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A client is admitted to the hospital with a diagnosis of heart failure, and the health care provider prescribes a BNP level. What results would indicate to the nurse that the client is in moderate heart failure?
- A. 120 pg/mL
- B. 400 pg/mL
- C. 780 pg/mL
- D. 980 pg/mL
Correct Answer: C
Rationale: The result of 780 pg/mL indicates that the client has moderate heart failure, 120 pg/mL indicates that the client has heart failure present, 400 pg/mL indicates that the client has mild heart failure, and 980 pg/mL indicates that the client is in severe heart failure.
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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.
A client is awaiting the availability of a heart for transplant. What option may be available to the client as a bridge to transplant?
- A. Implanted cardioverter-defibrillator (ICD)
- B. Pacemaker
- C. Intra-aortic balloon pump (IABP)
- D. Ventricular assist device (VAD)
Correct Answer: D
Rationale: VADs may be used for one of three purposes: (1) a bridge to recovery, (2) a bridge to transport, or (3) destination therapy (mechanical circulatory support when there is no option for a heart transplant). An implanted cardioverter-defibrillator or pacemaker is not a bridge to transplant and will only correct the conduction disturbance and not the pumping efficiency. An IABP is a temporary, secondary mechanical circulatory pump to supplement the ineffectual contraction of the left ventricle. The IABP is intended for only a few days.
A client with heart failure reports not having had a bowel movement in 2 days. Why would it be important for the nurse to obtain a prescription for a stool softener?
- A. Straining engages the Valsalva maneuver, which can cause dangerous effects.
- B. The client should not develop hemorrhoids.
- C. The client can develop a rectal fissure, which will increase pain levels.
- D. The client should have a bowel movement every day to avoid development of an intestinal obstruction.
Correct Answer: A
Rationale: Avoid activities that engage the Valsalva maneuver, such as straining with bowel elimination or using the arms to pull and reposition oneself. The Valsalva maneuver increases intrathoracic pressure, reduces right atrial filling, triggers tachycardia, and increases blood pressure. The client's discomfort would be increased if hemorrhoids or a rectal fissure developed but would not engage the Valsalva maneuver. It is not necessary for the client to have a bowel movement on a daily basis.
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 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.