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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
Correct Answer: A
Rationale: ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure. Digoxin therapy for heart failure is no longer considered a first-line measure. Calcium channel blockers are not generally used in the treatment of heart failure. The β-adrenergic agonists such as dobutamine are administered through the IV route and are not used as initial therapy for heart failure.
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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.
Correct Answer: B
Rationale: Indications for a heart transplant include end-stage heart failure, but other factors such as coping skills, family support, and patient motivation to follow the rigorous post-transplant regimen are also considered. Patients with diabetes who have well-controlled blood glucose levels may be candidates for heart transplant. Although heart transplants can be associated with many complications, this response does not address the patient's question.
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
Correct Answer: D
Rationale: Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus alternans is the alternation of strong and weak peripheral pulses during palpation. Orthopnea indicates that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time period.
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
Correct Answer: B
Rationale: Anemia is a precipitating cause of heart failure. Also, hypovolemia and hypothyroidism are precipitating causes. Diabetes is not a precipitating cause of heart failure.
Which assessment finding in a patient admitted with chronic heart failure requires the most rapid action by the nurse?
- A. Oxygen saturation of 88%
- B. Weight gain of 1 kg
- C. Apical pulse rate of 106 beats/minute
- D. Urine output of 50 ml over 2 hours
Correct Answer: A
Rationale: In a person with HF, oxygen saturation of the blood may be reduced because the blood is not adequately oxygenated in the lungs. Administration of oxygen, if the O2 saturation is less than 90%, can improve tissue oxygenation. Thus, appropriate use of oxygen therapy helps relieve dyspnea and fatigue. An increase in apical pulse rate, 1-kg weight gain, and decreases in urine output also indicate worsening heart failure and require rapid nursing actions, but the low oxygen saturation rate requires the most immediate nursing action.
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)
Correct Answer: C
Rationale: BNP is secreted when ventricular pressures increase, as with heart failure, and elevated BNP indicates a probable or very probable diagnosis of heart failure. 12-lead ECGs, ABGs, and CK also may be used in determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as BNP.