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

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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The nurse is providing discharge instructions to a client with heart failure preparing to leave the following day. What type of diet should the nurse request the dietitian to discuss with the client?

  • A. Low-fat diet
  • B. Low-potassium diet
  • C. Low-cholesterol diet
  • D. Low-sodium diet
Correct Answer: D

Rationale: Medical management of both left-sided and right-sided heart failure is directed at reducing the heart's workload and improving cardiac output primarily through dietary modifications, drug therapy, and lifestyle changes. A low-sodium diet is prescribed, and fluids may be restricted. Because the client will be on a diuretic such as Lasix, he may become potassium depleted and would need potassium in the diet. A low-cholesterol and low-fat diet may be prescribed but are not specific to the heart failure.

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 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.

The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure?

  • A. Decreased urinary output
  • B. Dyspnea on exertion
  • C. Hypotension
  • D. Tachycardia
Correct Answer: B

Rationale: Left-sided heart failure produces hypoxemia as a result of reduced cardiac output of arterial blood and respiratory symptoms. Many clients notice unusual fatigue with activity. Some find exertional dyspnea to be the first symptom. An increase in urinary output may be seen later as fluid accumulates. Hypotension would be a later sign of decompensating heart failure as well as tachycardia.

The nurse is preparing to administer digoxin to a client with heart failure. The nurse obtains an apical pulse rate for 1 minute and determines a rate of 52 beats/minute. What is the first action by the nurse?

  • A. Administer the medication and inform the charge nurse about the rate.
  • B. Withhold the medication and notify the health care provider of the heart rate.
  • C. Administer atropine to speed the heart rate and then administer the digoxin.
  • D. Administer the medications and then notify the health care provider.
Correct Answer: B

Rationale: Digitalis drugs are withheld if the heart rate is less than 60 or more than 120 beats/minute until a health care provider is consulted. The other choices would have the nurse administer the drug, which would not be the standard of practice.

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