NUR 390 exam 2
The nurse is caring for a patient who is receiving IV furosemide and morphine for the treatment of acute
decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator
that the treatment has been effective?
a. Weight loss of 2 lb in 24 hours
b. Hourly urine output greater than 60 mL
c. Reduced dyspnea with the head of bed at 30 degrees
d. Patient denies experiencing chest pain or chest pressure *** Reduced dyspnea with the head of bed
at 30 degrees
Which topic will the nurse plan to include in discharge teaching for a patient who has heart failure with
reduced ejection fraction (HFrEF)?
a. Need to begin an aerobic exercise program several times weekly
b. Benefits and effects of angiotensin-converting enzyme (ACE) inhibitors
c. Use of salt substitutes to replace table salt when cooking and at the table
d. Importance of making an annual appointment with the health care provider *** ANS: B Patients with
HFrEF would receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise may
not be possible for a patient with this level of heart failure. Salt substitutes are not usually
recommended because of the risk of hyperkalemia. The patient will need to see the primary care
provider more often than annually.
IV sodium nitroprusside is prescribed for a patient with acute pulmonary edema. Which reassessment
finding indicates that the nurse should decrease the rate of nitroprusside infusion?
a. Ventricular ectopy
b. Dry, hacking cough
c. Systolic BP below 90 mm Hg
d. Heart rate below 50 beats/min *** ANS: 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
,. Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with
acute shortness of breath has heart failure?
a. Serum troponin
b. Arterial blood gases
c. B-type natriuretic peptide
d. 12-lead electrocardiogram *** ANS: C B-type natriuretic peptide (BNP) is secreted when ventricular
pressures increase, as they do with heart failure. Elevated BNP indicates a very probable diagnosis of
heart failure. A 12-lead electrocardiogram, arterial blood gases, and troponin may also be used in
determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as
BNP.
A patient who has just been admitted with pulmonary edema is scheduled to receive the following
medications. Which medication would the nurse question before giving?
a. Captopril (Capoten) 25 mg
b. Furosemide (Lasix) 60 mg
c. Digoxin (Lanoxin) 0.125 mg
d. Carvedilol (Coreg) 3.125 mg *** ANS: D Although carvedilol is appropriate for the treatment of
chronic heart failure, it is not used for patients in pulmonary edema with acute decompensated heart
failure (ADHF) because of the risk of worsening the heart failure. -Blockers can reduce myocardial
contractility, so care must be taken in patients with volume overload. The other drugs are appropriate
for the patient with ADHF.
A patient in the intensive care unit who has acute decompensated heart failure (ADHF) reports severe
dyspnea and is anxious, tachypneic, and tachycardic. Several drugs have been prescribed for the patient.
Which action would the nurse take first?
a. Give PRN IV morphine sulfate 4 mg.
b. Give PRN IV diazepam (Valium) 2.5 mg.
c. Increase nitroglycerin infusion by 5 mcg/min.
d. Increase dopamine infusion by 2 mcg/kg/min *** ANS: A Morphine improves alveolar gas exchange,
improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in
,reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not
improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output, but
it will also increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve
cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will
not act as quickly as morphine to decrease dyspnea.
An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with
metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the
health care provider?
a. 2+ bilateral pedal edema
b. Heart rate of 52 beats/min
c. Report of increased fatigue
d. Blood pressure 88/42 mm Hg *** ANS: D The patient's blood pressure indicates that the dose of
metoprolol may need to be decreased because of hypotension. Bradycardia is a frequent adverse effect
of -adrenergic blockade, though it may need to be monitored. -Adrenergic blockade initially will worsen
symptoms of heart failure in many patients and patients would be taught that some increase in
symptoms, such as fatigue and edema, is expected during the initiation of therapy with this class of
drugs.
An intraaortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. Which data
would indicate to the nurse that the goals of IABP treatment are being met?
a. Urine output of 25 mL/hr
b. Heart rate of 110 beats/min
c. Cardiac output (CO) of 5 L/min
d. Stroke volume (SV) of 40 mL/beat *** ANS: C A CO of 5 L/min is normal and indicates that the IABP
has been successful in treating the shock. The low SV signifies continued cardiogenic shock. The
tachycardia and low urine output also suggest continued cardiogenic shock.
. The nurse is caring for a patient who has an intraaortic balloon pump in place. Which action would the
nurse include in the plan of care?
a. Avoid the use of anticoagulant medications.
, b. Monitor the patient's urinary output every hour.
c. Provide passive range of motion for all extremities.
d. Position the patient supine with head flat at all times *** ANS: B Monitoring urine output will help
determine whether the patient's cardiac output has improved. It also will help assess for balloon
displacement blocking the renal arteries. The head of the bed can be elevated up to 30 degrees. Heparin
is used to prevent thrombus formation. Limited movement is allowed for the extremity with the balloon
insertion site to prevent displacement of the balloon.
While waiting for heart transplantation, a patient with severe cardiomyopathy has a ventricular assist
device (VAD) implanted. Which action would the nurse include in the plan of care for this patient?
a. Preparing the patient for a permanent VAD
b. Teaching the patient the reason for bed rest
c. Monitoring the incision for signs of infection
d. Administering immunosuppressants medications *** ANS: C The insertion site for the VAD provides a
source for transmission of infection to the circulatory system and requires frequent monitoring. Patients
with VADs can have some mobility and may not be on bed rest. The VAD is a bridge to transplantation,
not a permanent device. Immunosuppression is not necessary for nonbiologic devices such as the VAD.
Which nursing intervention is likely to be most effective when assisting the patient with coronary artery
disease to make dietary changes?
a. Inform the patient about a diet containing no saturated fat and minimal salt.
b. Emphasize the increased cardiac risk unless the patient makes dietary changes.
c. Help the patient modify favorite high-fat recipes by using monounsaturated oils.
d. Give the patient a list of low-sodium, low-cholesterol foods to include in the diet. *** ANS: C Lifestyle
changes are more likely to be successful when consideration is given to the patient's values and
preferences. The highest percentage of calories from fat should come from monounsaturated or
polyunsaturated fats. Although low-sodium and low-cholesterol foods are appropriate, providing the
patient with a list alone is not likely to be successful in making dietary changes. Completely removing
saturated fat from the diet is not a realistic expectation. Up to 7% of calories in the therapeutic lifestyle
changes diet can come from saturated fat. Telling the patient about the increased risk without assisting
further with strategies for dietary change is unlikely to be successful.
The nurse is caring for a patient who is receiving IV furosemide and morphine for the treatment of acute
decompensated heart failure (ADHF) with severe orthopnea. Which clinical finding is the best indicator
that the treatment has been effective?
a. Weight loss of 2 lb in 24 hours
b. Hourly urine output greater than 60 mL
c. Reduced dyspnea with the head of bed at 30 degrees
d. Patient denies experiencing chest pain or chest pressure *** Reduced dyspnea with the head of bed
at 30 degrees
Which topic will the nurse plan to include in discharge teaching for a patient who has heart failure with
reduced ejection fraction (HFrEF)?
a. Need to begin an aerobic exercise program several times weekly
b. Benefits and effects of angiotensin-converting enzyme (ACE) inhibitors
c. Use of salt substitutes to replace table salt when cooking and at the table
d. Importance of making an annual appointment with the health care provider *** ANS: B Patients with
HFrEF would receive an ACE inhibitor to decrease the progression of heart failure. Aerobic exercise may
not be possible for a patient with this level of heart failure. Salt substitutes are not usually
recommended because of the risk of hyperkalemia. The patient will need to see the primary care
provider more often than annually.
IV sodium nitroprusside is prescribed for a patient with acute pulmonary edema. Which reassessment
finding indicates that the nurse should decrease the rate of nitroprusside infusion?
a. Ventricular ectopy
b. Dry, hacking cough
c. Systolic BP below 90 mm Hg
d. Heart rate below 50 beats/min *** ANS: 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
,. Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with
acute shortness of breath has heart failure?
a. Serum troponin
b. Arterial blood gases
c. B-type natriuretic peptide
d. 12-lead electrocardiogram *** ANS: C B-type natriuretic peptide (BNP) is secreted when ventricular
pressures increase, as they do with heart failure. Elevated BNP indicates a very probable diagnosis of
heart failure. A 12-lead electrocardiogram, arterial blood gases, and troponin may also be used in
determining the causes or effects of heart failure but are not as clearly diagnostic of heart failure as
BNP.
A patient who has just been admitted with pulmonary edema is scheduled to receive the following
medications. Which medication would the nurse question before giving?
a. Captopril (Capoten) 25 mg
b. Furosemide (Lasix) 60 mg
c. Digoxin (Lanoxin) 0.125 mg
d. Carvedilol (Coreg) 3.125 mg *** ANS: D Although carvedilol is appropriate for the treatment of
chronic heart failure, it is not used for patients in pulmonary edema with acute decompensated heart
failure (ADHF) because of the risk of worsening the heart failure. -Blockers can reduce myocardial
contractility, so care must be taken in patients with volume overload. The other drugs are appropriate
for the patient with ADHF.
A patient in the intensive care unit who has acute decompensated heart failure (ADHF) reports severe
dyspnea and is anxious, tachypneic, and tachycardic. Several drugs have been prescribed for the patient.
Which action would the nurse take first?
a. Give PRN IV morphine sulfate 4 mg.
b. Give PRN IV diazepam (Valium) 2.5 mg.
c. Increase nitroglycerin infusion by 5 mcg/min.
d. Increase dopamine infusion by 2 mcg/kg/min *** ANS: A Morphine improves alveolar gas exchange,
improves cardiac output by reducing ventricular preload and afterload, decreases anxiety, and assists in
,reducing the subjective feeling of dyspnea. Diazepam may decrease patient anxiety, but it will not
improve the cardiac output or gas exchange. Increasing the dopamine may improve cardiac output, but
it will also increase the heart rate and myocardial oxygen consumption. Nitroglycerin will improve
cardiac output and may be appropriate for this patient, but it will not directly reduce anxiety and will
not act as quickly as morphine to decrease dyspnea.
An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with
metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the
health care provider?
a. 2+ bilateral pedal edema
b. Heart rate of 52 beats/min
c. Report of increased fatigue
d. Blood pressure 88/42 mm Hg *** ANS: D The patient's blood pressure indicates that the dose of
metoprolol may need to be decreased because of hypotension. Bradycardia is a frequent adverse effect
of -adrenergic blockade, though it may need to be monitored. -Adrenergic blockade initially will worsen
symptoms of heart failure in many patients and patients would be taught that some increase in
symptoms, such as fatigue and edema, is expected during the initiation of therapy with this class of
drugs.
An intraaortic balloon pump (IABP) is being used for a patient who is in cardiogenic shock. Which data
would indicate to the nurse that the goals of IABP treatment are being met?
a. Urine output of 25 mL/hr
b. Heart rate of 110 beats/min
c. Cardiac output (CO) of 5 L/min
d. Stroke volume (SV) of 40 mL/beat *** ANS: C A CO of 5 L/min is normal and indicates that the IABP
has been successful in treating the shock. The low SV signifies continued cardiogenic shock. The
tachycardia and low urine output also suggest continued cardiogenic shock.
. The nurse is caring for a patient who has an intraaortic balloon pump in place. Which action would the
nurse include in the plan of care?
a. Avoid the use of anticoagulant medications.
, b. Monitor the patient's urinary output every hour.
c. Provide passive range of motion for all extremities.
d. Position the patient supine with head flat at all times *** ANS: B Monitoring urine output will help
determine whether the patient's cardiac output has improved. It also will help assess for balloon
displacement blocking the renal arteries. The head of the bed can be elevated up to 30 degrees. Heparin
is used to prevent thrombus formation. Limited movement is allowed for the extremity with the balloon
insertion site to prevent displacement of the balloon.
While waiting for heart transplantation, a patient with severe cardiomyopathy has a ventricular assist
device (VAD) implanted. Which action would the nurse include in the plan of care for this patient?
a. Preparing the patient for a permanent VAD
b. Teaching the patient the reason for bed rest
c. Monitoring the incision for signs of infection
d. Administering immunosuppressants medications *** ANS: C The insertion site for the VAD provides a
source for transmission of infection to the circulatory system and requires frequent monitoring. Patients
with VADs can have some mobility and may not be on bed rest. The VAD is a bridge to transplantation,
not a permanent device. Immunosuppression is not necessary for nonbiologic devices such as the VAD.
Which nursing intervention is likely to be most effective when assisting the patient with coronary artery
disease to make dietary changes?
a. Inform the patient about a diet containing no saturated fat and minimal salt.
b. Emphasize the increased cardiac risk unless the patient makes dietary changes.
c. Help the patient modify favorite high-fat recipes by using monounsaturated oils.
d. Give the patient a list of low-sodium, low-cholesterol foods to include in the diet. *** ANS: C Lifestyle
changes are more likely to be successful when consideration is given to the patient's values and
preferences. The highest percentage of calories from fat should come from monounsaturated or
polyunsaturated fats. Although low-sodium and low-cholesterol foods are appropriate, providing the
patient with a list alone is not likely to be successful in making dietary changes. Completely removing
saturated fat from the diet is not a realistic expectation. Up to 7% of calories in the therapeutic lifestyle
changes diet can come from saturated fat. Telling the patient about the increased risk without assisting
further with strategies for dietary change is unlikely to be successful.
