Disorders of the Heart: Chapter 19, Care of Patients with Cardiac Disorders

Question 1 of 9

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For which reason may diuretics be used to treat a patient with heart failure (HF)?

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  • To reduce fluid retention in the lungs and lower extremitiesDiuretics reduce fluid retention in the lungs and the lower extremities.
• • To slow the heart down if tachycardia is causing HFBeta-adrenergic blockers are used to slow the heart down if tachycardia is causing HF.
• • To increase the force of heart contraction, thereby increasing cardiac outputDigitalis increases the force of the heart contraction, thereby increasing cardiac output.
• • To relax and dilate the blood vessels to allow the vessels to accommodate larger percentages of the total blood volumeVenous dilators such as isosorbide dinitrate and nitroglycerin relax and dilate the blood vessels to allow the vessels to accommodate larger percentages of the total blood volume.

Question 2 of 9

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Which teaching point would be included in the discharge instructions for a patient with mild heart failure (HF)? Select all that apply. One, some, or all responses may be correct.

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  • Daily weight monitoringIt is important to teach the patient to check weight at the same time every day and record it. If the patient can see that fluid weight gain is occurring, they may be able to avert a trend back into decompensated HF by adjusting diuretic medication, decreasing sodium intake, treating infection, and decreasing activity and resting more.
• • Increasing sodium intakeThe nurse would instruct the patient to limit (not increase) sodium intake.
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  • Balancing physical activity with restInstruction would also include balancing rest with physical activity.
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  • Adverse side effects of medication needing reportingThe nurse would teach self-administration of medications and awareness of adverse side effects that must be reported.
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  • Symptom changes to report to the health care providerThe nurse would teach symptoms that should be reported to the health care provider if they become worse or appear for the first time.

Question 3 of 9

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A patient with a heart failure (HF) history visited the cardiologist for reports of dyspnea and fatigue during short walks and climbing one flight of stairs but does not experience dyspnea at rest. Which stage of HF is this patient experiencing?

• • Stage AThe requirement for Stage A (American Heart Association Staging Heart Failure) is an at-risk status for HF but no heart damage. This patient does have a history of HF already and is symptomatic.
• • Stage BThe requirement for Stage B (American Heart Association Staging Heart Failure) is structural heart disease but no HF symptoms. This patient is having symptoms of dyspnea and fatigue.
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  • Stage CThe requirement for Stage C (American Heart Association Staging Heart Failure) is past or present HF symptoms. This patient is experiencing present HF symptoms of dyspnea and fatigue during short walks and climbing one flight of stairs. This dyspnea and fatigue in HF is a result of the increased workload on the heart as well as the formation of fluid around the lungs.
• • Stage DRequirement for Stage D (American Heart Association Staging Heart Failure) is advanced disease needing ongoing treatment. Advanced disease presents as the patient having dyspnea at rest and with very little activity. This patient denied dyspnea at rest.

Question 4 of 9

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Which symptom of heart failure (HF) occurs as a direct result of the heart muscle becoming weak and the blood vessels becoming constricted?

• • Weight gainWeight gain is a common symptom in HF patients as sodium and water retention occurs.
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  • CongestionCongestion develops in HF because the weakened heart is unable to move the amount of blood it receives efficiently through the system. Constricted blood vessels also create congestion because the blood cannot pass through.
• • FatigueFatigue is a common symptom in HF. It is caused by a decreased hemoglobin resulting in decreased oxygenation. Fatigue is also secondary to shortness of breath and anemia.
• • AnemiaAnemia is a symptom in HF. It occurs because there is a reduction in hemoglobin resulting from sodium and water retention.

Question 5 of 9

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Which symptom would be found in the patient with left-sided heart failure (HF)?

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  • Pink, frothy sputumResidual blood prevents part of the blood from the lungs from entering the left side of the heart. This causes fluid to back up into the pulmonary vessels. The pressure within those vessels increases, and fluid leaks into the lung tissue—producing congestion and eventually pulmonary edema. Pink frothy sputum is a symptom of pulmonary edema.
• • Lower extremity edemaWhen the right side of the heart fails, the edema is first evident in the lower extremities (dependent edema).
• • Sacral edemaWhen the right side of the heart fails, the edema is first evident in the lower extremities (dependent edema). Also, fluid accumulates in the liver and abdominal organs as the portal circulation becomes involved.
• • Weight gainWhen the right side of the heart fails, the edema is first evident in the lower extremities (dependent edema). Also, fluid accumulates in the liver and abdominal organs as the portal circulation becomes involved. This accumulation of fluid is responsible for weight gain.

Question 6 of 9

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Which type of heart failure (HF) is revealed when the cardiologist informs a patient with symptoms of shortness of breath and congestion that the echocardiogram (ECG) shows a 30% ejection fraction?

• • Right-sidedAn ejection fraction of 40% or less is a marker of left-sided HF, not right-sided.
• • Left-sided, diastolicEjection fraction is normal in primary diastolic failure, so diastolic failure is not indicated by the ECG finding.
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  • Left-sided, systolicAn ejection fraction of 40% or less is a marker of left-sided systolic HF.
• • Left- and right-sidedThis patient has no symptoms of right-sided HF. An ejection fraction of 40% or less is a marker of left-sided systolic HF.

Question 7 of 9

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Which food would the nurse include in the diet plan for a patient with heart failure? Select all that apply. One, some, or all responses may be correct.

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  • Salmon and tunaThe nurse would advise the patient to eat fish at least twice a week. Fatty fish such as salmon, mackerel, and tuna are best.
• • Whole milkThe nurse would advise the patient to eliminate as much fat as possible and use skim or 1% fat milk and nonfat or low-fat yogurt, cheeses, and ice cream.
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  • Fresh or frozen vegetablesThe nurse would advise the patient to eat five to seven servings of fruit and vegetables per day and use fresh or frozen vegetables and fresh fruit or fruit canned in juice rather than high-fructose corn syrup.
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  • Olive oil and canola oilThe nurse would advise the patient to use fats with no more than 2 g of saturated fat per tablespoon. Olive, canola, corn, or safflower oil and liquid and tub margarines are good choices.
• • Fried chicken breastThe nurse would advise the patient to cook using little or no fat; broil, bake, roast, poach, stir fry, microwave, or steam foods rather than frying them. The patient should also eliminate as much fat as possible by trimming meat and skinning poultry before cooking.

Question 8 of 9

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Which short-term treatment is appropriate for the patient with heart failure (HF) that medications and diet therapy have failed to treat? Select all that apply. One, some, or all responses may be correct.

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  • Cardiac resynchronization therapy (CRT)CRT involves synchronizing the pumping action of the atria and ventricles for more efficient pumping by use of a biventricular pacemaker. This is the treatment of choice when drug therapy does not control HF.
• • Ventricular restoration surgerySurgery to reduce the size of an enlarged heart (ventricular restoration surgery) may be effective for some patients; however, this is not a short-term therapy.
• • Left ventricular assist device (LVAD)An LVAD may be used to help with the heart’s pumping action; however, this is not short term, and it is used after other treatments have failed.
• • Heart transplantationThis is a last resort treatment when all other treatments have failed. It is not a short-term treatment.
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  • Intra-aortic balloon pump (IABP)Short-term treatment for severe HF can be accomplished with an IABP. It is designed to increase blood supply to the myocardium and decrease the workload.

Question 9 of 9

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The nurse is providing discharge instructions for the patient who was admitted with a diagnosis of left-sided heart failure (HF). The patient smokes one pack a day, leads a very sedentary lifestyle, has a body mass index (BMI) within normal limits, and has no history of dependent edema. Organize the discharge instructions for this patient from highest to lowest priority.

1. Smoking cessation
2. Activity level
3. Diet
4. Monitoring intake and output

≤>≤GENERIC RATIONALE>> Instructional materials regarding smoking cessation are offered to all smokers on admission and discharge, and patients are counseled about the importance of quitting smoking (Centers for Medicare & Medicaid Services, 2020). Tobacco treatment, the term used by The Joint Commission, is a standalone core measure and is not specific to any one diagnosis because smoking cessation is key to controlling many diseases. Because of the patient being sedentary, exercise and activity is the next level of importance. BMI is within normal limits, so diet would follow in priority. A heart healthy diet is important in the ongoing treatment of HF. Lastly, this patient has no history of edema and is not obese, so monitoring intake and output would have the lowest priority for this patient.