Nokea
A client in the hospital informs the nurse he 'feels like his heart is racing and can't catch his breath.' What does the nurse understand occurs as a result of a tachyarrhythmia?
- A. It causes a loss of elasticity in the myocardium.
- B. It reduces ventricular ejection volume.
- C. It increases afterload.
- D. It increases preload.
Correct Answer: B
Rationale: Reducing ventricular ejection volume because diastole, during which the ventricle fills with blood (preload), is shortened as a result of a tachyarrhythmia. Causing a loss of elasticity in the muscle is a result of cardiomyopathy. Afterload is decreased not increased.
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A client with right-sided heart failure is admitted to the medical-surgical unit. What information obtained from the client may indicate the presence of edema?
- A. The client says that he has been urinating less frequently at night.
- B. The client says he has been hungry in the evening.
- C. The client says his rings have become tight and are difficult to remove.
- D. The client says he is short of breath when ambulating.
Correct Answer: C
Rationale: Clients may observe that rings, shoes, or clothing have become tight. The client would most likely be urinating more frequently in the evening. Accumulation of blood in abdominal organs may cause anorexia, nausea, flatulence, and a decrease in hunger. Shortness of breath with ambulation would occur most often in left-sided heart failure.
What disease process(es) contributes to chronic heart failure? Select all that apply.
- A. Tachyarrhythmias
- B. Valvular disease
- C. Pancreatic disease
- D. Renal failure
- E. Pulmonary insufficiency
Correct Answer: A,B,D
Rationale: Hypertension, tachyarrhythmias, valvular disease, cardiomyopathy, and renal failure can contribute to chronic heart failure. Pancreatic disease and pulmonary insufficiency do not contribute to chronic heart failure.
A client diagnosed with pulmonary edema has a PaCO2 of 72 mm Hg and an oxygen saturation of 84%. What method of oxygen delivery would best meet the needs of this client?
- A. Intubation and mechanical ventilation
- B. Face mask with nonrebreather
- C. Oxygen cannula at 6 L/minute
- D. Venturi mask at 35%
Correct Answer: A
Rationale: The client's respiratory status is severely compromised and has developed signs of respiratory failure. When respiratory failure occurs, the client is intubated and oxygen is administered under continuous positive airway pressure or with mechanical ventilation with positive end-expiratory pressure. A face mask, cannula, or Venturi mask will not deliver the concentration or ventilatory support that an endotracheal tube with mechanical ventilation will provide.
A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion?
- A. Assess for reduced urine output.
- B. Assess for reduced blood sodium levels.
- C. Assess for elevated blood potassium levels.
- D. Assess for elevated blood urea nitrogen levels.
Correct Answer: D
Rationale: Elevated blood urea nitrogen indicates impaired renal perfusion in a client with left-sided heart failure. Serum sodium levels may be elevated. Reduced urine output or elevated blood potassium levels do not indicate impaired renal perfusion in a client with left-sided heart failure.
A client develops cardiogenic pulmonary edema and is extremely apprehensive. What medication can the nurse administer with a health care provider's prescription that will relieve anxiety and slow respiratory rate?
- A. Furosemide
- B. Nitroglycerin
- C. Dopamine
- D. Morphine sulfate
Correct Answer: D
Rationale: Morphine seems to help relieve respiratory symptoms by depressing higher cerebral centers, thus relieving anxiety and slowing respiratory rate. Morphine also promotes muscle relaxation and reduces the work of breathing. Furosemide is a loop diuretic and will decrease fluid accumulation but will not reduce anxiety. Nitroglycerin will promote smooth muscle relaxation in the vessel walls and will relieve pain but not reduce anxiety. Dopamine is an inotrope that will increase the force of ventricular contraction but will not alleviate anxiety.