Heart Failure - Practice Questions
1. While assessing a 68-yr-old with ascites, the nurse also notes jugular ve-
nous 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.:correct answer 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.
2. 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: correct answer d.
Reduced dyspneawith 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.
3. 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) in-
hibitors: correct answer d. Benefits and side effects of angiotensin-converting
enzyme (ACE) in-hibitors
, The core measures for the treatment of heart failure established by The Joint Com-
mission indicate that patients with an ejection fraction below 40% should 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.
4. 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 down if the patient develops
a. ventricular ectopy.
b. a dry, hacking cough.
c. a systolic BP below 90 mm Hg.
d. a heart rate below 50 beats/min.: correct answer c. a systolic BP below 90
mm Hg.
Sodium nitroprusside is a potent vasodilator and the major adverse effect is severe
hypotension. Coughing and bradycardia are not adverse effects of this medication.
1. While assessing a 68-yr-old with ascites, the nurse also notes jugular ve-
nous 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.:correct answer 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.
2. 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: correct answer d.
Reduced dyspneawith 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.
3. 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) in-
hibitors: correct answer d. Benefits and side effects of angiotensin-converting
enzyme (ACE) in-hibitors
, The core measures for the treatment of heart failure established by The Joint Com-
mission indicate that patients with an ejection fraction below 40% should 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.
4. 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 down if the patient develops
a. ventricular ectopy.
b. a dry, hacking cough.
c. a systolic BP below 90 mm Hg.
d. a heart rate below 50 beats/min.: correct answer c. a systolic BP below 90
mm Hg.
Sodium nitroprusside is a potent vasodilator and the major adverse effect is severe
hypotension. Coughing and bradycardia are not adverse effects of this medication.
