Nokea
The nurse is caring for a patient with chronic heart failure. Which of the following conditions is a cause of chronic heart disease?
- A. Dysrhythmias
- B. Pulmonary embolus
- C. Myocarditis
- D. Congenital heart disease
Correct Answer: D
Rationale: Congenital heart disease is a cause of chronic heart failure. Dysrhythmias, pulmonary embolus, and myocarditis are causes of acute heart failure.
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Which of the following actions is priority when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving a nitrate?
- A. Monitor blood pressure frequently.
- B. Encourage patient to ambulate in room.
- C. Titrate nitrate rate slowly before discontinuing.
- D. Teach patient about safe home use of the medication.
Correct Answer: A
Rationale: Nitrates cause vasodilation therefore BP should be frequently monitored. Since the patient is likely to have orthostatic hypotension, the patient should not be encouraged to ambulate. Nitrate does not require titration and the priority is not to teach about safe use at home.
During a visit to a patient with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2 kg weight gain, and complains of 'feeling too tired to do anything.' Based on these data, which of the following is the best nursing diagnosis for the patient?
- A. Activity intolerance related to physical deconditioning
- B. Disturbed body image related to alteration in self-perception
- C. Impaired skin integrity related to alteration in fluid volume (peripheral edema)
- D. Ineffective breathing pattern related to respiratory muscle fatigue
Correct Answer: A
Rationale: The patient's statement supports the diagnosis of activity intolerance. There are no data to support the other diagnoses, although the nurse will need to assess for other patient problems.
The nurse is caring for a patient in the intensive care unit with acute decompensated heart failure (ADHF) who has symptoms of severe dyspnea and is anxious, tachypneic, and tachycardic. All these medications have been prescribed for the patient. Which of the following actions should the nurse implement first?
- A. Give IV diazepam 2.5 mg
- B. Administer IV morphine sulphate 2 mg
- C. Increase nitroglycerin infusion by 5 mcg/min.
- D. Increase dopamine infusion by 2 mcg/kg/min.
Correct Answer: B
Rationale: Morphine improves alveolar gas exchange, improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output, but it also will increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will not act as quickly as morphine to decrease dyspnea.
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 topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure and an ejection fraction of 38%?
- A. Need to participate in an aerobic exercise program several times weekly
- B. Use of salt substitutes to replace table salt when cooking and at the table
- C. Importance of making a yearly appointment with the primary care provider
- D. Benefits and adverse effects of angiotensin-converting enzyme (ACE) inhibitors
Correct Answer: D
Rationale: The core measure for the treatment of heart failure in patients with a low ejection fraction is to receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise may not be appropriate for a patient with this level of heart failure, salt substitutes are not usually recommended because of the risk of hyperkalemia, and the patient will need to see the primary care provider more frequently than annually.