Heart Failure

• While assessing a 68-yr-old with ascites, the nurse also notes jugular venous distention (JVD) with the head of the patient's bed elevated 45 degrees. The nurse knows this finding indicates


  a. decreased fluid volume.b. jugular vein atherosclerosis.c. increased right atrial pressure.d. incompetent jugular vein valves.c. increased right atrial pressure.

  The jugular veins empty into the superior vena cava and then into the right atrium, so JVD with the patient sitting at a 45-degree angle reflects increased right atrial pressure. JVD is an indicator of excessive fluid volume (increased preload), not decreased fluid volume. JVD is not caused by incompetent jugular vein valves or atherosclerosis.See an expert-written answer!We have an expert-written solution to this problem!
• The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator that the treatment has been effective?

  a. Weight loss of 2 lb in 24 hoursb. Hourly urine output greater than 60 mLc. Reduction in patient complaints of chest paind. Reduced dyspnea with the head of bed at 30 degreesd. Reduced dyspnea with the head of bed at 30 degrees

  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 the bed at 30 degrees. The other assessment data may also indicate that diuresis or improvement in cardiac output has occurred but are not as specific to evaluating this patient's response.See an expert-written answer!We have an expert-written solution to this problem!
• Which topic will the nurse plan to include in discharge teaching for a patient with heart failure with reduced ejection fraction (HFrEF)?

  a. Need to begin an aerobic exercise program several times weeklyb. Use of salt substitutes to replace table salt when cooking and at the tablec. Importance of making an annual appointment with the health care providerd. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitorsd. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors

  The core measures for the treatment of heart failure established by The Joint Commission indicate that patients with an ejection fraction below 40% should receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise may not be appropriate for a patient with this level of heart failure, salt substitutes are not usually recommended because of the risk of hyperkalemia, and the patient will need to see the primary care provider more frequently than annually.See an expert-written answer!We have an expert-written solution to this problem!
• IV sodium nitroprusside is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to titrate the nitroprusside rate down if the patient develops


  a. ventricular ectopy.b. a dry, hacking cough.c. a systolic BP below 90 mm Hg.d. a heart rate below 50 beats/min.c. a systolic BP below 90 mm Hg.

  Sodium nitroprusside is a potent vasodilator and the major adverse effect is severe hypotension. Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause increased ventricular ectopy.
• A patient who has chronic heart failure tells the nurse, "I was fine when I went to bed, but I woke up in the middle of the night feeling like I was suffocating!" The nurse will document this assessment finding as


  a. orthopnea.b. pulsus alternans.c. paroxysmal nocturnal dyspnea.d. acute bilateral pleural effusion.c. paroxysmal nocturnal dyspnea.

  Paroxysmal nocturnal dyspnea is caused by the reabsorption of fluid from dependent body areas when the patient is sleeping and is characterized by waking up suddenly with the feeling of suffocation. Pulsus alternans is the alteration of strong and weak peripheral pulses during palpation. Orthopnea indicates that the patient is unable to lie flat because of dyspnea. Pleural effusions develop over a longer time period.See an expert-written answer!We have an expert-written solution to this problem!
• During a visit to a 78-yr-old patient with chronic heart failure, the home care nurse finds that the patient has ankle edema, a 2-kg weight gain over the past 2 days, and complains of "feeling too tired to get out of bed." Based on these data, a correct nursing diagnosis for the patient is


  a. activity intolerance related to fatigue.b. impaired skin integrity related to edema.c. disturbed body image related to weight gain.d. impaired gas exchange related to dyspnea on exertion.a. activity intolerance related to fatigue.

  The patient's statement supports the diagnosis of activity intolerance. There are no data to support the other diagnoses, although the nurse will need to assess for additional patient problems.
• The nurse working on the heart failure unit knows that teaching an older female patient with newly diagnosed heart failure is effective when the patient states that

  a. she will take furosemide (Lasix) every day at bedtime.b. the nitroglycerin patch is to be used when chest pain develops.c. she will call the clinic if her weight goes up 3 pounds in 1 week.d. an additional pillow can help her sleep if she is short of breath at night.c. she will call the clinic if her weight goes up 3 pounds in 1 week.

  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 3 lb in 2 days or 3 to 5 lb in a week. 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 needed" 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 further elevating the head of the bed.
• When teaching the patient with newly diagnosed heart failure about a 2000-mg sodium diet, the nurse explains that foods to be restricted include


  a. canned and frozen fruits.b. yogurt and milk products.c. fresh or frozen vegetables.d. eggs and other high-protein foods.b. yogurt and milk products.

  Yogurt and milk products (e.g., cheese) naturally contain a significant amount of sodium, and the intake of these should be limited for patients on a diet that limits sodium to 2000 mg daily. The other foods listed have minimal levels of sodium and can be eaten without restriction.See an expert-written answer!We have an expert-written solution to this problem!
• The nurse plans discharge teaching for a patient with chronic heart failure who has prescriptions for digoxin (Lanoxin) and hydrochlorothiazide. Appropriate instructions for the patient include

  a. limit dietary sources of potassium.b. take the hydrochlorothiazide before bedtime.c. notify the health care provider if nausea develops.d. take the digoxin if the pulse is below 60 beats/min.c. notify the health care provider if nausea develops.

  Nausea is an indication of digoxin toxicity and should be reported so that the provider can assess the patient for toxicity and adjust the digoxin dose, if necessary. The patient will need to include potassium-containing foods in the diet to avoid hypokalemia. Patients should be taught to check their pulse daily before taking the digoxin and if the pulse is less than 60 beats/min, to call their provider before taking the digoxin. Diuretics should be taken early in the day to avoid sleep disruption.
• While admitting an 82-yr-old patient with acute decompensated heart failure to the hospital, the nurse 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 a


  a. plan for around-the-clock care.b. consultation with a psychologist.c. transfer to a long-term care facility.d. referral to a home health care agency.d. referral to a home health care agency.

  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 a psychologist consult, long-term care, or around-the-clock home care.See an expert-written answer!We have an expert-written solution to this problem!
• Following an acute myocardial infarction, a previously healthy 63-yr-old develops clinical manifestations of heart failure. The nurse anticipates discharge teaching will include information about


  a. -Adrenergic blockers.b. calcium channel blockers.c. digitalis and potassium therapy regimens.d. angiotensin-converting enzyme (ACE) inhibitors.d. angiotensin-converting enzyme (ACE) inhibitors.

  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, and digoxin is added to the treatment protocol when therapy with other drugs such as ACE-inhibitors, diuretics, and -adrenergic blockers is insufficient. Calcium channel blockers are not generally used in the treatment of heart failure. The -adrenergic blockers are not used as initial therapy for new onset heart failure.See an expert-written answer!We have an expert-written solution to this problem!
• A 53-yr-old patient with stage D heart failure and type 2 diabetes asks the nurse whether heart transplant is a possible therapy. Which response by the nurse is most accurate?

  a. "Your heart failure has not reached the end stage yet."b. "You could not manage the multiple complications of that surgery."c. "The suitability of a heart transplant for you depends on many factors."d. "Because you have diabetes, you would not be a heart transplant candidate."c. "The suitability of a heart transplant for you depends on many factors."

  Indications for a heart transplant include end-stage heart failure (stage D), but other factors such as coping skills, family support, and patient motivation to follow the rigorous posttransplant 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, there are no data to suggest that the patient could not manage the care.
• Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure?

  a. Serum troponinb. Arterial blood gasesc. B-type natriuretic peptided. 12-lead electrocardiogramc. B-type natriuretic peptide

  B-type natriuretic peptide (BNP) is secreted when ventricular pressures increase, as they do with heart failure. Elevated BNP indicates a probable or very probable diagnosis of heart failure. A 12-lead electrocardiogram, arterial blood gases, and troponin may also be used in determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as BNP.See an expert-written answer!We have an expert-written solution to this problem!
• Which action should the nurse include in the plan of care when caring for a patient admitted with acute decompensated heart failure (ADHF) who is receiving nesiritide (Natrecor)?

  a. Monitor blood pressure frequently.b. Encourage patient to ambulate in room.c. Titrate nesiritide slowly before stopping.d. Teach patient about home use of the drug.a. Monitor blood pressure frequently.

  Nesiritide is a potent arterial and venous dilator, and the major adverse effect is hypotension. Because the patient is likely to have orthostatic hypotension, the patient should not be encouraged to ambulate. Nesiritide does not require titration and is used for ADHF but not in a home setting.See an expert-written answer!We have an expert-written solution to this problem!
• A patient with heart failure has a new order for captopril 12.5 mg PO. After giving the first dose and teaching the patient about the drug, which statement by the patient indicates that teaching has been effective?


  a. "I will be sure to take the medication with food."b. "I will need to eat more potassium-rich foods in my diet."c. "I will call for help when I need to get up to use the bathroom."d. "I will expect to feel more short of breath for the next few days."c. "I will call for help when I need to get up to use the bathroom."

  Captopril can cause hypotension, especially after the initial dose, so it is important that the patient not get up out of bed without assistance until the nurse has had a chance to evaluate the effect of the first dose. The angiotensin-converting enzyme (ACE) inhibitors are potassium sparing, and the nurse should not teach the patient to purposely increase sources of dietary potassium. Increased shortness of breath is expected with the initiation of -adrenergic blocker therapy for heart failure, not for ACE inhibitor therapy. ACE inhibitors are best absorbed when taken an hour before eating.See an expert-written answer!We have an expert-written solution to this problem!
• A patient who has just been admitted with pulmonary edema is scheduled to receive the following medications. Which medication should the nurse question before giving?

  a. captopril 25 mgb. furosemide (Lasix) 60 mgc. digoxin (Lanoxin) 0.125 mgd. carvedilol (Coreg) 3.125 mgd. carvedilol (Coreg) 3.125 mg

  Although carvedilol is appropriate for the treatment of chronic heart failure, it is not used for patients with acute decompensated heart failure (ADHF) because of the risk of worsening the heart failure. The other drugs are appropriate for the patient with ADHF.See an expert-written answer!We have an expert-written solution to this problem!
• A patient with a history of chronic heart failure is admitted to the emergency department with severe dyspnea and a dry, hacking cough. Which action should the nurse do first?

  
  

  a. Auscultate the abdomen.

  b. Check the capillary refill.

  c. Auscultate the breath sounds.

  d. Ask about the patient's allergies.


  c. Auscultate the breath sounds.

  This patient's severe dyspnea and cough indicate that acute decompensated heart failure (ADHF) is occurring. ADHF usually manifests as pulmonary edema, which should be detected and treated immediately to prevent ongoing hypoxemia and cardiac/respiratory arrest. The other assessments will provide useful data about the patient's volume status and also should be accomplished rapidly, but detection (and treatment) of pulmonary complications is the priority.
• A patient with chronic heart failure who is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor and who is on a low-sodium diet tells the home health nurse about a 5-lb weight gain in the past 3 days. The nurse's priority action will be to

  
  

  a. have the patient recall the dietary intake for the past 3 days.

  b. ask 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 restricting dietary sodium.

  c. assess the patient for clinical manifestations of acute heart failure.

  The 5-lb weight gain over 3 days indicates that the patient's chronic heart failure may be worsening. It is important that the patient be assessed immediately 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.See an expert-written answer!We have an expert-written solution to this problem!
• A patient in the intensive care unit with acute decompensated heart failure (ADHF) complains of severe dyspnea and is anxious, tachypneic, and tachycardic. Several drugs have been ordered for the patient. The nurse's priority action will be to

  a. give PRN IV morphine sulfate 4 mg.b. give PRN IV diazepam (Valium) 2.5 mg.c. increase nitroglycerin infusion by 5 mcg/min.d. increase dopamine infusion by 2 mcg/kg/min.a. give PRN IV morphine sulfate 4 mg.

  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 will also 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.See an expert-written answer!We have an expert-written solution to this problem!
• After receiving change-of-shift report on four patients admitted to a heart failure unit, which patient should the nurse assess first?

  a. A patient who reported dizziness after receiving the first dose of captoprilb. A patient who is cool and clammy, with new-onset confusion and restlessnessc. A patient who has crackles bilaterally in the lung bases and is receiving oxygen.d. A patient who is receiving IV nesiritide (Natrecor) and has a blood pressure of 100/62b. A patient who is cool and clammy, with new-onset confusion and restlessness

  The patient who has "wet-cold" clinical manifestations of heart failure is perfusing inadequately and needs rapid assessment and changes in management. The other patients also should be assessed as quickly as possible but do not have indications of severe decreases in tissue perfusion.See an expert-written answer!We have an expert-written solution to this problem!
• Which assessment finding in a patient admitted with acute decompensated heart failure (ADHF) requires the most immediate action by the nurse?

  a. O2 saturation of 88%b. Weight gain of 1 kg (2.2 lb)c. Heart rate of 106 beats/mind. Urine output of 50 mL over 2 hoursa. O2 saturation of 88%

  A decrease in O2 saturation to less than 92% indicates hypoxemia, and the nurse should start supplemental O2 immediately. An increase in apical pulse rate, 1-kg weight gain, and decreases in urine output also indicate worsening heart failure and require nursing actions, but the low O2 saturation rate requires the most immediate nursing action.See an expert-written answer!We have an expert-written solution to this problem!
• A patient has recently started on digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril for the management of heart failure. Which assessment finding by the home health nurse is a priority to communicate to the health care provider?

  a. Presence of 1+ to 2+ edema in the feet and anklesb. Palpable liver edge 2 cm below the ribs on the right sidec. Serum potassium level 3.0 mEq/L after 1 week of therapyd. Weight increase from 120 pounds to 122 pounds over 3 daysc. Serum potassium level 3.0 mEq/L after 1 week of therapy

  Hypokalemia can predispose the patient to life-threatening dysrhythmias (e.g., premature ventricular contractions) and potentiate the actions of digoxin. Hypokalemia also increases the risk for digoxin toxicity, which can also cause life-threatening dysrhythmias. The other data indicate that the patient's heart failure requires more effective therapies, but they do not require nursing action as rapidly as the low serum potassium level.See an expert-written answer!We have an expert-written solution to this problem!
• An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider?


  a. 2+ bilateral pedal edemab. Heart rate of 56 beats/minc. Complaints of increased fatigued. Blood pressure (BP) of 88/42 mm Hgd. Blood pressure (BP) of 88/42 mm Hg

  The patient's BP indicates that the dose of metoprolol may need to be decreased because of hypotension. Bradycardia is a frequent adverse effect of -adrenergic blockade, but the rate of 56 is not unusual though it may need to be monitored. -Adrenergic blockade initially will worsen symptoms of heart failure in many patients and patients should be taught that some increase in symptoms, such as fatigue and edema, is expected during the initiation of therapy with this class of drugs.See an expert-written answer!We have an expert-written solution to this problem!
• A patient who is receiving dobutamine for the treatment of acute decompensated heart failure (ADHF) has the following nursing interventions included in the plan of care. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?

  a. Teach the patient the reasons for remaining on bed rest.b. Change the peripheral IV site according to agency policy.c. Monitor the patient's blood pressure and heart rate every hour.d. Titrate the rate to keep the systolic blood pressure >90 mm Hg.c. Monitor the patient's blood pressure and heart rate every hour.

  An experienced LPN/LVN would be able to monitor BP and heart rate and would know to report significant changes to the RN. Teaching patients, making adjustments to the drip rate for vasoactive drugs, and inserting a new peripheral IV catheter require RN level education and scope of practice.See an expert-written answer!We have an expert-written solution to this problem!
• After receiving change-of-shift report on a heart failure unit, which patient should the nurse assess first?

  a. Patient who is taking carvedilol (Coreg) and has a heart rate of 58b. Patient who is taking digoxin and has a potassium level of 3.1 mEq/Lc. Patient who is taking captopril and has a frequent nonproductive coughd. Patient who is taking isosorbide dinitrate/hydralazine (BiDil) and has a headacheb. Patient who is taking digoxin and has a potassium level of 3.1 mEq/L

  The patient's low potassium level increases the risk for digoxin toxicity and potentially life-threatening dysrhythmias. The nurse should assess the patient for other signs of digoxin toxicity and then notify the health care provider about the potassium level. The other patients also have side effects of their drugs, but their symptoms do not indicate potentially life-threatening complications.See an expert-written answer!We have an expert-written solution to this problem!
• A patient admitted with acute dyspnea is newly diagnosed with dilated cardiomyopathy. Which information will the nurse plan to teach the patient about managing this disorder?


  a. A heart transplant should be scheduled as soon as possible.b. Elevating the legs above the heart will help relieve dyspnea.c. Careful compliance with diet and medications will prevent heart failure.d. Notify the doctor about any symptoms of heart failure such as shortness of breath.d. Notify the doctor about any symptoms of heart failure such as shortness of breath.

  The patient should be instructed to notify the health care provider about any worsening of heart failure symptoms. Because dilated cardiomyopathy does not respond well to therapy, even patients with good compliance with therapy may have recurrent episodes of heart failure. Elevation of the legs above the heart will worsen symptoms (although this approach is appropriate for a patient with hypertrophic cardiomyopathy). The patient with terminal or end-stage cardiomyopathy may consider heart transplantation.See an expert-written answer!We have an expert-written solution to this problem!
• To determine the effects of therapy for a patient who is being treated for heart failure, which laboratory result will the nurse plan to review?

  a. Troponinc. Low-density lipoprotein (LDL)b. Homocysteine (Hcy)d. B-type natriuretic peptide (BNP)d. B-type natriuretic peptide (BNP)

  Increased levels of BNP are a marker for heart failure. The other laboratory results would be used to assess for myocardial infarction (troponin) or risk for coronary artery disease (Hcy and LDL).See an expert-written answer!We have an expert-written solution to this problem!
• While doing the admission assessment for a thin 76-year-old patient, the nurse observes pulsation of the abdominal aorta in the epigastric area. Which action should the nurse take?

  a. Teach the patient about aneurysms.b. Notify the hospital rapid response team.c. Instruct the patient to remain on bed rest.d. Document the finding in the patient chart.d. Document the finding in the patient chart.

  Visible pulsation of the abdominal aorta is commonly observed in the epigastric area for thin individuals. The nurse should simply document the finding in the admission assessment. Unless there are other abnormal findings (such as a bruit, pain, or hyper/hypotension) associated with the pulsation, the other actions are not necessary.
• While assessing a patient who was admitted with heart failure, the nurse notes that the patient has jugular venous distention (JVD) when lying flat in bed. Which action should the nurse take next?

  a. Obtain vital signs, including oxygen saturation.b. Have the patient perform the Valsalva maneuver.c. Document this JVD finding in the patient's record.d. Observe for JVD with the patient elevated 45 degrees.d. Observe for JVD with the patient elevated 45 degrees.

  When the patient is lying flat, the jugular veins are at the level of the right atrium, so JVD is a common (but not a clinically significant) finding. Obtaining vital signs and oxygen saturation is not warranted at this point. JVD is an expected finding when a patient performs the Valsalva maneuver because right atrial pressure increases. JVD that persists when the patient is sitting at a 30- to 45-degree angle or greater is significant. The nurse will document the JVD in the medical record if it persists when the head is elevated.See an expert-written answer!We have an expert-written solution to this problem!
• A client is admitted with early-stage heart failure. Which assessment finding does the nurse expect?

  a. A decrease in blood pressure and urine outputb. An increase in creatinine and extremity edemac. An increase in heart rate and respiratory rated. A decrease in respirations and oxygen saturationc. An increase in heart rate and respiratory rate

  In heart failure, stimulation of the sympathetic nervous system represents the most immediate response. Adrenergic receptor stimulation causes an increase in heart rate and respiratory rate. Blood pressure will remain the same or will elevate slightly. Changes in creatinine occur when kidney damage has occurred, which is a later manifestation. Other later manifestations may include edema, increased respiratory rate, and lowered oxygen saturation readings.
• A client with systolic dysfunction has an ejection fraction of 38%. The nurse assesses for which physiologic change?

  a. Increase in stroke volumeb. Decrease in tissue perfusionc. Increase in oxygen saturationd. Decrease in arterial vasoconstrictionb. Decrease in tissue perfusion

  In systolic dysfunction, the ventricle is unable to contract with enough force to eject blood effectively during systole. As the ejection fraction decreases (50% to 70% is normal), tissue perfusion decreases and the client develops activity intolerance. Stroke volume and oxygen saturation do not increase with a low ejection fraction.
• The nurse is assessing clients on a cardiac unit. Which client does the nurse assess most carefully for developing left-sided heart failure?


  a. Middle-aged woman with aortic stenosisb. Middle-aged man with pulmonary hypertensionc. Older woman who smokes cigarettes dailyd. Older man who has had a myocardial infarctiona. Middle-aged woman with aortic stenosis

  Although most people with heart failure will have failure that progresses from left to right, it is possible to have left-sided failure alone for a short period. It is also possible to have heart failure that progresses from right to left. Causes of left ventricular failure include mitral or aortic valve disease, coronary artery disease (CAD), and hypertension.See an expert-written answer!We have an expert-written solution to this problem!
• The nurse is assessing a client in an outpatient clinic. Which client statement alerts the nurse to possible left-sided heart failure?

  a. "I have been drinking more water than usual."b. "I have been awakened by the need to urinate at night."c. "I have to stop halfway up the stairs to catch my breath."d. "I have experienced blurred vision on several occasions."c. "I have to stop halfway up the stairs to catch my breath."

  Clients with left-sided heart failure report weakness or fatigue while performing normal activities of daily living, as well as difficulty breathing, or "catching their breath." This occurs as fluid moves into the alveoli. Nocturia is often seen with right-sided heart failure. Thirst and blurred vision are not related to heart failure.
• A client with a history of myocardial infarction calls the clinic to report the onset of a cough that is troublesome only at night. What direction does the nurse give to the client?


  a. "Please come into the clinic for an evaluation."b. "Increase your fluid intake during waking hours."c. "Use an over-the-counter cough suppressant."d. "Sleep on two pillows to facilitate postnasal drainage."a. "Please come into the clinic for an evaluation."

  The client with a history of myocardial infarction is at risk for developing heart failure. The onset of nocturnal cough is an early manifestation of heart failure, and the client needs to be evaluated as soon as possible.See an expert-written answer!We have an expert-written solution to this problem!
• The nurse is assessing a client admitted to the cardiac unit. What statement made by the client alerts the nurse to the possibility of right-sided heart failure?

  a. "I sleep with four pillows at night."b. "My shoes fit really tight lately."c. "I wake up coughing every night."d. "I have trouble catching my breath."b. "My shoes fit really tight lately."

  Signs of systemic congestion occur with right-sided heart failure. Fluid is retained, pressure builds in the venous system, and peripheral edema develops. Left-sided heart failure symptoms include respiratory symptoms. Orthopnea, coughing, and difficulty breathing all could be results of left-sided heart failure.See an expert-written answer!We have an expert-written solution to this problem!
• The nurse notes that the client's apical pulse is displaced to the left. What conclusion can be drawn from this assessment?

  a. This is a normal finding.b. The heart is hypertrophied.c. The left ventricle is contracted.d. The client has pulsus alternans.b. The heart is hypertrophied.

  The client with heart failure typically has an enlarged heart that displaces the apical pulse to the left.See an expert-written answer!We have an expert-written solution to this problem!
• The nurse assesses a client and notes the presence of an S3 gallop. What is the nurse's best intervention?

  a. Assess for symptoms of left-sided heart failure.b. Document this as a normal finding.c. Call the health care provider immediately.d. Transfer the client to the intensive care unit.a. Assess for symptoms of left-sided heart failure.

  The presence of an S3 gallop is an early diastolic filling sound indicative of increasing left ventricular pressure and left ventricular failure. The other actions are not warranted.See an expert-written answer!We have an expert-written solution to this problem!
• A client asks the nurse why it is important to be weighed every day if he has right-sided heart failure. What is the nurse's best response?

  a. "Weight is the best indication that you are gaining or losing fluid."b. "Daily weights will help us make sure that you're eating properly."c. "The hospital requires that all inpatients be weighed daily."d. "You need to lose weight to decrease the incidence of heart failure."a. "Weight is the best indication that you are gaining or losing fluid."

  Daily weights are needed to document fluid retention or fluid loss. One liter of fluid equals 2.2 pounds.
• A client has been admitted to the intensive care unit with worsening pulmonary manifestations of heart failure. What is the nurse's best action?


  a. Place the client in a high Fowler's position.b. Begin cardiopulmonary resuscitation (CPR).c. Promote rest and minimize activities.d. Administer loop diuretics as prescribed.d. Administer loop diuretics as prescribed.

  The client with worsening heart failure is most at risk for pulmonary edema as a consequence of fluid retention. Administering diuretics will decrease the fluid overload, thereby decreasing the incidence of pulmonary edema. High Fowler's position might help the client breathe easier but will not solve the problem. CPR is not warranted in this situation. Rest is important for clients with heart failure, but this is not the priority.See an expert-written answer!We have an expert-written solution to this problem!
• A client with heart failure is experiencing acute shortness of breath. What is the nurse's priority action?

  a. Place the client in a high Fowler's position.b. Perform nasotracheal suctioning of the client.c. Auscultate the client's heart and lung sounds.d. Place the client on a 1000 mL fluid restriction.a. Place the client in a high Fowler's position.

  Placing a client in a high Fowler's position, especially with pillows under each arm, can maximize chest expansion and improve oxygenation. The nurse next should auscultate the client's heart and lungs. The client may or may not need fluid restriction to help manage heart failure, and suctioning is not needed.See an expert-written answer!We have an expert-written solution to this problem!