Chapter 30- Management of Patients With Complications From Heart Disease

1. The nurse notes that a patient has developed a cough productive for mucoid sputum, shortness of breath, cyanotic hands, and noisy, moist-sounding, rapid breathing. These symptoms indicate: A) Pericarditis C) Pulmonary edema B) Heart failure D) Right ventricular hypertrophy Ans: C Difficulty: Moderate 2. Based upon the following assessment data collected by the nurse, what increases a patient's risk for heart failure? A) Lasix 20 mg/day C) African-American man B) Potassium level of 5.7 mEq/L D) Age of 65 years or older Ans: D Difficulty: Easy 3. The nurse is reviewing the past medical history of a patient with heart failure presented to the emergency room. Which of the following is the primary cause of the patient's heart failure? A) Type I diabetes C) Atherosclerosis B) Arteriosclerosis D) Pulmonary congestion Ans: C Difficulty: Moderate 4. Which assessment would be most appropriate for a patient who is receiving a loop diuretic for heart failure? A) Monitor liver function studies. B) Monitor for hypotension. C) Encourage the patient to spend time outdoors to aid in vitamin D absorption. D) Restrict the intake of potassium. Ans: B Difficulty: Moderate 5. The nurse documents on the patient's chart that he is experiencing orthopnea, which that he is having difficulty breathing: A) Without use of oxygen C) With movement B) While sitting upright D) When lying flat Ans: D Difficulty: Moderate 6. Which of the following assessment findings may indicate right-sided heart failure? A) Pulmonary edema B) Distended neck veins C) Dry cough D) Orthopnea Ans: B Difficulty: Moderate 7. A patient admitted with heart failure is complaining of persistent nausea. The nurse recognizes that gastrointestinal distress associated with right-sided heart failure is
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A) B) C) D)

caused by: Venous stasis and venous engorgement within the abdominal organs An anxiety and stress response by the patient Constipation from decreased gastrointestinal motility Urinary retention due to lack of renal perfusion Ans: A Difficulty: Difficult

8. An adult patient with heart failure is prescribed digoxin. The nurse should explain to the patient that when taking this medication, he or she should watch for the following adverse side effects: A) Fatigue and nausea C) Weight loss B) Increased urine output D) Decreased pulmonary crackles Ans: A Difficulty: Moderate 9. When being discharged home, to assess fluid balance, a patient with heart failure should be instructed to: A) Monitor blood pressure. C) Monitor weight daily. B) Assess radial pulses. D) Monitor bowel movements. Ans: C Difficulty: Moderate 10. A patient is experiencing cardiogenic shock secondary to hypervolemia. The nurse should expect which of the following treatments to be ordered? A) Albumin IV B) Cardioversion C) Diuretics D) Elevation of the feet Ans: C Difficulty: Moderate 11. A patient with cardiac disease has developed an intracardiac thrombus. The most common complication of this is: A) Pulmonary embolism C) Mesenteric embolism B) Cerebral embolism D) Peripheral embolism Ans: A Difficulty: Moderate 12. An adult man is admitted after a motor vehicle accident complaining of chest pain, shortness of breath, and distended neck veins. The nurse notes that the pulse pressure is narrowing. The patient may be experiencing: A) Myocardial infarction C) Heart failure B) Cardiac tamponade D) Pulmonary edema Ans: B Difficulty: Moderate 13. The nurse suspects that a 68-year-old patient has digoxin toxicity. The nurse should assess for:

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A) B)

Hearing loss Vision changes Ans: B Difficulty: Easy

C) D)

Decreased urine output Gait instability

14. A 65-year-old man comes to the emergency department with severe chest pain and shortness of breath. He's diaphoretic, pale, and weak. Suddenly, the patient collapses. What should the nurse do first? A) Check for a carotid pulse. B) Open the airway and check for spontaneous respirations. C) Give two full breaths. D) Gently shake him and shout, "Are you OK?" Ans: D Difficulty: Easy 15. The nurse notes that an 84-year-old male returning from the operating room (OR) after postinguinal hernia repair has fluid volume excess and is at risk for left-sided heart failure. Which of the following signs and symptoms indicates left-sided heart failure? A) Jugular vein distention C) Bibasilar fine crackles B) Right upper quadrant pain D) Dependent edema Ans: C Difficulty: Moderate 16. The nurse is caring for a patient with left-sided heart failure. To reduce fluid volume excess, the nurse anticipates the physician will order: A) Antiembolism stockings B) Oxygen C) Diuretics D) Anticoagulants Ans: C Difficulty: Easy 17. A patient with left-sided heart failure complains of increasing shortness of breath and is agitated and coughing up pink-tinged, foamy sputum. The nurse should recognize these as signs and symptoms of: A) Right-sided heart failure C) Pneumonia B) Acute pulmonary edema D) Cardiogenic shock Ans: B Difficulty: Moderate 18. A 74-year-old man with a history of heart failure is admitted to the coronary care unit with acute pulmonary edema. He's intubated and placed on a ventilator. Which of the following parameters should the nurse closely monitor in assessing the patient's response to a bolus dose of IV furosemide (Lasix)? A) Daily weight C) Serum sodium levels B) 24-hour intake and output D) Hourly urine output Ans: D Difficulty: Easy

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19. The nurse is caring for a patient with cardiogenic shock after a myocardial infarction. What mechanical device will assist in increasing coronary perfusion and cardiac output and decreasing myocardial workload and oxygen consumption in this patient? A) Cardiac pacemaker C) Defibrillator B) Hypothermia/hyperthermia machine D) Intra-aortic balloon pump Ans: D Difficulty: Difficult 20. The nurse is caring for a patient experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect? A) Pulmonary embolism C) Cardiac tamponade B) Heart failure D) Tension pneumothorax Ans: B Difficulty: Difficult 21. A patient is placed on a low-sodium diet. Which statement by the patient indicates that the nurse's nutritional teaching plan has been effective? A) "I will have a ham and cheese sandwich with potato chips for lunch." B) "I will have a baked potato with broiled chicken for dinner." C) "I will have a tossed salad with sardines and oil and vinegar dressing for lunch." D) "I will have chicken bouillon soup with crackers and an apple for lunch." Ans: B Difficulty: Moderate 22. To assess hepatojugular reflux in a patient with heart failure, the nurse should: A) Elevate the patient's head to 90 degrees. B) Press the right upper abdomen. C) Press the left upper abdomen. D) Lay the patient flat in bed. Ans: B Difficulty: Moderate 23. The nurse is administering captopril to a patient with heart failure. Which assessment finding would prompt the nurse to withhold the next dose and notify the physician? A) Hypertension C) Dyspnea and crackles B) Third (S3) heart sound D) Hyperkalemia Ans: D Difficulty: Difficult 24. A patient admitted with heart failure is able to initiate brushing her teeth and combing her hair but unable to finish these activities or wash her body due to dyspnea and fatigue. Upon ambulation to the bathroom, the patient also experiences dyspnea, fatigue, and chest pain. Based upon this information, what New York Heart Association Classification will be assigned to this patient? A) I B) II C) III D) IV

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Ans: C Difficulty: Difficult 25. Prior to administering spironolactone (Aldactone) 25 mg to a patient with heart failure, the nurse reviews the patient's most recent laboratory results. What laboratory value is of greatest concern? A) Albumin B) Sodium C) Potassium D) Creatinine Ans: C Difficulty: Moderate 26. Upon evaluation of the patient's laboratory data, the nurse notes an increase in the patient's B-type natriuretic peptide (BNP) and is aware that this increased laboratory value generally indicates a diagnosis of: A) Valvular disease C) Pulmonary edema B) Heart failure D) Cardiogenic shock Ans: B Difficulty: Easy 27. During the morning assessment, a patient admitted with heart failure complains of feeling tired from a poor night of sleep. She tells the nurse that she has been up and down all night because I have to urinate every couple of hours. The patient asks the nurse why she urinates so frequently during the night. The nurse responds: A) Your frequent urination is caused by your bedtime dose of a diuretic. B) It must be related to your excessive intake of fluid before bedtime. C) You must have a urinary tract infection and will need an antibiotic. D) Your heart is not working as hard while you sleep and your kidneys are filtering better. Ans: D Difficulty: Difficult 28. The nurse is preparing the patient with heart failure for discharge. During the patient teaching session, the nurse realizes that the patient will require further teaching in relationship to taking valsartan (Diovan) when the patient states: A) I will notify my physician if I have dizziness when I stand up. B) If I notice a change in the amount that I urinate, I will call my doctor. C) I will call my doctor if I have weakness in my legs. D) I will use these prescriptions for blood work when I notice side effects from the medication. Ans: D Difficulty: Difficult 29. A patient admitted to the telemetry unit with heart failure is exhibiting signs and symptoms of pulmonary edema. The nurse is aware that positioning will promote circulation. The nurse will position the patient: A) In an upright position in bed or with the legs dangling over the side of the bed B) On his left side in a supine position

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C) D)

In a supine position on his back In a Trendelenburg position Ans: A Difficulty: Moderate

30. A patient in cardiac arrest is ordered to receive an initial dose of sodium bicarbonate intravenously to correct metabolic acidosis. What initial dose of sodium bicarbonate will this 187-lb individual receive? A) 50 mEq B) 75 mEq C) 85 mEq D) 100 mEq Ans: C Difficulty: Moderate 31. A patient is admitted to the critical care unit with the diagnosis of cardiogenic shock. The nurse knows the initial management procedure of a patient with cardiogenic shock and is aware that which of the following medications is not given? A) Norepinephrine (Levophed) C) Dobutamine (Dobutrex) B) Furosemide(Lasix) D) Nitroprusside (Nipride) Ans: A Difficulty: Moderate 32. After receiving the nursing report, the nurse recognizes the patient admitted with which of the following to be at greatest risk for the development of cardiogenic shock? A) Acute renal failure C) Malignant hypertension B) Myocardial infarction D) Stroke Ans: B Difficulty: Moderate 33. A cardiopulmonary resuscitation (CPR) instructor is presenting a health care provider CPR course. The instructor reviews the ABCDs of basic CPR, which A) Airway, breathing, cardioversion, and diuretics B) Assessment, balloon pump, circulation, and drugs C) Adrenalin, Bumex, Cardizem, and Dobutrex D) Airway, breathing, circulation, and defibrillation Ans: D Difficulty: Moderate 34. When assessing the patient with pericardial effusion, the nurse will check for pulsus paradoxus, which is characterized by a: A) Diastolic blood pressure that is lower during exhalation B) Diastolic blood pressure that is higher during inhalation C) Systolic blood pressure that is higher during exhalation D) Systolic blood pressure that is lower during inhalation Ans: D Difficulty: Moderate 35. When assessing a patient after a pericardiocentesis that was performed for cardiac

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A) B) C) D)

tamponade, the nurse is aware that the cardiac tamponade has been relieved when the following assessment findings are present: Decrease in central venous pressure and increase in blood pressure Decrease in central venous pressure and decrease in blood pressure Increase in central venous pressure and increase in blood pressure Increase in central venous pressure and decrease in blood pressure Ans: A Difficulty: Moderate

36. The nurse entering the patient's medical-surgical room, finds the patient in cardiac arrest. Cardiopulmonary resuscitation (CPR) is initiated and the code team is alerted. Upon arrival of the code team and placement of the patient on a cardiac monitor, it is determined that the electrocardiogram shows ventricular tachycardia. The next step in the management of this patient will include: A) Continuation of cardiopulmonary resuscitation B) Defibrillation C) Immediate transfer to the intensive care unit D) Chest x-ray Ans: B Difficulty: Moderate 37. The nurse observes the anesthesiologist confirm the placement of the endotracheal tube (ET) using two different methods: a primary method and a secondary method. A secondary method of confirmation of ET placement includes: A) Visualization of the ET through the vocal cords B) Auscultation of breath sounds in five areas on the chest C) Use of a CO2 detector D) Bilateral chest expansion Ans: C Difficulty: Moderate 38. The cardiac monitor technician immediately alerts the nurse that her patient is showing no cardiac rhythm. Upon assessment of the patient, the nurse determines that the patient is experiencing cardiac arrest. In providing cardiac resuscitation documentation, the nurse will describe this initial absence of cardiac rhythm as: A) Pulseless electrical activity (PEA) C) Ventricular tachycardia B) Ventricular fibrillation D) Asystole Ans: D Difficulty: Moderate

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