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The nurse working in the heart failure clinic will know that teaching for a patient with newly diagnosed heart failure has been effective when the patient does which of the following actions?
- A. Uses an additional pillow to sleep when feeling short of breath at night.
- B. Tells the home care nurse that furosemide is taken daily at bedtime.
- C. Calls the clinic when the weight increases from 56 to 59 kg in 2 days.
- D. Says that the nitroglycerin patch will be used for any chest pain that develops.
Correct Answer: C
Rationale: Teaching for a patient with heart failure includes information about the need to weigh daily and notify the health care provider about an increase of more than 2 kg in a 2 day period. Nitroglycerin patches are used primarily to reduce preload (not to prevent chest pain) in patients with heart failure and should be used daily, not on an 'as necessary' basis. Diuretics should be taken earlier in the day to avoid nocturia and sleep disturbance. The patient should call the clinic if increased orthopnea develops, rather than just compensating by elevating the head of the bed further.
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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.
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.
Following an acute myocardial infarction, a previously healthy patient develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about which of the following medications?
- A. Angiotensin-converting enzyme (ACE) inhibitors
- B. Digitalis preparations
- C. β-Adrenergic agonists
- D. Calcium channel blockers
Correct Answer: A
Rationale: ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure. Digoxin therapy for heart failure is no longer considered a first-line measure. Calcium channel blockers are not generally used in the treatment of heart failure. The β-adrenergic agonists such as dobutamine are administered through the IV route and are not used as initial therapy for heart failure.
The nurse is caring for a patient with right-sided heart failure who asks the nurse what caused the heart failure. Which of the following causes is the primary cause of right-sided heart failure?
- A. Cor pulmonale
- B. Chronic pulmonary hypertension
- C. Left-sided heart failure
- D. Acute decompensated heart failure
Correct Answer: C
Rationale: The primary cause of right-sided failure is left-sided failure. In this situation, left-sided failure results in pulmonary congestion and increased pressure in the blood vessels of the lungs (pulmonary hypertension).
The nurse is caring for an older-adult patient with heart failure and learns that the patient lives alone and sometimes confuses the 'water pill' with the 'heart pill.' When planning for the patient's discharge the nurse will facilitate which of the following actions?
- A. Transfer to a dementia care service
- B. Referral to a home health care agency
- C. Placement in a long-term care facility
- D. Arrangements for around-the-clock care
Correct Answer: B
Rationale: The data about the patient suggest that assistance in developing a system for taking medications correctly at home is needed. A home health nurse will assess the patient's home situation and help the patient develop a method for taking the two medications as directed. There is no evidence that the patient requires services such as dementia care, long-term care, or around-the-clock home care.