• While admitting an 82-yr-old patient with acute decompensated heart failure to
the hospital, the nurse learns that the patient lives alone and
... [Show More] sometimes confuses
the “water pill” with the “heart pill.” When planning for the patient’s discharge
the nurse will facilitate a
a. plan for around-the-clock care.
b. consultation with a psychologist.
c. transfer to a long-term care facility.
d. referral to a home health care agency.
ANS: D
The data about the patient suggest that assistance in developing a system for
taking medicationscorrectly at home is needed. A home health nurse will assess
the patient’s home situation and help the patient develop a method for taking the
two medications as directed. There is no evidence that the patient requires
services such as a psychologist consult, long-term care, or around-the-clock home
care.
DIF: Cognitive Level: Apply (application) REF: 752
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
• Following an acute myocardial infarction, a previously healthy 63-yr-old develops
clinical manifestations of heart failure. The nurse anticipates discharge teaching
ADULT HEALTH 2 Chapter 34: Heart Failure
Lewis: Medical-Surgical Nursing, 10th Edition EXAM Questions
and Answers 100%Correct/Verified -REVISION GUIDE 2022
ADULT HEALTH 2 Chapter 34: Heart Failure
Lewis: Medical-Surgical Nursing, 10th Edition EXAM Questions
and Answers 100%Correct/Verified -REVISION GUIDE 2022
will include informationabout
a. -Adrenergic blockers.
b. calcium channel blockers.
c. digitalis and potassium therapy regimens.
d. angiotensin-converting enzyme (ACE) inhibitors.
ANS: D
ACE inhibitor therapy is currently recommended to prevent the development of
heart failure in patients who have had a myocardial infarction and as a first-line
therapy for patients with chronicheart failure. Digoxin therapy for heart failure is
no longer considered a first-line measure, and digoxin is added to the treatment
protocol when therapy with other drugs such as ACE-inhibitors,diuretics, and -
adrenergic blockers is insufficient. Calcium channel blockers are not generally
used in the treatment of heart failure. The -adrenergic blockers are not used as
initial therapy fornew onset heart failure.
DIF: Cognitive Level: Apply (application) REF: 745
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
ADULT HEALTH 2 Chapter 34: Heart Failure
Lewis: Medical-Surgical Nursing, 10th Edition EXAM Questions
and Answers 100%Correct/Verified -REVISION GUIDE 2022
ADULT HEALTH 2 Chapter 34: Heart Failure
Lewis: Medical-Surgical Nursing, 10th Edition EXAM Questions
and Answers 100%Correct/Verified -REVISION GUIDE 2022
• A 53-yr-old patient with stage D heart failure and type 2 diabetes asks the nurse
whether hearttransplant is a possible therapy. Which response by the nurse is
most accurate?
a. “Your heart failure has not reached the end stage yet.”
b. “You could not manage the multiple complications of that surgery.”
c. “The suitability of a heart transplant for you depends on many factors.”
d. “Because you have diabetes, you would not be a heart transplant candidate.”
ANS: C
Indications for a heart transplant include end-stage heart failure (stage D), but
other factors suchas coping skills, family support, and patient motivation to
follow the rigorous posttransplant regimen are also considered. Patients with
diabetes who have well-controlled blood glucose levels may be candidates for
heart transplant. Although heart transplants can be associated with many
complications, there are no data to suggest that the patient could not manage the
care.
DIF: Cognitive Level: Apply (application) REF: 753
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
• Which diagnostic test will be most useful to the nurse in determining whether a
patient admittedwith acute shortness of breath has heart failure?
a. Serum troponin c. B-type natriuretic peptide
b. Arterial blood gases d. 12-lead electrocardiogram
ANS: C
ADULT HEALTH 2 Chapter 34: Heart Failure
Lewis: Medical-Surgical Nursing, 10th Edition EXAM Questions
and Answers 100%Correct/Verified -REVISION GUIDE 2022
ADULT HEALTH 2 Chapter 34: Heart Failure
Lewis: Medical-Surgical Nursing, 10th Edition EXAM Questions
and Answers 100%Correct/Verified -REVISION GUIDE 2022
B-type natriuretic peptide (BNP) is secreted when ventricular pressures increase,
as they do withheart failure. Elevated BNP indicates a probable or very probable
diagnosis of heart failure. A 12-lead electrocardiogram, arterial blood gases, and
troponin may also be used in determining the causes or effects of heart failure but
are not as clearly diagnostic of heart failure as BNP.
DIF: Cognitive Level: Analyze (analysis) REF: 740
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
• Which action should the nurse include in the plan of care when caring for a patient
admitted withacute decompensated heart failure (ADHF) who is receiving
nesiritide (Natrecor)?
a. Monitor blood pressure frequently.
b. Encourage patient to ambulate in room.
c. Titrate nesiritide slowly before stopping.
d. Teach patient about home use of the drug.
ANS: A
Nesiritide is a potent arterial and venous dilator, and the major adverse effect is
hypotension. Because the patient is likely to have orthostatic hypotension, the
patient should not be encouraged to ambulate. Nesiritide does not require
titration and is used for ADHF but not in ahome setting.
DIF: Cognitive Level: Apply (application) REF: 744
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
ADULT HEALTH 2 Chapter 34: Heart Failure
Lewis: Medical-Surgical Nursing, 10th Edition EXAM Questions
and Answers 100%Correct/Verified -REVISION GUIDE 2022
ADULT HEALTH 2 Chapter 34: Heart Failure
Lewis: Medical-Surgical Nursing, 10th Edition EXAM Questions
and Answers 100%Correct/Verified -REVISION GUIDE 2022
• A patient with heart failure has a new order for captopril 12.5 mg PO. After
giving the first doseand teaching the patient about the drug, which statement by
the patient indicates that teaching has been effective?
a. “I will be sure to take the medication with food.”
b. “I will need to eat more potassium-rich foods in my diet.”
c. “I will call for help when I need to get up to use the bathroom.”
d. “I will expect to feel more short of breath for the next few days.”
ANS: C
Captopril can cause hypotension, especially after the initial dose, so it is
important that the patient not get up out of bed without assistance until the nurse
has had a chance to evaluate theeffect of the first dose. The angiotensinconverting enzyme (ACE) inhibitors are potassium sparing, and the nurse should
not teach the patient to purposely increase sources of dietary potassium.
Increased shortness of breath is expected with the initiation of -adrenergic
blockertherapy for heart failure, not for ACE inhibitor therapy. ACE inhibitors
are best absorbed whentaken an hour before eating.
DIF: Cognitive Level: Apply (application) REF: 747
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
• A patient who has just been admitted with pulmonary edema is scheduled
to receive thefollowing medications. Which medication should the nurse
question before giving?
a. captopril 25 mg c. digoxin (Lanoxin) 0.125 mg
b. furosemide (Lasix) 60 mg d. carvedilol (Coreg) 3.125 mg [Show Less]