Nursing 406 - Adult Health Care » Spring 2020 » Chapter 29 Quiz

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Question #1
Which is a key diagnostic indicator of heart failure?
A.   Brain natriuretic peptide (BNP)
B.   Creatinine
C.   Complete blood count (CBC)
D.   Blood urea nitrogen (BUN)
Question #2
The nurse is gathering data from a client recently admitted to the hospital. The nurse asks the client about experiencing orthopnea. What question would the nurse ask to obtain this information?
A.   "Are you coughing up blood at night?"
B.   "How far can you walk without becoming short of breath?"
C.   "Are you only able to breathe when you are sitting upright?"
D.   "Are you urinating excessively at night?"
Question #3
When the client has increased difficulty breathing when lying flat, the nurse records that the client is demonstrating
A.   orthopnea.
B.   hyperpnea.
C.   paroxysmal nocturnal dyspnea.
D.   dyspnea upon exertion.
Question #4
The nurse recognizes which symptom as a classic sign of cardiogenic shock?
A.   Increased urinary output
B.   High blood pressure
C.   Restlessness and confusion
D.   Hyperactive bowel sounds
Question #5
Which measurement should a nurse use to monitor the respiratory status of a client with pulmonary edema?
A.   Skin color assessment
B.   Arterial blood gas (ABG) analysis
C.    Lung sounds
D.   Pulse oximetry
Question #6
While auscultating the heart sounds of a client with heart failure, the nurse hears an extra heart sound immediately after the second heart sound (S2). How should the nurse document this sound?
A.   a fourth heart sound (S4).
B.   a murmur.
C.   a first heart sound (S1).
D.   a third heart sound (S3).
Question #7
Which is a cerebrovascular manifestation of heart failure?
A.   Dizziness
B.   Nocturia
C.   Tachycardia
D.   Ascites
Question #8
Which medication reverses digitalis toxicity?
A.   Ibuprofen
B.   Warfarin
C.   Amlodipine
D.   Digoxin immune FAB
Question #9
The nurse is caring for a client with suspected right-sided heart failure. What would the nurse know that clients with suspected right-sided heart failure may experience?
A.   Increased perspiration
B.   Sleeping in a chair or recliner
C.   Gradual unexplained weight gain
D.   Increased urine output
Question #10
The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure?
A.   Dyspnea on exertion
B.   Hypotension
C.   Tachycardia
D.   Decreased urinary output
Question #11
A patient is prescribed digitalis preparations. Which of the following conditions should the nurse closely monitor when caring for the patient?
A.   Enlargement of joints
B.   Flexion contractures
C.   Potassium levels
D.   Vasculitis
Question #12
The nurse identifies which symptom as a characteristic of right-sided heart failure?
A.   Jugular vein distention (JVD)
B.   Cough
C.   Dyspnea
D.   Pulmonary crackles
Question #13
A client has been experiencing increasing shortness of breath and fatigue. The health care provider has ordered a diagnostic test in order to determine what type of heart failure the client is having. What diagnostic test does the nurse anticipate being ordered?
A.   A chest x-ray
B.   An electrocardiogram
C.   A ventriculogram
D.   An echocardiogram
Question #14
A nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein distention. What condition should the nurse suspect?
A.   Tension pneumothorax
B.   Pulmonary embolism
C.   Heart failure
D.   Cardiac tamponade
Question #15
A client is prescribed digitalis medication. Which condition should the nurse closely monitor when caring for the client?
A.   Vasculitis
B.   Enlargement of joints
C.   nausea and vomiting
D.   Flexion contractures
Question #16
Which term describes the degree of stretch of the ventricular cardiac muscle fibers at the end of diastole?
A.    Afterload
B.   Stroke volume
C.   Preload
D.    Ejection fraction
Question #17
Which New York Heart Association classification of heart failure has a poor prognosis and includes symptoms of cardiac insufficiency at rest?
A.   IV
B.   II
C.   I
D.   III
Question #18
Frequently, what is the earliest symptom of left-sided heart failure?
A.   chest pain
B.   anxiety
C.   dyspnea on exertion
D.   confusion
Question #19
A client with right-sided heart failure is admitted to the medical-surgical unit. What information obtained from the client may indicate the presence of edema?
A.   The client says he is short of breath when ambulating.
B.   The client says his rings have become tight and are difficult to remove.
C.   The client says he has been hungry in the evening.
D.   The client says that he has been urinating less frequently at night.
Question #20
The nurse is providing discharge instructions to a client with heart failure preparing to leave the following day. What type of diet should the nurse request the dietitian to discuss with the client?
A.   Low-fat diet
B.   Low-sodium diet
C.    Low-cholesterol diet
D.   Low-potassium diet
Question #21
A client develops cardiogenic pulmonary edema and is extremely apprehensive. What medication can the nurse administer with physician orders that will relieve anxiety and slow respiratory rate?
A.   Nitroglycerin
B.   Morphine sulfate
C.   Furosemide
D.   Dopamine
Question #22
A patient in severe pulmonary edema is being intubated by the respiratory therapist. What priority action by the nurse will assist in the confirmation of tube placement in the proper position in the trachea?
A.   Listen for breath sounds over the epigastrium.
B.   Call for a chest x-ray.
C.   Observe for mist in the endotracheal tube.
D.   Attach a pulse oximeter probe and obtain values.
Question #23
The nurse is caring for a client with heart failure who is receiving torsemide. What implementation will help the nurse evaluate the client's response of the medication?
A.   asking the client about comfort level
B.   measuring intake and output
C.   obtaining cardiac output with a pulmonary catheter
D.   using mechanical ventilation
Question #24
A client with heart failure must be monitored closely after starting diuretic therapy. What is the best indicator for the nurse to monitor?
A.   fluid intake and output.
B.   urine specific gravity.
C.   weight.
D.   vital signs.
Question #25
A client is at risk for excess fluid volume. Which nursing intervention ensures the most accurate monitoring of the client's fluid status?
A.   Assessing the client's vital signs every 4 hours
B.   Weighing the client daily at the same time each day
C.   Checking the client's lungs for crackles during every shift
D.   Measuring and recording fluid intake and output
Question #26
A client with chronic heart failure is receiving digoxin 0.25 mg by mouth daily and furosemide 20 mg by mouth twice daily. The nurse should assess the client for what sign of digoxin toxicity?
A.   taste and smell alterations.
B.   visual disturbances.
C.   dry mouth and urine retention.
D.   nocturia and sleep disturbances.
Question #27
A client with acute pericarditis is exhibiting distended jugular veins, tachycardia, tachypnea, bradycardia, and muffled heart sounds. The nurse recognizes these as symptoms of what occurrence?
A.   The parietal and visceral pericardial membranes adhere to each other, preventing normal myocardial contraction.
B.   Fibrin accumulation on the visceral pericardium infiltrates into the myocardium, creating generalized myocardial dysfunction.
C.   The pericardial space is eliminated with scar tissue and thickened pericardium.
D.   Excess pericardial fluid compresses the heart and prevents adequate diastolic filling.
Question #28
A nurse is assessing a client with congestive heart failure for jugular vein distension (JVD). Which observation is important to report to the physician?
A.   JVD is noted 2 cm above the sternal angle.
B.   No JVD is present.
C.   JVD is noted at the level of the sternal angle.
D.   JVD is noted 4 cm above the sternal angle.
Question #29
Which diagnostic study is usually performed to confirm the diagnosis of heart failure?
A.   Electrocardiogram (ECG)
B.    Echocardiogram
C.   Serum electrolytes
D.   Blood urea nitrogen (BUN)
Question #30
A nurse caring for a client recently admitted to the ICU observes the client coughing up large amounts of pink, frothy sputum. Lung auscultation reveals course crackles to lower lobes bilaterally. Based on this assessment, the nurse recognizes this client is developing
A.   tuberculosis.
B.   decompensated heart failure with pulmonary edema.
C.    acute exacerbation of chronic obstructive pulmonary disease.
D.   bilateral pneumonia.
Question #31
The nurse is asssessing a client with crackling breath sounds or pulmonary congestion. What is the cause of the congestion?
A.   ascites
B.   hepatomegaly
C.   nocturia
D.   inadequate cardiac output
Question #32
The nurse is caring for a client with severe compensated heart failure. What human brain natriuretic peptide (BNP) medication may be used in a critical care unit with hemodynamic monitoring?
A.   captopril
B.   Natrecor
C.   enalapril
D.   metoprolol
Question #33
A nurse is administering digoxin. What client parameter would cause the nurse to hold the digoxin and notify the health care prescriber?
A.   heart rate of 55 beats per minute
B.   urine output of 300 mL in eight hours
C.   atrial fibillation rhythm
D.   blood pressure of 125/80
Question #34
A health care provider in the outpatient department examines a client with chronic heart failure to investigate recent-onset peripheral edema and increased shortness of breath. The nurse documents the severity of pitting edema as +1. What is the best description of this type of edema?
A.    Barely detectable depression when the thumb is released from the swollen area; normal foot and leg contours
B.   A 5- to 10-mm depression when the thumb is released from the swollen area; foot and leg swelling
C.   Detectable depression of less than 5 mm when the thumb is released from the swollen area; normal foot and leg contours
D.    A depression of more than 1 cm when the thumb is released from the swollen area; severe foot and leg swelling
Question #35
The nurse is administering digoxin to a client with heart failure. What laboratory value may predispose the client to digoxin toxicity?
A.   sodium level of 152 mEq/L
B.   calcium level of 7.5 mg/dL
C.   magnesium level of 2.5 mg/dL
D.   potassium level of 2.8 mEq/L
Question #36
A client has been having cardiac symptoms for several months and is seeing a cardiologist for diagnostics to determine the cause. How will the client's ejection fraction be measured?
A.   echocardiogram
B.   electrocardiogram
C.   cardiac ultrasound
D.   cardiac catheterization
Question #37
The nurse identifies which symptom as a manifestation of right-sided heart failure (HF)?
A.   Reduction in cardiac output
B.   Reduction in forward flow
C.   Accumulation of blood in the lungs
D.   Congestion in the peripheral tissues
Question #38
A patient has missed 2 doses of digitalis. What laboratory results would indicate to the nurse that the patient is within therapeutic range?
A.   2.0 mg/mL
B.   0.25 mg/mL
C.   3.2 mg/mL
D.   4.0 mg/mL
Question #39
A patient is admitted to the intensive care unit (ICU) with left-sided heart failure. What clinical manifestations does the nurse anticipate finding when performing an assessment? (Select all that apply.),,
A.   Jugular vein distention
B.   Dyspnea
C.   Ascites
D.   Cough
E.   Pulmonary crackles
Question #40
The nurse is teaching a client about medications prescribed for severe volume overload from heart failure. What diuretic is the first-line treatment for clients diagnosed with heart failure?
A.    furosemide
B.   spironolactone
C.   metolazone
D.   mannitol
Question #41
The nurse is interviewing a client during an initial visit at a cardiologist's office. What symptom will the nurse expect to find as an early symptom of chronic heart failure?
A.   fatigue
B.   pedal edema
C.   irregular pulse
D.   nocturia
Question #42
A client has been diagnosed with systolic heart failure. What percentage will the nurse expect the patient’s ejection fraction to be?
A.   5%
B.   30%
C.   65%
D.   55%
Question #43
A client is receiving captopril for heart failure. During the nurse's assessment, what sign indicates that the medication therapy is ineffective?
A.   skin rash
B.   postural hypotension
C.   dry cough
D.   peripheral edema
Question #44
Which is a manifestation of right-sided heart failure?
A.   Reduction in cardiac output
B.   Systemic venous congestion
C.   Reduction in forward flow
D.   Accumulation of blood in the lungs
Question #45
The nurse is caring for a client with suspected right-sided heart failure. What would the nurse know that clients with suspected right-sided heart failure may experience?
A.   Increased urine output
B.   Gradual unexplained weight gain
C.   Sleeping in a chair or recliner
D.   Increased perspiration
Question #46
Which is a classic sign of cardiogenic shock?
A.   Hyperactive bowel sounds
B.   Tissue hypoperfusion
C.   High blood pressure
D.   Increased urinary output
Question #47
Which feature is the hallmark of systolic heart failure?
A.   Low ejection fraction (EF)
B.   Pulmonary congestion
C.   Basilar crackles
D.   Limited activities of daily living (ADLs)
Question #48
The nurse is providing care to a client with cardiogenic shock requring a intra-aortic balloon pump (IABP). What is the therapeutic effect of the IABP therapy?
A.   decreased right ventricular workload
B.   decreased left ventricular workload
C.   decreased renal perfusion
D.   decreased peripheral perfusion to the extremities
Question #49
The nurse is admitting a client with frothy pink sputum. What does the nurse suspect is the primary underlying disorder of pulmonary edema?
A.   decreased right ventricular elasticity
B.   decreased left ventricular pumping
C.   increased right atrial resistance
D.   increased left atrial contractility
Question #50
A nurse is caring for a client with acute pulmonary edema. To immediately promote oxygenation and relieve dyspnea, what action should the nurse perform?
A.   place the client in high Fowler's position
B.    perform chest physiotherapy
C.   administer oxygen
D.   have the client take deep breaths and cough
Question #51
A nurse is caring for a client with left-sided heart failure. During the nurse's assessment, the client is wheezing, restless, tachycardic, and has severe apprehension. The nurse knows that these are symptoms of what?
A.   Progressive heart failure
B.   Pulmonary hypertension
C.   Acute pulmonary edema
D.   Cardiogenic shock
Question #52
A client has a significant history of congestive heart failure. What should the nurse specifically assess during the client's semiannual cardiology examination? Select all that apply.
A.   Monitor the client for signs of lethargy or confusion.
B.   Examine the client's joints for crepitus.
C.   Examine the client's neck for distended veins.
D.   Examine the client's eyes for excess tears.
Question #53
A client with left-sided heart failure is in danger of impaired renal perfusion. How would the nurse assess this client for impaired renal perfusion?
A.   Assess for elevated blood potassium levels.
B.   Assess for elevated blood urea nitrogen levels.
C.   Assess for reduced blood sodium levels.
D.   Assess for reduced urine output.
Question #54
A client in the hospital informs the nurse he “feels like his heart is racing and can't catch his breath.” What does the nurse understand occurs as a result of a tachydysrhythmia?
A.    It reduces ventricular ejection volume.
B.    It increases preload.
C.   It causes a loss of elasticity in the myocardium.
D.   It increases afterload.
Question #55
The nurse understands that a client with which cardiac arrhythmia is most at risk for developing heart failure?
A.   First-degree heart block
B.   Atrial fibrillation
C.   Sinus tachycardia
D.   Supraventricular tachycardia
Question #56
The nurse is assessing a client with left-sided heart failure. What assessment finding is expected?
A.   ascites
B.   air hunger
C.   pitting edema of the legs
D.   jugular vein distention
Question #57
The nurse is discussing basic cardiac hemodynamics and explains preload to the client. What nursing intervention will decrease preload?
A.   sustained elevation of the client's legs
B.   application of antiembolytic stockings
C.   administration of a vasodilating drug (as ordered by a health care provider)
D.   increasing activity
Question #58
A client asks the nurse if systolic heart failure will affect any other body function. What body system response correlates with systolic heart failure (HF)?
A.   increased blood volume ejected from ventricle
B.   decrease in renal perfusion
C.   dehydration
D.   vasodilation of skin
Question #59
Following a left anterior myocardial infarction, a client undergoes insertion of a pulmonary artery catheter. Which finding most strongly suggests left-sided heart failure?
A.   Decreased central venous pressure
B.   Increased pulmonary artery diastolic pressure
C.   Decreased mean pulmonary artery pressure
D.   Increase in the cardiac index
Question #60
A patient is undergoing a pericardiocentesis. Following withdrawal of pericardial fluid, which assessment by the nurse indicates that cardiac tamponade has been relieved?
A.   Decrease in central venous pressure (CVP)
B.   Increase in CVP
C.   Decrease in blood pressure
D.   Absence of cough
Question #61
The nurse is administering sublingual nitroglycerin to a client with chest pain. What action will the nurse take after administering two sublingual tablets if the client continues with chest pain and has a blood pressure of 120/82 mm Hg?
A.   Administer the third sublingual nitroglycerin tablet.
B.   Hold any further treatment until the client's blood pressure increases.
C.   Notify the health care provider of the chest pain.
D.   Wait ten minutes after the second tablet to assess pain.
Question #62
A client with a history of heart failure is returning from the operating room after inguinal hernia repair and the nurse assesses a low pulse oximetry reading. What is the most important nursing intervention?
A.   Assess for jugular vein distention.
B.   Administer pain medication.
C.   Assess the surgical incisional area.
D.   Titrate oxygen therapy.
Question #63
A client with heart failure must be monitored closely after starting diuretic therapy. What is the best indicator for the nurse to monitor?
A.   fluid intake and output.
B.   vital signs.
C.   urine specific gravity.
D.   weight.
Question #64
A client has had an echocardiogram to measure ejection fracton. The nurse explains that ejection fraction is the percentage of blood the left ventricle ejects upon contraction. What is the typical percentage of blood a healthy heart ejects?
A.   45%
B.   50%
C.   55%
D.   40%
Question #65
A nurse is teaching clients newly diagnosed with coronary heart disease (CHD) about the disease process and risk factors for heart failure. Which problem can cause left-sided heart failure (HF)?
A.   Ineffective right ventricular contraction
B.   Pulmonary embolus
C.   Myocardial ischemia
D.   Cystic fibrosis
Question #66
The nurse is performing a respiratory assessment for a patient in left-sided heart failure. What does the nurse understand is the best determinant of the patient’s ventilation and oxygenation status?
A.   End-tidal CO2
B.   Pulse oximetry
C.   Arterial blood gases
D.   Listening to breath sounds
Question #67
Assessment of a client on a medical surgical unit finds a regular heart rate of 120 beats per minute, audible third and fourth heart sounds, blood pressure of 84/64 mm Hg, bibasilar crackles on lung auscultation, and a urine output of 5 mL over the past hour. What is the reason the nurse anticipates transferring the client to the intensive care unit?
A.   The client is experiencing heart failure.
B.   The client shows signs of aneurysm rupture.
C.   The client is in the early stage of right-sided heart failure.
D.   The client is going into cardiogenic shock.

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