Nokea
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.
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The nurse assists the client to the bathroom, which is approximately 10 feet from the bed. The client ambulates 3 feet and states, 'I cannot catch my breath.' How would the nurse document this finding?
- A. Can't walk without becoming short of breath
- B. Has paroxysmal nocturnal dyspnea when walking
- C. Has orthopnea when walking
- D. Experiences exertional dyspnea when walking 3 feet; states, I cannot catch my breath.
Correct Answer: D
Rationale: Exertional dyspnea is the effort at breathing when active. Answer A is vague and does not give a more detailed explanation for documentation purposes. Orthopnea is the inability to breathe unless sitting upright, and paroxysmal nocturnal dyspnea is being awakened by breathlessness.
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 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 preparing to administer furosemide to a client with severe heart failure. What lab study should be of most concern for this client while taking furosemide?
- A. BNP of 100
- B. Sodium level of 135
- C. Hemoglobin of 12
- D. Potassium level of 3.1
Correct Answer: D
Rationale: Severe heart failure usually requires a loop diuretic such as furosemide (Lasix). These drugs increase sodium and therefore water excretion, but they also increase potassium excretion. If a client becomes hypokalemic, digitalis toxicity is more likely. The BNP does not demonstrate a severe heart failure. Sodium level of 135 is within normal range, as is the hemoglobin level.
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.