Saddleback College N 172
Lewis Ch. 38 Heart
Failure Exam Questions
Verified and Provided
with A+ Graded Answers
,While assessing a 68-year-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.
ANS: 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 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
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 pounds 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
ANS: 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 33%?
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. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
d. Importance of making an annual appointment with the primary care provider
ANS: C
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
, IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema.
During the first hours of administration, the nurse will need to titrate the nitroprusside rate
if the patient develops
a.ventricular ectopy.
b.a dry, hacking cough.
c. a systolic BP <90 mm Hg.
d. a heart rate <50 beats/minute.
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
A patient who has chronic heart failure tells the nurse, "I was 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 finding as
a.orthopnea.
b. pulsus alternans.
c. paroxysmal nocturnal dyspnea.
d. acute bilateral pleural effusion.
ANS: C
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
Lewis Ch. 38 Heart
Failure Exam Questions
Verified and Provided
with A+ Graded Answers
,While assessing a 68-year-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.
ANS: 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 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
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 pounds 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
ANS: 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 33%?
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. Benefits and side effects of angiotensin-converting enzyme (ACE) inhibitors
d. Importance of making an annual appointment with the primary care provider
ANS: C
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
, IV sodium nitroprusside (Nipride) is ordered for a patient with acute pulmonary edema.
During the first hours of administration, the nurse will need to titrate the nitroprusside rate
if the patient develops
a.ventricular ectopy.
b.a dry, hacking cough.
c. a systolic BP <90 mm Hg.
d. a heart rate <50 beats/minute.
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
A patient who has chronic heart failure tells the nurse, "I was 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 finding as
a.orthopnea.
b. pulsus alternans.
c. paroxysmal nocturnal dyspnea.
d. acute bilateral pleural effusion.
ANS: C
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
