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Level 4 - Exam 1: Heart Failure Questions With Complete Solutions
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Level 4 - Exam 1: Heart Failure Questions With Complete Solutions
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Level 4 - Exam 1: Heart Failure QuestionsWith Complete Solutions
A 19-year-old student comes to the student health center at the
end of the semester complaining that, "My heart is skipping
beats." An electrocardiogram (ECG) shows occasional
premature ventricular contractions (PVCs). What action should
the nurse take next? a. Start supplemental O2 at 2 to 3 L/min via
nasal cannula.
b. Ask the patient about current stress level and caffeine use. c.
Ask the patient about any history of coronary artery disease. d.
Have the patient taken to the hospital emergency department
(ED). Correct Answers ANS: B In a patient with a normal
heart, occasional PVCs are a benign finding. The timing of the
PVCs suggests stress or caffeine as possible etiologic factors. It
is unlikely that the patient has coronary artery disease, and this
should not be the first question the nurse asks. The patient is
hemodynamically stable, so there is no indication that the patient
needs to be seen in the ED or that oxygen needs to be
administered.
A 20-year-old has a mandatory electrocardiogram (ECG) before
participating on a college soccer team and is found to have sinus
bradycardia, rate 52. Blood pressure (BP) is 114/54, and the
student denies any health problems. What action by the nurse is
most appropriate? a. Allow the student to participate on the
soccer team. b. Refer the student to a cardiologist for further
diagnostic testing. c. Tell the student to stop playing
immediately if any dyspnea occurs. d. Obtain more detailed
information about the student's family health history. Correct
,Answers ANS: A In an aerobically trained individual, sinus
bradycardia is normal. The student's normal BP and negative
health history indicate that there is no need for a cardiology
referral or for more detailed information about the family's
health history. Dyspnea during an aerobic activity such as soccer
is normal.
A 53-year-old patient with Stage D heart failure and type 2
diabetes asks the nurse whether heart transplant is a possible
therapy. Which response by the nurse is most appropriate?
a. "Because you have diabetes, you would not be a candidate for
a heart transplant."
b. "The choice of a patient for a heart transplant depends on
many different factors."
c. "Your heart failure has not reached the stage in which heart
transplants are needed."
d. "People who have heart transplants are at risk for multiple
complications after surgery." Correct Answers ANS: B
Indications for a heart transplant include end-stage heart failure
(Stage D), but other factors such as coping skills, family
support, and patient motivation to follow the rigorous
posttransplant regimen are also considered. Diabetic patients
who have well-controlled blood glucose levels may be
candidates for heart transplant. Although heart transplants can
be associated with many complications, this response does not
address the patient's question.
A nurse is caring for a patient who is orally intubated and
receiving mechanical ventilation. To decrease the risk for
ventilator-associated pneumonia, which action will the nurse
include in the plan of care? a. Elevate head of bed to 30 to 45
,degrees. b. Suction the endotracheal tube every 2 to 4 hours. c.
Limit the use of positive end-expiratory pressure. d. Give enteral
feedings at no more than 10 mL/hr. Correct Answers ANS: A
Elevation of the head decreases the risk for aspiration. Positive
end-expiratory pressure is frequently needed to improve
oxygenation in patients receiving mechanical ventilation.
Suctioning should be done only when the patient assessment
indicates that it is necessary. Enteral feedings should provide
adequate calories for the patient's high energy needs.
A nurse is caring for a patient with acute respiratory distress
syndrome (ARDS) who is receiving mechanical ventilation
using synchronized intermittent mandatory ventilation (SIMV).
The settings include fraction of inspired oxygen (FIO2) 80%,
tidal volume 450, rate 16/minute, and positive end-expiratory
pressure (PEEP) 5 cm. Which assessment finding is most
important for the nurse to report to the health care provider? a.
Oxygen saturation 99% b. Respiratory rate 22 breaths/minute c.
Crackles audible at lung bases d. Heart rate 106 beats/minute
Correct Answers ANS: A The FIO2 of 80% increases the risk
for oxygen toxicity. Because the patient's O2 saturation is 99%,
a decrease in FIO2 is indicated to avoid toxicity. The other
patient data would be typical for a patient with ARDS and
would not need to be urgently reported to the health care
provider.
A nurse is caring for a patient with ARDS who is being treated
with mechanical ventilation and high levels of positive end-
expiratory pressure (PEEP). Which assessment finding by the
nurse indicates that the PEEP may need to be reduced? a. The
patient's PaO2 is 50 mm Hg and the SaO2 is 88%. b. The patient
, has subcutaneous emphysema on the upper thorax. c. The
patient has bronchial breath sounds in both the lung fields. d.
The patient has a first-degree atrioventricular heart block with a
rate of 58. Correct Answers ANS: B
The subcutaneous emphysema indicates barotrauma caused by
positive pressure ventilation and PEEP. Bradycardia,
hypoxemia, and bronchial breath sounds are all concerns and
will need to be addressed, but they are not specific indications
that PEEP should be reduced.
A nurse is caring for an obese patient with right lower lobe
pneumonia. Which position will be best to improve gas
exchange? a. On the left side b. On the right side c. In the tripod
position d. In the high-Fowler's position Correct Answers
ANS: A The patient should be positioned with the "good" lung
in the dependent position to improve the match between
ventilation and perfusion. The obese patient's abdomen will limit
respiratory excursion when sitting in the high-Fowler's or tripod
positions.
A patient admitted with acute respiratory failure has a nursing
diagnosis of ineffective airway clearance related to thick,
secretions. Which action is a priority for the nurse to include in
the plan of care? a. Encourage use of the incentive spirometer. b.
Offer the patient fluids at frequent intervals. c. Teach the patient
the importance of ambulation. d. Titrate oxygen level to keep O2
saturation >93%. Correct Answers ANS: B Because the reason
for the poor airway clearance is the thick secretions, the best
action will be to encourage the patient to improve oral fluid
intake. Patients should be instructed to use the incentive
spirometer on a regular basis (e.g., every hour) in order to
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