Chapter 29: Management of Patients With Complications from Heart Disease. M/S – Flashcards
Unlock all answers in this set
Unlock answersquestion
The nurse is discussing cardiac hemodynamics with a nursing student. The nurse explains preload to the student and then asks the student what nursing interventions might cause increased preload. The student correctly answers which of the following?
answer
Correct response: Application of antiembolytic stockings Explanation: Preload is the amount of blood presented to the ventricles just before systole. Anything that assists in returning blood to the heart (eg, antiembolytic stockings) or preventing blood from pooling in the extremities will increase preload. Anything that decreases the amount of blood returning to the heart will decrease preload, such as vasodilation or blood pooling in the extremities.
question
Sixty six-year-old David Steiner is already being treated for hypertension. His doctor, concerned about the potential for heart failure, has him come back for check-ups regularly. What does hypertension have to do with heart failure?
answer
Correct response: Hypertension causes the heart's chambers to enlarge and weaken. Explanation: Hypertension causes the heart's chambers to enlarge and weaken, making it impossible for the ventricles to eject all the blood they receive.
question
(see full question) The student nurse is caring for a client with heart failure. Diuretics have been ordered. What method might be used with a debilitated patient to help the nurse evaluate the client''s response to diuretics?
answer
Correct response: Using a urinary catheter Explanation: To evaluate response to diuretics, a urinary catheter is used. Mechanical ventilation helps maintain a normal breathing pattern. A pulmonary artery catheter helps estimate cardiac output. A biventricular pacemaker is used to sustain life.
question
A client with heart failure has been receiving an intravenous infusion at 150 mL/hr. Now the client is short of breath. The nurse auscultates crackles bilaterally and notes neck vein distention and tachycardia. Using critical thinking skills, what should the nurse do first?
answer
Correct response: Slow the infusion and notify the physician. Explanation: The client has fluid overload, so the nurse should first slow the infusion to prevent additional overload, and then notify the physician to obtain further orders. Notifying the physician without slowing the infusion would increase the client's risk. Discontinuing the infusion is not appropriate, because having a vascular access will be important. Administering a diuretic without turning down the intravenous infusion rate is counterproductive.
question
A patient has been diagnosed with systolic heart failure. The nurse would expect the patient's ejection fraction to be at which level?
answer
Correct response: Severely reduced Explanation: The ejection fraction is normal in diastolic heart failure, but severely reduced in systolic heart failure.
question
(see full question) 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). The nurse should document this as:
answer
Correct response: a third heart sound (S3). Explanation: An S3 is heard following an S2, which commonly occurs in clients experiencing heart failure and results from increased filling pressures. An S1 is a normal heart sound made by the closing of the mitral and tricuspid valves. An S4 is heard before an S1 and is caused by resistance to ventricular filling. A murmur is heard when there is turbulent blood flow across the valves.
