HEART FAILURE NCLEX REVIEW QUESTIONS 100% VERIFIED ANSWERS 2024/2025 CORRECT STUDY SET, Exams of Nursing

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HEART FAILURE NCLEX

REVIEW QUESTIONS 100%

VERIFIED ANSWERS

2024/2025 CORRECT STUDY

SET

The nurse is preparing to administer digoxin to a patient with heart failure. In preparation, laboratory results are reviewed with the following findings: sodium 139 mEq/L, potassium 5. mEq/L, chloride 103 mEq/L, and glucose 106 mg/dL. What should the nurse do next? A. Withhold the daily dose until the following day. B. Withhold the dose and report the potassium level. C. Give the digoxin with a salty snack, such as crackers. D. Give the digoxin with extra fluids to dilute the sodium level. B. Withhold the dose and report the potassium level. The normal potassium level is 3.5 to 5.0 mEq/L. The patient is hyperkalemic, which makes the patient more prone to digoxin toxicity. For this reason, the nurse should withhold the dose and report the potassium level. The physician may order the digoxin to be given once the potassium level has been treated and decreases to within normal range. What is the priority assessment by the nurse caring for a patient receiving IV nesiritide (Natrecor) to treat heart failure? A. Urine output B. Lung sounds C. Blood pressure D. Respiratory rate

C. Blood pressure Although all identified assessments are appropriate for a patient receiving IV nesiritide, the priority assessment would be monitoring for hypotension, the main adverse effect of nesiritide. A patient admitted with heart failure appears very anxious and complains of shortness of breath. Which nursing actions would be appropriate to alleviate this patient's anxiety (select all that apply)? A. Administer ordered morphine sulfate. B. Position patient in a semi-Fowler's position. C. Position patient on left side with head of bed flat. D. Instruct patient on the use of relaxation techniques. E. Use a calm, reassuring approach while talking to patient. A, B, D, E. Morphine sulfate reduces anxiety and may assist in reducing dyspnea. The patient should be positioned in semi-Fowler's position to improve ventilation that will reduce anxiety. Relaxation techniques and a calm reassuring approach will also serve to reduce anxiety. A male patient with a long-standing history of heart failure has recently qualified for hospice care. What measure should the nurse now prioritize when providing care for this patient? A. Taper the patient off his current medications. B. Continue education for the patient and his family. C. Pursue experimental therapies or surgical options. D. Choose interventions to promote comfort and prevent suffering. D. Choose interventions to promote comfort and prevent suffering. The central focus of hospice care is the promotion of comfort and the prevention of suffering. Patient education should continue, but providing comfort is paramount. Medications should be continued unless they are not tolerated. Experimental therapies and surgeries are not commonly used in the care of hospice patients.

What should the nurse recognize as an indication for the use of dopamine (Intropin) in the care of a patient with heart failure? A. Acute anxiety B. Hypotension and tachycardia C. Peripheral edema and weight gain D. Paroxysmal nocturnal dyspnea (PND) B. Hypotension and tachycardia Dopamine is a β-adrenergic agonist whose inotropic action is used for treatment of severe heart failure accompanied by hemodynamic instability. Such a state may be indicated by tachycardia accompanied by hypotension. PND, anxiety, edema, and weight gain are common signs and symptoms of heart failure, but these do not necessarily warrant the use of dopamine. A patient with a recent diagnosis of heart failure has been prescribed furosemide (Lasix) in an effort to physiologically do what for the patient? A. Reduce preload. B. Decrease afterload. C. Increase contractility. D. Promote vasodilation. A. Reduce preload. Diuretics such as furosemide are used in the treatment of HF to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload. They do not directly influence afterload, contractility, or vessel tone. A patient with a diagnosis of heart failure has been started on a nitroglycerin patch by his primary care provider. What should this patient be taught to avoid? A. High-potassium foods B. Drugs to treat erectile dysfunction C. Nonsteroidal antiinflammatory drugs D. Over-the-counter H2-receptor blockers

B. Drugs to treat erectile dysfunction The use of erectile drugs concurrent with nitrates creates a risk of severe hypotension and possibly death. High-potassium foods, NSAIDs, and H2-receptor blockers do not pose a risk in combination with nitrates. A stable patient with acute decompensated heart failure (ADHF) suddenly becomes dyspneic. Before positioning the patient on the bedside, what should the nurse assess first? A. Urine output B. Heart rhythm C. Breath sounds D. Blood pressure D. Blood pressure The nurse should evaluate the blood pressure before dangling the patient on the bedside because the blood pressure can decrease as blood pools in the periphery and preload decreases. If the patient's blood pressure is low or marginal, the nurse should put the patient in the semi-Fowler's position and use other measures to improve gas exchange. The patient has heart failure (HF) with an ejection fraction of less than 40%. What core measures should the nurse expect to include in the plan of care for this patient (select all that apply)? A. Left ventricular function is documented. B. Controlling dysrhythmias will eliminate HF. C. Prescription for digoxin (Lanoxin) at discharge D. Prescription for angiotensin-converting enzyme (ACE) inhibitor at discharge E. Education materials about activity, medications, weight monitoring, and what to do if symptoms worsen A, D, E. The Joint Commission has identified these three core measures for heart failure patients. Although controlling dysrhythmias will improve CO and workload, it will not eliminate HF. Prescribing digoxin

for all HF patients is no longer done because there are newer effective drugs and digoxin toxicity occurs easily related to electrolyte levels and the therapeutic range must be maintained. After having an MI, the nurse notes the patient has jugular venous distention, gained weight, developed peripheral edema, and has a heart rate of 108/minute. What should the nurse suspect is happening? A. ADHF B. Chronic HF C. Left-sided HF D. Right-sided HF D. Right-sided HF An MI is a primary cause of heart failure. The jugular venous distention, weight gain, peripheral edema, and increased heart rate are manifestations of right-sided heart failure. Beyond the first year after a heart transplant, the nurse knows that what is a major cause of death? A. Infection B. Acute rejection C. Immunosuppression D. Cardiac vasculopathy D. Cardiac vasculopathy Beyond the first year after a heart transplant, malignancy (especially lymphoma) and cardiac vasculopathy (accelerated CAD) are the major causes of death. During the first year after transplant, infection and acute rejection are the major causes of death. Immunosuppressive therapy will be used for posttransplant management to prevent rejection and increases the patient's risk of an infection. The patient with chronic heart failure is being discharged from the hospital. What information should the nurse emphasize in the patient's discharge teaching to prevent progression of the disease to ADHF? A. Take medications as prescribed.

B. Use oxygen when feeling short of breath. C. Only ask the physician's office questions. D. Encourage most activity in the morning when rested. A. Take medications as prescribed. The goal for the patient with chronic HF is to avoid exacerbations and hospitalization. Taking the medications as prescribed along with nondrug therapies such as alternating activity with rest will help the patient meet this goal. If the patient needs to use oxygen at home, it will probably be used all the time or with activity to prevent respiratory acidosis. Many HF patients are monitored by a care manager or in a transitional program to assess the patient for medication effectiveness and monitor for patient deterioration and encourage the patient. This nurse manager can be asked questions or can contact the health care provider if there is evidence of worsening HF. The home care nurse visits a 73-year-old Hispanic woman with chronic heart failure. Which clinical manifestations, if assessed by the nurse, would indicate acute decompensated heart failure (pulmonary edema)? A. Fatigue, orthopnea, and dependent edema B. Severe dyspnea and blood-streaked, frothy sputum C. Temperature is 100.4o F and pulse is 102 beats/minute D. Respirations 26 breaths/minute despite oxygen by nasal cannula B. Severe dyspnea and blood-streaked, frothy sputum Clinical manifestations of pulmonary edema include anxiety, pallor, cyanosis, clammy and cold skin, severe dyspnea, use of accessory muscles of respiration, a respiratory rate > 30 breaths per minute, orthopnea, wheezing, and coughing with the production of frothy, blood-tinged sputum. Auscultation of the lungs may reveal crackles, wheezes, and rhonchi throughout the lungs. The heart rate is rapid, and blood pressure may be elevated or decreased. A 54-year-old male patient who had bladder surgery 2 days ago develops acute decompensated heart failure (ADHF) with severe dyspnea. Which action by the nurse would be indicated first? A. Perform a bladder scan to assess for urinary retention. B. Restrict the patient's oral fluid intake to 500 mL per day.

C. Assist the patient to a sitting position with arms on the overbed table. D. Instruct the patient to use pursed-lip breathing until the dyspnea subsides. C. Assist the patient to a sitting position with arms on the overbed table. The nurse should place the patient with ADHF in a high Fowler's position with the feet horizontal in the bed or dangling at the bedside. This position helps decrease venous return because of the pooling of blood in the extremities. This position also increases the thoracic capacity, allowing for improved ventilation. Pursed-lip breathing helps with obstructive air trapping but not with acute pulmonary edema. Restricting fluids takes considerable time to have an effect. A 70-year-old woman with chronic heart failure and atrial fibrillation asks the nurse why warfarin (Coumadin) has been prescribed for her to continue at home. Which response by the nurse is accurate? A. "The medication prevents blood clots from forming in your heart." B. "The medication dissolves clots that develop in your coronary arteries." C. "The medication reduces clotting by decreasing serum potassium levels." D. "The medication increases your heart rate so that clots do not form in your heart." A. "The medication prevents blood clots from forming in your heart." Chronic heart failure causes enlargement of the chambers of the heart and an altered electrical pathway, especially in the atria. When numerous sites in the atria fire spontaneously and rapidly, atrial fibrillation occurs. Atrial fibrillation promotes thrombus formation within the atria with an increased risk of stroke and requires treatment with cardioversion, antidysrhythmics, and/or anticoagulants. Warfarin is an anticoagulant that interferes with hepatic synthesis of vitamin K- dependent clotting factors. Which of the following patients are MOST at risk for developing heart failure? Select-all-that- apply:* A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction. B. A 55 year old female with a health history of asthma and hypoparathyroidism. C. A 30 year old male with a history of endocarditis and has severe mitral stenosis.

D. A 45 year old female with lung cancer stage 2. E. A 58 year old female with uncontrolled hypertension and is being treated for influenza. A, C, E The answers to this question are options: A, C, E. These patients are at most risk for heart failure. Remember risks factor for developing heart failure include: remember the mnemonic FAILURE: Faulty heart valves ( Option C mitral stenosis in this case), Arrhythmias, Infarction (Option A), Lineage, Uncontrolled hypertension (Option E), Recreational drug usage, Evaders (Option E with influenza) A patient is being discharged home after hospitalization of left ventricular systolic dysfunction. As the nurse providing discharge teaching to the patient, which statement is NOT a correct statement about this condition?* A. "Signs and symptoms of this type of heart failure can include: dyspnea, persistent cough, difficulty breathing while lying down, and weight gain." B. "It is important to monitor your daily weights, fluid and salt intake." C. "Left-sided heart failure can lead to right-sided heart failure, if left untreated." D. "This type of heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema." D Option D is the answer. This is a description of right-sided heart failure NOT left ventricular systolic dysfunction. Left-sided systolic dysfunction is where the left side of the heart is unable to CONTRACT efficiently which causes blood to back-up into the lungs...leading to pulmonary edema. A patient is diagnosed with left-sided systolic dysfunction heart failure. Which of the following are expected findings with this condition? A. Echocardiogram shows an ejection fraction of 38%. B. Heart catheterization shows an ejection fraction of 65%. C. Patient has frequent episodes of nocturnal paroxysmal dyspnea. D. Options A and C are both expected findings with left-sided systolic dysfunction heart failure. D The answer is D. Both Options A and C are correct. Option B is a finding expected in left-sided

DIASTOLIC dysfunction heart failure because the issue is with the ability of the ventricle to FILL properly...therefore a patient usually has a normal ejection fraction. Remember a normal EF is >60% in a healthy heart. Also, the left = lungs. Left-sided heart failure leads to a build up of fluid in the lungs due to the decreased amount of blood being pumped through the left ventricle, like a kink in a hose. Patients with heart failure can experience episodes of exacerbation. All of the patients below have a history of heart failure. Which of the following patients are at MOST risk for heart failure exacerbation?* A. A 55 year old female who limits sodium and fluid intake regularly. B. A 73 year old male who reports not taking Amiodarone for one month and is experiencing atrial fibrillation. C. A 67 year old female who is being discharged home from heart valve replacement surgery. D. A 78 year old male who has a health history of eczema and cystic fibrosis. B Option B is the correct answer. Patients who are in an arrhythmia (especially a-fib) are at risk for developing heart failure because the heart is not contracting properly and blood is pooling in the chambers. What type of heart failure does this statement describe? The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath.* A. Left ventricular systolic dysfunction B. Left ventricular ride-sided dysfunction C. Right ventricular diastolic dysfunction D. Left ventricular diastolic dysfunction D The answer is D. This statement describes left ventricular DIASTOLIC dysfunction. The ventricles cannot fill with blood, and blood filling the ventricles happens during diastole. If it was systolic heart failure, the ventricles would fill fine, but they would not eject the blood as they should.

15. Which of the following is a late sign of heart failure?* A. Shortness of breath

B. Orthopnea C. Edema D. Frothy-blood tinged sputum D The answer is D. Shortness of breath, orthopnea, and edema are EARLY signs and symptoms. Frothy- blood tinged sputum is a late sign. This is known as pulmonary edema and acute decompensation heart failure. A patient is being treated for cardiogenic shock. Which statement below best describes this condition? Select all that apply: A. "The patient will experience an increase in cardiac output due to an increase in preload and afterload." B. "A patient with this condition will experience decreased cardiac output and decreased tissue perfusion." C. "This condition occurs because the heart has an inadequate blood volume to pump." D. "Cardiogenic shock leads to pulmonary edema." B, D Cardiogenic shock occurs when the heart can NOT pump enough blood to meet the perfusion needs of the body. The cardiac output will be DECREASED, which will DECREASE tissue perfusion and cause cell injury to organs/tissues. In this condition, the heart is WEAK and can't pump blood out of the heart. This can be due to either a systolic (contraction) or diastolic (filling) issue along with a structural or dysrhythmia issue. In cardiogenic shock, there is NOT an issue with blood volume, but there is a problem with the heart itself. You're precepting a new nurse. You ask the new nurse to list the purpose of why a patient with cardiogenic shock may benefit from an intra-aortic balloon pump. What responses below indicate the new nurse understands the purpose of an intra-aortic balloon pump? Select all that apply: A. "This device increases the cardiac afterload, which will increase cardiac output." B. "This device will help increase blood flow to the coronary arteries."

C. "The balloon pump will help remove extra fluid from the heart and lungs." D. "The balloon pump will help increase cardiac output." B, D An intra-aortic balloon pump increases coronary artery blood flow and cardiac output. It does not directly remove extra fluid from the heart and lungs. Cardiac output is equal to the heart rate multiplied by the stroke volume. Treatment for cardiogenic shock includes medications that increase cardiac output. One of the factors that help determine cardiac output is stroke volume. Select all the factors that determine stroke volume? A. Cardiac Index B. Preload C. Pulmonary capillary wedge pressure D. Afterload E. Heart rate F. Contractility B, D, F Cardiac output is determined by the person's heart rate times the stroke volume. Stroke volume is the amount of blood pumped from the left ventricle with each BEAT (50-100 ml). It's determined by the preload, afterload, and contractility of the heart. These factors in a patient with cardiogenic shock can be manipulated with medications to increase the cardiac output. Which patient below is at MOST risk for developing cardiogenic shock? A. A 52-year-old male who is experiencing a severe allergic reaction from shellfish. B. A 25-year-old female who has experienced an upper thoracic spinal cord injury. C. A 72-year-old male who is post-op from a liver transplant. D. A 49-year-old female who is experiencing an acute myocardial infarction. D An acute MI (heart attack) is the main cause of cardiogenic shock. It happens because a coronary artery has become blocked. Coronary arteries supply the heart muscle's cells with oxygenated blood.

If they don't receive this oxygenated blood they will die, which causes the heart muscle to quit working (hence pumping efficiently). When the heart muscle fails to pump efficiently, cardiac output fails and cardiogenic shock occur. You're caring for a patient with cardiogenic shock. Which finding below suggests the patient's condition is worsening? Select all that apply: A. Blood pressure 98/ B. Urinary output 22 mL/hr C. Cardiac Index 3.3 L/min/m D. Pulmonary artery wedge pressure 30 mmHg B, D When answering this question look for values that are abnormal and that point to worsening tissue perfusion (urinary output should be 30 mL/hr or greater....if it's lower than this it show the kidneys are not being perfused) and worsening cardiac output (the blood pressure and cardiac index are within normal limits BUT pulmonary artery wedge pressure is NOT). A pulmonary artery wedge pressure (also called pulmonary capillary wedge pressure) is the pressure reading of the filling pressure in the left atrium. A normal PAWP is 4-12 mmHg and if it's >18 mmHg this indicates cardiogenic shock. If it reads high, that means there is back-flowing of blood into the heart and lungs (hence the left ventricle is failing to pump efficiently and increasing the pressure in the left atrium). A paradoxical pulse occurs in a client who had a coronary artery bypass graft (CABG) surgery 2 days ago. Which of the following surgical complications should the nurse suspect? A. Left-sided heart failure B. Aortic regurgitation C. Complete heart block D. Pericardial tamponade D. Pericardial tamponade (cardiac tamponade) A paradoxical pulse (a palpable decrease in pulse amplitude on quiet inspiration), AKA pulsus paradoxus, signals pericardial tamponade, a complication of CABG surgery. Left-sided heart failure can cause pulsus alternans (pulse amplitude alternation from beat to beat, with a regular rhythm).

Aortic regurgitation may cause bisferious pulse (an increased arterial pulse with a double systolic peak). Complete heart block may cause a bounding pulse (a strong pulse with increased pulse pressure). A woman with severe mitral stenosis and mitral regurgitation has a pulmonary artery catheter inserted. The physician orders pulmonary artery pressure monitoring, including pulmonary capillary wedge pressures. The purpose of this is to help assess the: A. Degree of coronary artery stenosis B. Peripheral arterial pressure C. Pressure from fluid within the left ventricle D. Oxygen and carbon dioxide concentration in the blood C The pulmonary artery pressures are used to assess the heart's ability to receive and pump blood. The pulmonary capillary wedge pressure reflects the left ventricle end-diastolic pressure and guides the physician in determining fluid management for the client. The degree of coronary artery stenosis is assessed during a cardiac catheterization. The peripheral arterial pressure is assessed with an arterial line. Which signs cause the nurse to suspect cardiac tamponade after a client has cardiac surgery? Select all that apply. A. Tachycardia B. Hypertension C. Increased CVP D. Increased urine output E. Jugular vein distention A, C, E Blood in the pericardial sac compresses the heart so the ventricles cannot fill; this leads to a rapid thready pulse. Tamponade causes hypotension and a narrowed pulse pressure. As the tamponade increases, pressure on the heart interferes with the ejection of blood from the left ventricle, resulting in an increased pressure in the right side of the heart and the systemic circulation. As the heart

because more inefficient, there is a decrease in kidney perfusion and therefore urine output. The increased venous pressure caused JVD. A client has the diagnosis of left ventricular failure and a high pulmonary capillary wedge pressure (PCWP). The physician orders dopamine to improve ventricular function. The nurse will know the medication is working if the client's: A. Blood pressure rises B. Blood pressure decreases C. Cardiac index falls D. PCWP rises A. If dopamine as a positive effect, it will cause vasoconstriction peripherally, but increase renal perfusion and the blood pressure will rise. The cardiac index will also rise and the PCWP should decrease. A 35-year-old male was knifed in the street fight, admitted through the ER, and is now in the ICU. An assessment of his condition reveals the following symptoms: respirations shallow and rapid, CVP 15 cm H2O, BP 90 mm Hg systolic, skin cold and pale, urinary output 60-100 mL/hr for the last 2 hours. Analyzing these symptoms, the nurse will base a nursing diagnosis on the conclusion that the client has which of the following conditions? A. Hypovolemic shock B. Cardiac tamponade C. Wound dehiscence D. Atelectasis B. All of the client's symptoms are found in both cardiac tamponade and hypovolemic shock except the increase in urinary output. Which of the following are NOT typical signs and symptoms of pericarditis? (SATA) A. Fever

B. Increased pain when leaning forward C. ST segment depression D. Pericardial friction rub E. Radiating substernal pain felt in the left shoulder F. Breathing in relieves the pain B, C, F These are findings NOT found in pericarditis. B is wrong because leaning forward actually helps relieve pain felt in pericarditis (supine position makes it worst). C is wrong because ST segment ELEVATION is seen not depression. F is wrong because inspiration (breathing in) increases the pain felt with pericarditis.