Nokea
Which of the following patients is less likely to enroll in a cardiac rehabilitation program?
- A. A 64-year-old male who has diabetes
- B. A 51-year-old male who has a same-sex partner
- C. A 52-year-old single female
- D. A 39-year-old male with two children
Correct Answer: C
Rationale: Women are 36% less likely to enroll in cardiac rehabilitation programs.
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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.
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 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.
The home health nurse is visiting a patient with chronic heart failure who has prescriptions for a diuretic, an ACE-inhibitor, and a low-sodium diet and tells the nurse about a 2.3 kg weight gain in the last 3 days. Which of the following actions should the nurse do first?
- A. Ask the patient to recall the dietary intake for the last 3 days.
- B. Question the patient about the use of the prescribed medications.
- C. Assess the patient for clinical manifestations of acute heart failure.
- D. Teach the patient about the importance of dietary sodium restrictions.
Correct Answer: C
Rationale: The development of dependent edema or a sudden weight gain of more than 2 kg in 2 days is often indicative of exacerbated HF. It is important that the patient be immediately assessed for other clinical manifestations of decompensation, such as lung crackles. A dietary recall to detect hidden sodium in the diet, reinforcement of sodium restrictions, and assessment of medication compliance may be appropriate interventions but are not the first nursing actions indicated.
The nurse is teaching the patient with heart failure about a 2 g sodium diet. Which of the following foods should the nurse explain to the patient that need to be restricted?
- A. Canned and frozen fruits
- B. Fresh or frozen vegetables
- C. Milk, yogurt, and other milk products
- D. Eggs and other high-cholesterol foods
Correct Answer: C
Rationale: Milk and yogurt naturally contain a significant amount of sodium, and intake of these should be limited for patients on a diet that limits sodium to 2 g daily. Other milk products, such as processed cheeses, have very high levels of sodium and are not appropriate for a 2 g sodium diet. The other foods listed have minimal levels of sodium and can be eaten without restriction.