Heart Failure NCLEX Review Questions

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1.

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?

C. Assist the patient to a sitting position

with arms on the overbed table.

2.

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. 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.

A70-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."

3.

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.
B.
C.
D.

ADHF
Chronic HF
Left-sided HF
Right-sided HF

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.

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.

4.

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

5.

The home care

nurse visits a 73year-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

D. Cardiac vasculopathy

6.

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.

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.

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 male patient with a longstanding history of heart

failure has recently
qualified for hospice care.
What measure should the
nurse now prioritize when
providing care for this
patient?

7.

The nurse is administering

a dose of digoxin (Lanoxin)
to a patient with heart
failure (HF). The nurse
would become concerned
with the possibility of
digitalis toxicity if the
patient reported which
symptom(s)?
A.
B.
C.
D.

8.

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.

D. Anorexia and nausea

Anorexia, nausea, vomiting,
blurred or yellow vision, and
cardiac dysrhythmias are all
signs of digitalis toxicity. The
nurse would become concerned
and notify the health care
provider if the patient exhibited
any of these symptoms.

Muscle aches
Constipation
Pounding headache
Anorexia and nausea

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 5.6 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.

9.

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.

10.

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.

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
angiotensinconverting enzyme
(ACE) inhibitor at
discharge
E. Education
materials about
activity,
medications, weight
monitoring, and
what to do if
symptoms worsen

11.

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

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.

B. Drugs to treat erectile dysfunction

The use of erectile drugs concurrent
with nitrates creates a risk of severe
hypotension and possibly death. Highpotassium foods, NSAIDs, and H2receptor blockers do not pose a risk in
combination with nitrates.

12.

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.
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.

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 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.
B.
C.
D.

A. Reduce
preload.
B. Decrease
afterload.
C. Increase
contractility.
D. Promote
vasodilation.
13.

14.

15.

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.

16.

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.

Urine output
Heart rhythm
Breath sounds
Blood pressure

What is the priority

assessment by the
nurse caring for a
patient receiving
IV nesiritide
(Natrecor) to treat
heart failure?
A.
B.
C.
D.

D. Blood pressure

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.

Urine output
Lung sounds
Blood pressure
Respiratory rate

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 -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.