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The nurse is performing an initial assessment of a client diagnosed with HF. The nurse also assesses the patients sensorium and LOC. Why is the assessment of the patients sensorium and LOC important in patients with HF?
- A. HF ultimately affects oxygen transportation to the brain
- B. Patients with HF are susceptible to overstimulation of the sympathetic nervous system
- C. Decreased LOC causes an exacerbation of the signs and symptoms of HF
- D. The most significant adverse effect of medications used for HF treatment is altered LOC
Correct Answer: A
Rationale: As the volume of blood ejected by the heart decreases, so does the amount of oxygen transported to the brain. Sympathetic stimulation is not a primary concern in patients with HF, although it is a possibility. HF affects LOC but the reverse is not usually true. Medications used to treat HF carry many adverse effects, but the most common and significant effects are cardiovascular.
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A patient with a diagnosis of HF is started on a beta-blocker. What is the nurses priority role during gradual increases in the patients dose?
- A. Educating the patient that symptom relief may not occur for several weeks
- B. Stressing that symptom relief may take up to 4 months to occur
- C. Making adjustments to each days dose based on the blood pressure trends
- D. Educating the patient about the potential changes in LOC that may result from the drug
Correct Answer: A
Rationale: An important nursing role during titration is educating the patient about the potential worsening of symptoms during the early phase of treatment and stressing that improvement may take several weeks. Relief does not take 4 months, however. The nurse monitors blood pressure, but changes are not made based on short-term assessment results. Beta-blockers rarely affect LOC.
The nurse is caring for an adult patient with HF who is prescribed digoxin. When assessing the patient for adverse effects, the nurse should assess for which of the following signs and symptoms?
- A. Confusion and bradycardia
- B. Uncontrolled diuresis and tachycardia
- C. Numbness and tingling in the extremities
- D. Chest pain and shortness of breath
Correct Answer: A
Rationale: A key concern associated with digitalis therapy is digitalis toxicity. Symptoms include anorexia, nausea, visual disturbances, confusion, and bradycardia. The other listed signs and symptoms are not characteristic of digitalis toxicity.
The nurse is planning the care of a patient with HF. The nurse should identify what overall goals of this patients care?
- A. Improve functional status
- B. Prevent endocarditis
- C. Extend survival
- D. Limit physical activity
- E. Relieve patient symptoms
Correct Answer: A,C,E
Rationale: The overall goals of management of HF are to relieve the patients symptoms, to improve functional status and quality of life, and to extend survival. Activity limitations should be accommodated, but reducing activity is not a goal. Endocarditis is not a common complication of HF and preventing it is not a major goal of care.
A patient with HF has met with his primary care provider and begun treatment with an angiotensin-converting enzyme (ACE) inhibitor. When the patient begins treatment, the nurse should prioritize what assessment?
- A. Blood pressure
- B. Level of consciousness (LOC)
- C. Assessment for nausea
- D. Oxygen saturation
Correct Answer: A
Rationale: Patients receiving ACE inhibitors are monitored for hypotension, hyperkalemia (increased potassium in the blood), and alterations in renal function. ACE inhibitors do not typically cause alterations in LOC. Oxygen saturation must be monitored in patients with HF, but this is not particular to ACE inhibitor therapy. ACE inhibitors do not normally cause nausea.
The nurse is addressing exercise and physical activity during discharge education with a patient diagnosed with HF. What should the nurse teach this patient about exercise?
- A. Do not exercise unsupervised
- B. Eventually aim to work up to 30 minutes of exercise each day
- C. Slow down if you get dizzy or short of breath
- D. Start your exercise program with high-impact activities
Correct Answer: B
Rationale: Eventually, a total of 30 minutes of physical activity every day should be encouraged. Supervision is not necessarily required and the emergence of symptoms should prompt the patient to stop exercising, not simply to slow the pace. Low-impact activities should be prioritized.