Cardiovascular disorder- Congestive Heart Failure

Cardiovascular disorder-

CHF

By Maam Li

Multiple Choice

In which of the following disorders would the nurse expect to assess sacral edema in bedridden client?

• DM

• Pulmonary emboli

• Renal failure

• Right-sided heart failure

RATIONALE:

The most accurate area on the body to assed dependent edema in a bedridden client is the sacral area. Sacral, or dependent, edema is secondary to right-sided heart failure. Diabetes mellitus, pulmonary emboli, and renal disease aren’t directly linked to sacral edema.

Multiple Choice

Which of the following symptoms might a client with right-sided heart failure exhibit?

• Adequate urine output

• Polyuria

• Oliguria

• Polydipsia

RATIONALE:

Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which causes oliguria. Adequate urine output, polyuria, and polydipsia aren’t associated with right-sided heart failure.

Multiple Choice

Which ofthe following symptoms is most commonly associated with left-sided heart failure?

• Crackles

• Arrhythmias

• Hepatic engorgement

• Hypotension

RATIONALE:

Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into the pulmonary system. Arrhythmias can be associated with both right and left-sided heart failure. Left-sided heart failure causes hypertension secondary to an increased workload on the system.

Multiple Choice

. Which of the following classes of medications maximizes cardiac performance in clients with heat failure by increasing ventricular contractility?

• Beta-adrenergic blockers

• Calcium channel blocker

• Diuretics

• Inotropic agents

RATIONALE:

Inotropic agents are administered to increase the force of the heart’s contractions, thereby increasing ventricular contractility and ultimately increasing cardiac output. Beta-adrenergic blockers and calcium channel blockers decrease the heart rate and ultimately decrease the workload of the heart. Diuretics are administered to decrease the overall vascular volume, also decreasing the workload of the heart.

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Multiple Choice

A 69-year-old female has a history of heart

failure. She is admitted to the emergency department

with heart failure complicated by pulmonary

edema. On admission of this client, which of the

following should the nurse assess first?

• Blood pressure.

• Skin breakdown

• Serum potassium level

• Urine output.

RATIONALE:

• It is a priority to assess blood pressure first because people with pulmonary edema typically experience severe hypertension that requires early intervention.

• The client probably does not have skin breakdown on admission; however, when the client is stable, the nurse should inspect the skin.

• Potassium levels are not the first priority.

• The nurse should monitor urine output after the client is stable.

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Multiple Select

Which of the following nursing diagnoses would be appropriate for a client with systolic heart failure? Select all that apply.

• Ineffective peripheral tissue perfusion related to a decreased stroke volume.

• Activity intolerance related to impaired gas exchange and perfusion

• Dyspnea related to pulmonary congestion and impaired gas exchange.

• Decreased cardiac output related to impaired cardiac filling.

• Impaired renal perfusion related to a decreased cardiac output

RATIONALE:

1, 2, 3, 5. A decrease in cardiac output occurs from a decreased stroke volume with impaired contractility in systolic heart failure. This impairs peripheral and renal perfusion. The impaired perfusion and impaired oxygenation cause the symptoms of activity intolerance. The decreased systolic function causes an increase in residual volume and pressure in the left ventricle. A retrograde buildup of pressure from the left ventricle to left atria increases hydrostatic pressure in the pulmonary vasculature. This causes a leakage of fl uid into the interstitial tissue of the lungs resulting in pulmonary symptoms. With diastolic heart failure, there is impaired ventricular fi lling due to a rigid ventricle and reduced ventricular relaxation.

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Multiple Choice

In which of the following positions should the nurse place a client with suspected heart failure?

    

• Semi-sitting (low Fowler’s position).

• Lying on the right side (Sims’ position).

•   Sitting almost upright (high Fowler’s position).

• Lying on the back with the head lowere (Trendelenburg’s position).

RATIONALE

Sitting almost upright in bed with the feet and legs resting on the mattress decreases venous return to the heart, thus reducing myocardial workload. Also, the sitting position allows maximum space for lung expansion. Low Fowler’s position would be used if the client could not tolerate high Fowler’s position for some reason. Lying on the right side would not be a good position for the client in heart failure. The client in heart failure would not tolerate the Trendelenburg’s position.

Multiple Choice

A client with heart failure is receiving digoxin intravenously. The nurse should determine the effectiveness of the drug by assessing which of the following?

• Dilated coronary arteries.

• Increased myocardial contractility.

• Decreased cardiac arrhythmias.

• Decreased electrical conductivity in the heart

RATIONALE:

Digoxin is a cardiac glycoside with positive inotropic activity. This inotropic activity causes increased strength of myocardial contractions and thereby increases output of blood from the left ventricle. Digoxin does not dilate coronary arteries. Although digoxin can be used to treat arrhythmias and does decrease the electrical conductivity of the myocardium, these are not primary reasons for its use in clients with heart failure and pulmonary edema.

Multiple Choice

Which of the following foods should the nurse teach a client with heart failure to limit when following a 2-g sodium diet?

   

• Apples.

• Tomato juice.

• Whole wheat bread.

• Beef tenderloin.

RATIONALE: ​

• Canned foods and juices such as tomato juice are typically high in sodium and should be avoided in a sodium-restricted diet.

• Canned foods and juices in which sodium has been removed or limited are available. The client should be taught to read labels carefully.

• Apples and whole wheat breads are not high in sodium.

• Beef tenderloin would have less sodium than canned foods or tomato juice.

Multiple Choice

The nurse is admitting a 68-year-old male to the medical fl oor. The echocardiogram report revealed left ventricular enlargement. The nurse notes 2+ pitting edema in the ankles when getting the client into bed. Based on this fi nding, what should the nurse do fi rst?    

• Assess respiratory status.

• Draw blood for laboratory studies.

• Insert a Foley catheter.

• Weight the client.

​RATIONALE:

1. The ankle edema suggests fluid volume overload. The nurse should assess respiratory rate, lung sounds, and SpO2 to identify any signs of respiratory symptoms of heart failure requiring immediate attention.

2. The nurse can then draw blood for laboratory studies

3. Insert the Foley cathetere

4. Weigh the client

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Multiple Choice

The nurse’s discharge teaching plan for the client with heart failure should stress the importance of which of the following?

• Maintaining a high-fi ber diet.

• Walking 2 miles every day.

• Obtaining daily weights at the same time each day.

• Remaining sedentary for most of the day.

ANSWER: 3

• Heart failure is a complex and chronic condition. Education should focus on health promotion and preventive care in the home environment. Signs and symptoms can be monitored by the client. Instructing the client to obtain daily weights at the same time each day is very important. The client should be told to call the physician if there has been a weight gain of 2 lb or more. This may indicate fluid overload, and treatment can be prescribed early and on an outpatient basis, rather than waiting until the symptoms become life-threatening.

• Following a high-fi ber diet is beneficial, but it is not relevant to the teaching needs of the client with heart failure.

• Prescribing an exercise program for the client, such as walking 2 miles every day, would not be appropriate at discharge. The client’s exercise program would need to be planned in consultation with the physician and based on the history and the physical condition of the client. The client may require exercise tolerance testing before an exercise plan is laid out.

• Although the nurse does not prescribe an exercise program for the client, a sedentary lifestyle should not be recommended.

Multiple Select

When teaching a client with heart failure about preventing complications and future hospitalizations, which problems stated by the client as reasons to call the physician would indicate to the nurse that the client has understood the teaching? Select all that apply.

• Becoming increasingly short of breath at rest.

• Weight gain of 2 lb or more in 1 day.

• High intake of sodium for breakfast.

• Having to sleep sitting up in a reclining chair.

• Weight loss of 2 lb in 1 day.

RATIONALE:

ANSWER: 1, 2, 4.

The client stating that he would call the physician with increasing shortness of breath, weight gain over 2 lb in 1 day, and having to sleep sitting up, indicates that he has understood the teaching because these signs and symptoms suggest worsening of the client’s heart failure. Although the client will most likely be placed on a sodium-restricted diet, the client would not need to notify the physician if he or she had consumed a high-sodium breakfast. Instead the client would need to be alert for possible signs and symptoms of worsening heart failure and work to reduce sodium intake for the rest of that day and in the future.

​ONE MORE TO GO!.....