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LEWIS HEART FAILURE BANK QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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LEWIS HEART FAILURE BANK QUESTIONS AND ANSWERS WITH SOLUTIONS 2024
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LEWIS HEART FAILURE BANKQUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
During assessment of a 72-year-old with ankle swelling, the nurse 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. elevated right atrial pressure.
d. incompetent jugular vein valves. - ANSWER C
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 elevated 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.
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. When evaluating the patient
response to the medications, the best indicator that the treatment has been effective is
a. weight loss of 2 pounds overnight.
b. hourly urine output greater than 60 mL.
c. reduction in patient complaints of chest pain.
d. decreased dyspnea with the head of bed at 30 degrees. - ANSWER D
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 also may indicate that diuresis or
improvement in cardiac output has occurred but are not as specific to evaluating this patient's response.
Which topic will the nurse plan to include in discharge teaching for a patient with systolic heart failure
and an ejection fraction of 38%?
a. Need to participate in an aerobic exercise program several times weekly
b. Use of salt substitutes to replace table salt when cooking and at the table
c. Importance of making a yearly appointment with the primary care provider
d. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors - ANSWER D
, The core measures for the treatment of heart failure established by The Joint Commission indicate that
patients with an ejection fraction (EF) <40% 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.
Intravenous sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema. During
the first hours of administration, the nurse will need to adjust the nitroprusside rate if the patient
develops
a. a dry, hacking cough.
b. any ventricular ectopy.
c. a systolic BP <90 mm Hg.
d. a heart rate <50 beats/minute. - ANSWER C
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 felt 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
information as
a. pulsus alternans.
b. two-pillow orthopnea.
c. acute bilateral pleural effusion.
d. paroxysmal nocturnal dyspnea. - ANSWER D
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 alternation 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.
During a visit to a 72-year-old with chronic heart failure, the home care nurse finds that the patient has
ankle edema, a 2-kg weight gain, and complains of "feeling too tired to do anything." Based on these
data, the best nursing diagnosis for the patient is
a. activity intolerance related to fatigue.
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