Question 1

How should the nurse explain to a patient in heart failure the mechanism of action of an aldosterone antagonist?

Accepted Answer

A)   Reducing sodium and water retention
B)   Filtering potassium out with the water in the renal tubules
C)   Promoting the excretion of the urinary waste products urea and creatinine
D)   Retaining calcium to improve the condition of blood vessels in the glomeruli A

Question 2

A patient is very short of breath. Which finding should cause the nurse to consider that the shortness of breath might be due to heart failure?

Accepted Answer

A)   An echocardiogram that reflects increased right ventricular wall thickening
B)   A B-type natriuretic peptide (BNP)  of 300 pg/mL
C)   A left ventricular ejection fraction (VEF)  of 50%
D)   A serum sodium of 135 B

Question 3

Which finding should cause the nurse to suspect a patient with heart failure is experiencing end organ hypoperfusion? Select all that apply.

Accepted Answer

A)   Confusion
B)   Dropping blood pressure
C)   Urine output 15 mL per hour
D)   Heart rate 124
E)   Peripheral edema A,B,C,D

Question 4

A patient is diagnosed with left-sided heart failure. What should the nurse include when describing the disease process to this patient? Select all that apply.

Accepted Answer

A)   Pumping action of the heart is impaired.
B)   Filling action of the heart is impaired.
C)   Blood backs up in the left side of the heart.
D)   Extra fluid can build up in the lungs.
E)   Extra fluid can build up in the lower extremities.

Question 5

A patient is admitted for treatment of acute decompensated heart failure (ADHF). Which medication should the nurse prepare to administer first?

Accepted Answer

A)   Diuretic
B)   Vasopressor
C)   Beta blocker
D)   Inotropic agent

Question 6

What is the nurse least likely to assess in a patient experiencing acute decompensated heart failure with pulmonary edema?

Accepted Answer

A)   Dyspnea at rest, peripheral edema
B)   Hypertension, bradycardia
C)   Increased coughing, crackles
D)   Decreased O2 saturation, increased PAWP

Question 7

The nurse reviews teaching provided to a patient with heart failure. What should be emphasized during this teaching? Select all that apply.

Accepted Answer

A)   Enhanced admission assessment for post-discharge needs
B)   Enhanced teaching and learning
C)   Patient and family-centered handoff communication
D)   Post-acute care follow-up
E)   Stress reduction strategies

Question 8

While transferring a patient with heart failure from the bed to a chair, the nurse stops and decides to keep the patient in bed. What patient manifestation indicated to the nurse that this patient's status was deteriorating? Select all that apply.

Accepted Answer

A)   Respiratory rate 30
B)   Heart rate 134 on the cardiac monitor
C)   Gasping for breath
D)   Productive cough
E)   Jugular vein distention

Question 9

The nurse is preparing medications for the patient experiencing acute decompensated heart failure. Which medication should be administered first to improve gas exchange for the patient? Select all that apply.

Accepted Answer

A)   Morphine sulfate
B)   Nitroglycerin
C)   Nesiritide (Natrecor) 
D)   Dobutamine (Dobutrex) 
E)   Milrinone (Primacor)

Question 10

When teaching a patient with heart failure about ventricular remodeling, the nurse should recognize that additional teaching is needed if the patient makes which statement about remodeling?

Accepted Answer

A)   "It leads to progressive worsening of heart function."
B)   "It can be described as an enlargement of the pumping chamber."
C)   "It occurs with an increase in blood pressure and results in weight gain."
D)   "It develops primarily because the heart is pumping harder."

Question 11

Which findings should the nurse report to the health care provider as evidence that the condition of a patient with heart failure is deteriorating? Select all that apply.

Accepted Answer

A)   S3 and S4 heart sounds
B)   Oxygen saturation 80% on 4 L oxygen nasal cannula
C)   Urine output 10 mL over the last hour
D)   Onset of productive cough
E)   Weight loss of 3 lbs from previous weight

Question 12

A patient in heart failure is being given a first dose of lisinopril (Prinivil) 10 mg PO. Which finding should cause the nurse to question the administration of the first dose?

Accepted Answer

A)   Heart rate 92 beats per minute
B)   Blood pressure 100/72
C)   Potassium 5.7 mEq/dL
D)   Urine output 35 mL/hr

Question 13

The nurse notes that the QRS duration of a patient with a biventricular pacemaker is widening. What does this most likely indicate?

Accepted Answer

A)   Worsening of the patient's underlying cardiomyopathy
B)   Loss of ventricular capture
C)   Loss of ventricular synchronization
D)   Battery failure

Question 14

A patient has been receiving milrinone (Primacor) for cardiogenic shock from acute decompensated heart failure. What finding indicates that this medication has been effective in the patient? Select all that apply.

Accepted Answer

A)   Increased cardiac output
B)   Reduced pulmonary arterial wedge pressure
C)   Dropping blood pressure
D)   Onset of ventricular dysrhythmias
E)   Respiratory rate 28 and regular

Question 15

After teaching a patient with heart failure about beta blocking agents, the nurse recognizes that additional teaching is needed when the patient makes which statement?

Accepted Answer

A)   "I should weigh myself every day."
B)   "I need to check my blood sugar regularly."
C)   "I will notify my health care provider if I become increasingly short of breath."
D)   "I need to monitor myself daily for an increased heart rate and blood pressure."

Question 16

A patient in heart failure is to be started on an infusion of dobutamine (Dobutrex). What is most important for the nurse to assess before starting the infusion?

Accepted Answer

A)   Breath sounds
B)   Blood pressure
C)   Level of consciousness
D)   Urine output

Question 17

An 82-year-old patient is readmitted for heart failure (HF) 1 week after being discharged for the same diagnosis. Which findings most likely contributed to the patient's readmission? Select all that apply.

Accepted Answer

A)   Not knowing how or when to take medications
B)   Not prescribed appropriate medications, including ACE inhibitors and beta blockers
C)   No record of body weight since discharge
D)   Not filling prescribed medications
E)   Received the pneumococcal immunization during the last hospitalization

Question 18

What should the nurse realize when planning care for a patient with a body mass index of 40 who is newly diagnosed with heart failure?

Accepted Answer

A)   The prognosis will be better.
B)   Central obesity limits respiratory excursion.
C)   Activity needs to be emphasized.
D)   Medication adjustment is required.

Question 19

A patient with a history of type 2 diabetes mellitus and heart failure is prescribed carvedilol (Coreg). What should the nurse assess prior to administering this medication to the patient? Select all that apply.

Accepted Answer

A)   Blood pressure
B)   Pulse
C)   Blood glucose level
D)   Lung sounds
E)   Potassium level

Question 20

The nurse suspects that compensatory mechanisms have been activated in a patient with heart failure. What did the nurse assess to make this clinical determination?

Accepted Answer

A)   Temperature 100°F
B)   Respiratory rate 20 per minute
C)   Blood pressure 138/84 mm Hg
D)   Heart rate 118 beats per minute

Exam 7: Care of the Patient Experiencing Heart Failure