FNP 593 FINAL EXAM QUESTIONS AND ANSWERS

The nurse suspects a clients heart is failing when which of the following heart sounds is assessed? 1. S1 2. S2 3. S3 4. S4 - ANS-3. S3 An auscultated S3 is a sign that increased blood volume remains in the ventricle with each beat and that the heart is beginning to fail. S1 and S2 sounds are the first and second sounds heard when auscultating the heart. An S4 sound may indicate increased resistance to ventricular filling. A client is diagnosed with heart failure. Which of the following diagnostic tests is useful to determine the degree of the failure? 1.Brain natriuretic peptide level 2.Blood cultures 3.Sedimentation rate 4.Arterial blood gas - ANS-1.Brain natriuretic peptide level Brain natriuretic peptide is a hormone found in the left ventricle; it is used to help diagnose and grade the severity of heart failure. Blood cultures are used to diagnose carditis. Sedimentation rate is used to diagnose pericarditis. Arterial blood gasses are not used to determine the degree of heart failure. A nurse is instructing a client regarding medications and substances contraindicated for the client with heart failure. Which of the following would not be contraindicated? 1.Alcohol 2.Furosemide 3.Metformin 4.Pioglitazone - ANS-2. Furosemide Loop diuretics (e.g., furosemide) are part of the recommended medications for heart failure. Alcohol, metformin, and pioglitazone (a thiazolidinedione) are contraindicated. The nurse is determining nursing diagnoses appropriate for a client demonstrating productive cough with pink frothy sputum, shortness of breath, and crackles. Which of the following nursing diagnoses is of the most importance? 1.Activity intolerance 2.Anxiety 3. Impaired gas exchange 4. Risk for ineffective respiratory function - ANS-3. Impaired gas exchange The first priority is to maintain adequate oxygenation. The next diagnoses in priority would be risk for ineffective respiratory function. Activity intolerance would be the third diagnosis. Anxiety would be the last diagnosis in order of priority. In planning the care for a client diagnosed with heart failure, which of the following would be an appropriate goal? 1.Reduce myocardial contractility. 2.Increase cardiac workload. 3.Decrease ejection fraction. 4.Increase activity levels. - ANS-4.Increase activity levels. An increase in activity levels would be an appropriate goal for the client diagnosed with heart failure. The other options would be a decrease in ability, function, or management of the heart failure patient. The nurse is instructing a client diagnosed with mild heart failure on dietary modifications. Which of the following client statements indicates that the instruction has been effective? 1.I will avoid green beans. 2.I will avoid orange juice. 3.I will avoid soy sauce. 4.I will avoid apple sauce. - ANS-3.I will avoid soy sauce. Soy sauce is a high-sodium food choice; all the other choices are low sodium. Treatment for mild symptoms of heart failure includes dietary restriction of salt. A client is undergoing diagnostic testing for infective endocarditis. Which of the following laboratory tests would be most useful in diagno