Nokea
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.
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The nurse is caring for a client with heart failure. What procedure should the nurse prepare the client for in order to determine the ejection fraction to measure the efficiency of the heart as a pump?
- A. Echocardiogram
- B. A pulmonary arteriography
- C. A chest radiograph
- D. Electrocardiogram
Correct Answer: A
Rationale: The heart's ejection fraction is measured using an echocardiogram or multiple gated acquisition scan. A pulmonary arteriography is used to confirm cor pulmonale. A chest radiograph can reveal the enlargement of the heart. An electrocardiogram is used to determine the activity of the heart's conduction system.
The nurse instructs the client with heart failure to check weight at the same time each day using the same scale. When should the client contact the health care provider?
- A. If the weight gain is more than 3 lb in 1 week.
- B. If the weight gain is more than 4 lb in 1 month.
- C. If the weight gain is more than 2 lb in 24 hours.
- D. If the weight gain is more than 1 lb in 48 hours.
Correct Answer: C
Rationale: Clients should check weight at the same time each day using the same scale and should consult a health care provider if the weight gain is more than 2 pounds in 24 hours. The other options are not correct since there is a variance with weight on a daily basis.
What disease process(es) contributes to chronic heart failure? Select all that apply.
- A. Tachyarrhythmias
- B. Valvular disease
- C. Pancreatic disease
- D. Renal failure
- E. Pulmonary insufficiency
Correct Answer: A,B,D
Rationale: Hypertension, tachyarrhythmias, valvular disease, cardiomyopathy, and renal failure can contribute to chronic heart failure. Pancreatic disease and pulmonary insufficiency do not contribute to chronic heart failure.
The nurse is working in a long-term care facility with a group of older adults with cardiac disorders. Why would it be important for the nurse to closely monitor an older adult receiving digitalis preparations for cardiac disorders?
- A. Older adults are at increased risk for toxicity.
- B. Older adults are at increased risk for cardiac arrests.
- C. Older adults are at increased risk for hyperthyroidism.
- D. Older adults are at increased risk for asthma.
Correct Answer: A
Rationale: Older adults receiving digitalis preparations are at increased risk for toxicity because of the decreased ability of the kidneys to excrete the drug due to age-related changes. The margin between a therapeutic and toxic effect of digitalis preparations is narrow. Using digitalis preparations does not increase the risk of cardiac arrests, hyperthyroidism, or asthma.
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.