemide for the treatment of heart failure. What food should the nurse suggest that is rich in potassium?

  • A. Pasta
  • B. Peanut butter
  • C. Coffee
  • D. Angel food cake
Correct Answer: B

Rationale: Peanut butter is rich in potassium. Pasta, coffee, and angel food cake are low potassium items.

A client is scheduled for a multiple gated acquisition (MUGA) scan the following day. What medication is contraindicated for the nurse to administer the morning of the procedure?

  • A. Furosemide
  • B. Acetaminophen
  • C. Morphine sulfate
  • D. Guaifenesin
Correct Answer: A

Rationale: Diuretics are contraindicated the morning of a test to avoid any interruptions for urination. Clients are also medicated to relieve a cough that may cause movement during the test so administration of guaifenesin is not contraindicated. Acetaminophen and morphine sulfate are not contraindicated the morning of the test.

The nurse is caring for a client in the hospital with chronic heart failure that has marked limitations in his physical activity. The client is comfortable when resting in the bed or chair, but when ambulating in the room or hall, he becomes short of breath and fatigued easily. What type of heart failure is this considered according to the New York Heart Association (NYHA)?

  • A. Class I (Mild)
  • B. Class II (Mild)
  • C. Class III (Moderate)
  • D. Class IV (Severe)
Correct Answer: C

Rationale: Class III (Moderate) is when there is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitations, or dyspnea. Class I is ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea. The client does not experience any limitation of activity. Class II (Mild) is when the client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea. Class IV (Severe), the client is unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken.

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