Nokea
Which of the following diagnostic tests will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure?
- A. Serum creatine kinase (CK)
- B. Arterial blood gases (ABGs)
- C. B-type natriuretic peptide (BNP)
- D. 12-lead electrocardiogram (ECG)
Correct Answer: C
Rationale: BNP is secreted when ventricular pressures increase, as with heart failure, and elevated BNP indicates a probable or very probable diagnosis of heart failure. 12-lead ECGs, ABGs, and CK also may be used in determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as BNP.
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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 assessment finding in a patient admitted with chronic heart failure requires the most rapid action by the nurse?
- A. Oxygen saturation of 88%
- B. Weight gain of 1 kg
- C. Apical pulse rate of 106 beats/minute
- D. Urine output of 50 ml over 2 hours
Correct Answer: A
Rationale: In a person with HF, oxygen saturation of the blood may be reduced because the blood is not adequately oxygenated in the lungs. Administration of oxygen, if the O2 saturation is less than 90%, can improve tissue oxygenation. Thus, appropriate use of oxygen therapy helps relieve dyspnea and fatigue. An increase in apical pulse rate, 1-kg weight gain, and decreases in urine output also indicate worsening heart failure and require rapid nursing actions, but the low oxygen saturation rate requires the most immediate nursing action.
The nurse is caring for a patient with Class III status (NYHA) heart failure and type 2 diabetes and the patient asks the nurse whether heart transplant is a possible therapy. Which of the following responses by the nurse is best?
- A. Since you have diabetes, you would not be a candidate for a heart transplant.
- B. The choice of a patient for a heart transplant depends on many different factors.
- C. Your heart failure has not reached the stage in which heart transplants are considered.
- D. People who have heart transplants are at risk for multiple complications after surgery.
Correct Answer: B
Rationale: Indications for a heart transplant include end-stage heart failure, but other factors such as coping skills, family support, and patient motivation to follow the rigorous post-transplant regimen are also considered. Patients with diabetes who have well-controlled blood glucose levels may be candidates for heart transplant. Although heart transplants can be associated with many complications, this response does not address the patient's question.
The nurse is providing health-promotion teaching related to heart health and is explaining modifiable and nonmodifiable risk factors. Smoking is a modifiable risk factor. After a diagnosis of cardiovascular-related illness, approximately what percentage of patients that were smokers quit?
- A. 5
- B. 15
- C. 25
- D. 50
Correct Answer: A
Rationale: After diagnosis of a cardiovascular-related illness, fewer than 5% of Canadians quit smoking.
The nurse is caring for a patient who is receiving IV furosemide and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. When evaluating the patient response to the medications, which of the following is the best indicator that the treatment has been effective?
- A. Weight loss of 1 kg overnight
- B. Hourly urine output greater than 60 ml.
- C. Reduction in patient complaints of chest pain
- D. Decreased dyspnea with the head of bed at 30 degrees
Correct Answer: D
Rationale: Because the patient's major clinical manifestation of ADHF is orthopnea (caused by the presence of fluid in the alveoli), the best indicator that the medications are effective is a decrease in dyspnea with the head of bed at 30 degrees. The other assessment data also may indicate that diuresis or improvement in cardiac output has occurred but are not as specific to evaluating this patient's response.