Block 4 Advanced Cardiac

A patient with chronic heart failure is treated with hydrochlorothiazide, digoxin and lisinopril. To prevent the risk of digoxin toxicity with these drugs, it is most important the nurse monitor the patient's

• heart rate.
• blood pressure.
• gastrointestinal function.
•  potassium levels.

When caring for a patient after cardiac catheterization with coronary angiography, which of the following findings would be of most concern to the nurse?

• swelling at the catheter insertion site
• development of raised wheals on the patient trunk
• Absence of pulses distal to the catheter insertion site
• Patient states pain at the insertion site as 4 out of 10

A physical assessment finding that the nurse would expect to be present in the patient with acute left-sided heart failure is:

•  crackles, rales, and tachycardia
• hepato-splenomegaly and tachypnea
• peripheral edema and clammy, diaphoretic skin
• frothy blood tinged sputum and distended jugular veins

The nurse assesses the patient with chronic bi-ventricular heart failure for paroxysmal nocturnal dyspnea by questioning the patient regarding:

• frequent awaking to void during the night.
• the presence of a dry hacking cough with exertion.
• The presence of difficulty breathing when lying flat.
• episodes of coughing and asphyxia while asleep.

In the patient with dysrhythmia, the nurse identifies a nursing diagnosis of decrease cardiac output related to dysrhythmias when the patient experiences

• hypertension and bradycardia
• chest pain and decreased mentation
• abdominal distention and hepatomegaly
• bounding pules and a ventricular heave

A patient with acute MI is having multifocal PVCs and ventricular couplets. He is alert and has a BP of 118/78 with an irregular pulse of 86 beats/min. The most appropriate action by the nurse at this time is to: 

• continue to assess the patient.
• be prepared to administer cardiopulmonary resuscitation (CPR).
• administer antidysrhythmic drugs per protocol.
• ask the patient to perform valsava maneuver.

To detect a serious complication of acute heart failure post myocardial infarction, the nurse

• measures hourly urine output
• auscultates the chest for crackles
• uses continuous cardiac output monitoring
• takes vital signs for q 2 hours for the first 8 hours.

A patient with chronic heart failure has atrial fibrillation and an LV ejection fraction of 18%. To decrease the risk of complications from these conditions, the nurse anticipates the administration of

• diuretics.
• anticoagulants.
• Beta-adrenergic blockers.
• potassium supplements.

The diagnostic test that is most useful in differentiating the dyspnea related to heart failure from dyspnea of pulmonary disease is 

• exercise stress testing
• cardiac catheterization
• b-type natriuretic peptide (BNP) levels.
• determination of blood urea nitrogen (BUN)

A patient with heart failure has tachypnea, severe dyspnea, and an SpO2 of 84%. The nurse identifies a nursing diagnosis of impaired gas exchange related to increased preload and mechanical failure.  An appropriate nursing intervention for this diagnosis is

• assist the patient to cough and deep breathe q2hr.
• assess intake and output q 8 hr and weigh the patient daily
• encourage rest periods to reduce cardiac workload
• Place the client in high Fowler's position and feet dangling