Samuel Merritt University NURSG 128
Lewis - Ch 38 Heart
Failure Exam Questions
Verified and Provided
with A+ Graded Answers
,While assessing a 68-yr-old with ascites, the nurse also 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. increased right atrial pressure.
d. incompetent jugular vein valves.
c. increased right atrial pressure.
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 increased 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.
DIF: Cognitive Level: Understand (comprehension) REF: 739
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
Preload/Afterload
,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.
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. Reduction in patient complaints of chest pain
d. Reduced dyspnea with the head of bed at 30 degrees
d. Reduced dyspnea with the head of bed at 30 degrees
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 may also 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 heart
failure with reduced ejection fraction (HFrEF)?
a. Need to begin 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 an annual appointment with the health care provider
d. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
d. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
The core measures for the treatment of heart failure established by The Joint
Commission indicate that patients with an ejection fraction below 40% should receive
an ACE inhibitor to decrease the progression of heart failure.
HFrEF (systolic failure) is the inability to pump blood effectively. Caused by:
- impaired contractile function
- increased afterload (HTN, peripheral vascular resistance)
- mechanical abnormalities
Decreased LV ejection fraction (LVEF) is <40% (can be seen on Echocardiogram)
(Adams lecture)
Left sided heart failure
Lewis - Ch 38 Heart
Failure Exam Questions
Verified and Provided
with A+ Graded Answers
,While assessing a 68-yr-old with ascites, the nurse also 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. increased right atrial pressure.
d. incompetent jugular vein valves.
c. increased right atrial pressure.
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 increased 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.
DIF: Cognitive Level: Understand (comprehension) REF: 739
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
Preload/Afterload
,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.
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. Reduction in patient complaints of chest pain
d. Reduced dyspnea with the head of bed at 30 degrees
d. Reduced dyspnea with the head of bed at 30 degrees
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 may also 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 heart
failure with reduced ejection fraction (HFrEF)?
a. Need to begin 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 an annual appointment with the health care provider
d. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
d. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
The core measures for the treatment of heart failure established by The Joint
Commission indicate that patients with an ejection fraction below 40% should receive
an ACE inhibitor to decrease the progression of heart failure.
HFrEF (systolic failure) is the inability to pump blood effectively. Caused by:
- impaired contractile function
- increased afterload (HTN, peripheral vascular resistance)
- mechanical abnormalities
Decreased LV ejection fraction (LVEF) is <40% (can be seen on Echocardiogram)
(Adams lecture)
Left sided heart failure
