University of the Pacific NURS 208
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 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 pressure
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 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 patients 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 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 <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 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 mmHg
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 ares 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 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 pressure
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 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 patients 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 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 <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 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 mmHg
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 ares 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.
