Chapter 20- Heart Failure My Nursing Test Banks

 

1.

A patient in the CCU with chronic heart failure is prescribed an ACE inhibitor. What side effects should the nurse mention to him? Select all that apply.

A)

Angioderma

B)

Cough

C)

Rebound tachycardia

D)

Hyperkalemia

E)

Night sweats

F)

Anxiety

2.

A CCU nurse who works frequently with cardiac patients is putting together a teaching plan to follow when she instructs these patients on how to live with heart failure. Which points should she include in this plan? Select all that apply.

A)

Discontinue medications once you are feeling better, to avoid adverse effects.

B)

Take your medications about the same time every day.

C)

Avoid pepper and spices.

D)

Remove the saltshaker from your table.

E)

The best time to weigh yourself is in the afternoon.

F)

Try to perform 15 to 20 minutes of continuous activity each day.

3.

A patient with chronic cardiac failure in the CCU is on an ACE inhibitor but still has significant pitting edema in his extremities. Which medication, in addition to the ACE inhibitor, is the physician likely to prescribe to this patient?

A)

Digoxin

B)

A loop diuretic

C)

b-blocker

D)

Calcium channel blocker

4.

A patient presents to the CCU with acute, decompensated heart failure. The nurse observes that this patient has chronic obstructive pulmonary disease and hypotension. She eats a low-sodium diet and drinks alcohol excessively. Which of the following are contributing factors to this patients heart failure? Select all that apply.

A)

Chronic obstructive pulmonary disease

B)

Hypotension

C)

Low-sodium diet

D)

Excessive alcohol intake

5.

A patient is in the CCU with dilated cardiomyopathy and asymptomatic right-sided chronic heart failure. What finding will the nurse most likely discover in her assessment of this patient?

A)

Mitral regurgitation murmur

B)

Cheyne-Stokes respiratory pattern

C)

Unilateral crackles

D)

Rales

6.

A nurse in the CCU must assess a cardiac patients fluid status. Which of the following is the best method for him to use?

A)

Having the patient measure and record all liquids taken in and all urine excreted

B)

Weighing the patient daily

C)

Pulse oximetry

D)

Radionuclide ventriculography

7.

A patient presents to the CCU with shortness of breath on exertion. Which diagnostic study would be best for ruling out pneumonia or COPD as the cause of the patients symptoms?

A)

Echocardiography

B)

Radionuclide ventriculography

C)

Pulse oximetry

D)

Chest radiography

8.

A patient in the CCU with chronic heart failure experiences shortness of breath even when at rest. When he stands up and walks across the room, his shortness of breath worsens. Which class of heart failure does this patient exhibit, according to the New York Heart Association (NYHA) Functional Classification of Heart Failure?

A)

Class I

B)

Class II

C)

Class III

D)

Class IV

9.

A patient in the CCU has clear evidence of structural heart failure, as he lacks contractility in his left ventricle and his ejection fraction is only 37%. However, he has never shown any signs or symptoms of heart failure. According to the American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for Stages of Heart Failure, which stage of heart failure best characterizes this patients condition?

A)

Stage A

B)

Stage B

C)

Stage C

D)

Stage D

10.

A patient presents to the CCU with cardiac heart failure resulting from atrial tachycardia. Which of the following explains how atrial tachycardia can cause heart failure?

A)

Premature ventricular beats leading to sudden death

B)

Increase in muscle mass in ventricle

C)

Pulmonary embolus leading to acute right-sided heart failure

D)

Shortened diastole leading to decreased filling and diastolic dysfunction

11.

The nurse is caring for a patient who has been admitted with a diagnosis of heart failure. What does the term heart failure mean?

A)

It is characterized by rales and alveolar edema.

B)

It results from damage caused by acute myocardial infarction.

C)

It is a general clinical syndrome with many etiologies.

D)

All patients have similar symptoms.

12.

A patient has been diagnosed with left ventricular heart failure. What physical findings would the nurse expect?

A)

Enlarged liver

B)

Peripheral edema

C)

Pulmonary rales

D)

Enlarged spleen

13.

An elderly patient with uncontrolled hypertension and atrial fibrillation with rapid ventricular response is admitted with a diagnosis of heart failure. He has crepitant pulmonary rales and his chest x-ray shows pulmonary congestion. The patient probably has what type of heart failure?

A)

Left ventricular systolic failure

B)

Left ventricular diastolic failure

C)

Right ventricular failure

D)

Combination heart failure

14.

A patient has been admitted with acute left systolic heart failure secondary to acute myocardial infarction. The patient has dyspnea and orthopnea and a cardiac rhythm of sinus tachycardia. The physiologic dysfunction for this type of heart failure is what?

A)

Impaired contractility of the left ventricle

B)

Impaired compliance of the left ventricle

C)

Cardiac valve disease

D)

Acute myocardial infarction

15.

A patient has been admitted with right heart failure. The physiologic basis of right heart failure is what?

A)

Left heart failure

B)

Impaired right cardiac output

C)

Pulmonary hypertension

D)

Acute pulmonary embolus

16.

A patient has been diagnosed with acute left heart failure secondary to acute myocardial infarction and increased afterload. What changes in assessment findings does the nurse expect to find?

A)

Elevated pulmonary capillary wedge pressure

B)

Normal or low blood pressure

C)

Enlarged liver and spleen

D)

Lungs clear to auscultation

17.

A patient with heart failure is being monitored with a pulmonary artery catheter to assess cardiac output and its components. What pattern of results would indicate a need for immediate intervention?

A)

Heart rate, preload, contractility, and afterload are balanced and cardiac output is normal.

B)

Heart rate is rapid, preload is reduced, contractility and afterload are normal, and cardiac output is reduced.

C)

Heart rate is rapid, preload is high, contractility is high, afterload is low, and cardiac output is normal.

D)

Heart rate is low, preload is high, contractility is high, afterload is low, and cardiac output is normal.

18.

A patient has been diagnosed with chronic heart failure, compensated. What symptoms would the nurse expect to find?

A)

Frothy sputum progressing to pink frothy sputum

B)

Severe hypotension when supine

C)

Mild dyspnea on exertion or when supine

D)

4+ pitting edema of the lower extremities when dependent

19.

A patient with long-standing hypertension has a viral upper respiratory illness and is self-medicating with over-the-counter medications. The patient complains of severe dyspnea with activity and has new-onset crepitant rales and pitting edema of the lower extremities. In evaluating the patients medications, what medication should the nurse look for in particular?

A)

Furosemide (Lasix)

B)

Nonsteroidal anti-inflammatory medications (NSAIDs)

C)

Hydrochlorothiazide diuretic (HCTZ)

D)

Angiotensin-converting enzyme (ACE) inhibitor

20.

A patient with heart failure is being discharged. What discharge instruction should the nurse emphasize most?

A)

Date and time of next medical appointment

B)

Dietary alterations to reduce sodium intake

C)

Structured exercise program

D)

Maintaining weight within 1 to 2 pounds

21.

For a patient with heart failure, maintenance of a steady weight is an important goal. The nurse should teach the patient that which of the following is the most accurate method for monitoring fluid volume changes?

A)

Intake and output, with 24-hour totals and trends

B)

Daily weight at the same time every day

C)

Daily assessment of peripheral edema

D)

Periodic assessment of serum electrolyte values

22.

A patient with heart failure has been started on an ACE inhibitor. What lab value related to the ACE inhibitor would concern the nurse?

A)

Elevated serum potassium

B)

Elevated CK-MB

C)

Diminished sodium

D)

Increased prothrombin time

23.

A patient receiving an ACE inhibitor has a blood pressure of 85/50 mm Hg. The patient is asymptomatic otherwise. What is the best nursing action?

A)

Hold the medication because the blood pressure is too low.

B)

Recheck the blood pressure in 1 hour.

C)

Administer the medication because the patient is asymptomatic.

D)

Reschedule time of medication administration to hour of sleep.

24.

The patient is prescribed hydralazine and a nitrate for management of heart failure. The patient tells the nurse he has trouble taking medications that must be taken several times a day. What intervention will be the most helpful to the patient?

A)

Stress the importance of taking medications as prescribed.

B)

Ask the physician to change his therapy to long-acting medications that can be taken less often.

C)

Ask the physician to change his therapy to other drug classes at the same frequencies.

D)

Inform the physician that the patient is not taking his prescribed medications.

25.

A patient with heart failure is taking an ACE inhibitor and a diuretic as prescribed but continues to be symptomatic. What patient behavior would explain lack of achievement of therapeutic goals?

A)

Exercises regularly (walking and water aerobics)

B)

Diet of mostly canned food and soda pop

C)

Does not drink any alcoholic beverages

D)

Takes medications as prescribed

26.

A patient with heart failure comes to the clinic for a routine monitoring visit. What findings would indicate achievement of therapeutic goals?

A)

Lungs have crepitant rales.

B)

Complains of dyspnea on exertion

C)

Has pitting edema of lower extremities

D)

Weight is within 2 pounds of ideal weight.

Answer Key

1.

A, B, D

2.

B, D, F

3.

B

4.

A

5.

A

6.

B

7.

D

8.

D

9.

B

10.

D

11.

C

12.

C

13.

B

14.

A

15.

B

16.

A

17.

B

18.

C

19.

B

20.

D

21.

B

22.

A

23.

C

24.

B

25.

B

26.

D

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