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The nurse is administering captopril to a client with a diagnosis of heart failure. What type of medication does the nurse infer the client is taking?
- A. An angiotensin converting enzyme inhibitor (ACE) inhibitor
- B. A thiazide diuretic
- C. An angiotensin receptor blocker (ARB)
- D. A calcium channel blocker
Correct Answer: A
Rationale: Captopril is an ACE inhibitor. Although the other medications may be used alone or in conjunction with other medications, the ACE inhibitor is a standard medication used in heart failure unless not tolerated by the client.
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A client diagnosed with heart failure has been admitted to the ICU prior to invasive treatment. What treatment could be considered curative for this client?
- A. Cardiomyoplasty
- B. External pacemaker placement
- C. Surgical ventricular restoration
- D. Ventricular assist device
Correct Answer: C
Rationale: A procedure known as surgical ventricular restoration (SVR) decreases the size of the heart to a near normal size and shape by removing dysfunctional heart muscle that does not contract properly. Once the adynamic (nonfunctioning) area is removed, the ventricle is repaired with a patch. In the cases that were studied, 91% were free of congestive heart failure after surgery with an ejection fraction that increased from 30% to 40%. A cardiomyoplasty, placement of an external pacemaker, or a ventricular assist device are not considered curative for heart failure.
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.
The nurse is preparing a client for a multiple gated acquisition (MUGA) scan. What would be an important instruction for the nurse to give a client who is to undergo a MUGA scan?
- A. Avoid any activity at least 2 hours before the test.
- B. Drink plenty of fluids during the test.
- C. Avoid dairy products a day before and a day after the test.
- D. Lie very still at intermittent times during the test.
Correct Answer: D
Rationale: The nurse should instruct the client, who is to undergo a MUGA scan, to lie very still at intermittent times during the 45-minute test. The client need not drink plenty of fluids, avoid activities before/after the test, or avoid dairy products during the test.
The nurse is gathering data from a client recently admitted to the hospital. The nurse asks the client about experiencing orthopnea. What question would the nurse ask to obtain this information?
- A. Are you only able to breathe when you are sitting upright?
- B. How far can you walk without becoming short of breath?
- C. Are you coughing up blood at night?
- D. Are you urinating excessively at night?
Correct Answer: A
Rationale: To determine if a client is having orthopnea, the nurse needs to ask about the inability to breathe unless sitting upright. Determining how far the client can walk without becoming short of breath would indicate exertional dyspnea. Coughing up blood would indicate hemoptysis. Urinating excessively at night can be indicative of different factors such as taking a diuretic late in the evening causing the client to urinate often at night. This question would be vague.
The nurse observes a client with an onset of heart failure having rapid, shallow breathing at a rate of 32 breaths/minute. What blood gas analysis does the nurse anticipate finding initially?
- A. Metabolic acidosis
- B. Metabolic alkalosis
- C. Respiratory acidosis
- D. Respiratory alkalosis
Correct Answer: D
Rationale: At first, arterial blood gas analysis may reveal respiratory alkalosis as a result of rapid, shallow breathing. Later, there is a shift to metabolic acidosis as gas exchange becomes more impaired.