Heart Failure and Cardiac Output for Med-Surg Nursing

Every question in this set, with the answer

Use this to review after you finish — or instead of the timed version, if you would rather just read.

1. At 0700, a patient being evaluated for HF weighs three pounds more than yesterday morning. Both weights were obtained after voiding and in the same garments. Which entry best interprets this finding?

   1. Three-pound gain in 24 hours; the weight trend is not yet suggestive of HF because the five-pound weekly threshold has not been reached.
   2. Three-pound gain in 24 hours; this weight change is suggestive of HF.
   3. Three-pound gain in 24 hours; interpretation as an HF-related finding is deferred until BNP results are available.
   4. Three-pound gain in 24 hours; this is suggestive of HF only if pitting edema is also present.

   Answer: Three-pound gain in 24 hours; this weight change is suggestive of HF.

   The section identifies a three-pound gain in one day as suggestive of HF, independently of the five-pound weekly threshold. It does not require a BNP result or accompanying pitting edema before recognizing this weight change as a relevant finding.

2. At 0900, a nurse assesses a patient with HF and observes a productive cough with a small amount of frothy pink sputum. Crackles are heard at both posterior lung bases. Which entry best documents these respiratory findings?

   1. Productive cough with pink sputum; abnormal breath sounds present.
   2. Crackles at the lung bases; sputum findings consistent with HF.
   3. Productive cough with a small amount of frothy pink sputum; crackles at both posterior lung bases.
   4. Small amount of frothy sputum observed; respiratory assessment consistent with pulmonary fluid retention.

   Answer: Productive cough with a small amount of frothy pink sputum; crackles at both posterior lung bases.

   The correct entry records sputum color, consistency, and amount, together with the location of the adventitious sounds. The other entries omit observed details or replace them with a general interpretation, making the assessment less specific.

3. At 1900, a nurse reviews documentation for a patient receiving ordered diuretic therapy for HF. Blood pressure, pulse, lung sounds, and urine output are recorded, but today's weight and fluid intake are missing. Which actions address the gaps in documenting the patient's fluid response to therapy? Select all that apply.

   1. Obtain and document today's daily weight.
   2. Use the recorded blood pressure and pulse as the fluid-response assessment without adding intake data.
   3. Add the most recent ejection fraction as the measure of the current diuretic response.
   4. Complete strict intake and output documentation by including fluid intake.
   5. Carry forward the previous weight because urine output has already been documented.

   Answer: Obtain and document today's daily weight., Complete strict intake and output documentation by including fluid intake.

   The section specifically identifies daily weights and strict intake and output as measures of response to diuretic therapy. Blood pressure and pulse provide hemodynamic information but do not complete the missing fluid-response data. An ejection fraction or a carried-forward weight does not supply today's weight or complete the intake and output record.

4. At 2300, the nurse reviews the provided laboratory profile for a patient admitted with acute left-sided HF: BNP was 500 pg/mL at 0800, 750 pg/mL at 1700, and 1500 pg/mL at 2300. Which summary best interprets this trend for the nursing assessment?

   1. BNP is rising, consistent with increased myocardial stretch and pressure; interpret the trend alongside the patient's clinical findings.
   2. BNP is rising, consistent with the slight increase associated with age; document the trend primarily as an age-related variation.
   3. BNP is rising and establishes the patient's current condition; further clinical findings are unnecessary for interpreting the response to treatment.
   4. BNP is rising, indicating hepatic congestion; interpret the trend primarily as a liver function finding.

   Answer: BNP is rising, consistent with increased myocardial stretch and pressure; interpret the trend alongside the patient's clinical findings.

   The section links rising BNP to increased myocardial stretch and pressure and directs assessment of BNP alongside clinical presentation. A slight age-related increase does not adequately explain the rapid rise shown, and BNP does not replace clinical assessment. Hepatic congestion is discussed in relation to liver function tests, not as the primary interpretation of BNP.

5. At 0800, a patient with HF could lie flat comfortably, had no cough or extremity swelling, was alert and oriented, and completed activities of daily living without breathlessness. During the 1600 reassessment, which findings should the nurse flag in the assessment note as possible worsening HF? Select all that apply.

   1. The patient now reports needing to sit upright in a recliner because lying flat makes breathing difficult.
   2. The patient remains alert and oriented at the established baseline.
   3. The patient's rings now feel tight, and new sock indentations are visible on the lower legs.
   4. The patient continues to complete activities of daily living without breathlessness.
   5. A new productive cough with frothy pink sputum is observed.

   Answer: The patient now reports needing to sit upright in a recliner because lying flat makes breathing difficult., The patient's rings now feel tight, and new sock indentations are visible on the lower legs., A new productive cough with frothy pink sputum is observed.

   New difficulty breathing while lying flat, signs of fluid retention, and frothy pink sputum are changes consistent with the section's HF manifestations. The section identifies new deviations from the previous assessment as cues to possible complications or worsening disease. Unchanged baseline mentation and continued activity without breathlessness do not represent deterioration from the morning assessment.

6. At 08:00, you review a handoff draft that labels the amount of blood ejected from the left ventricle during one systolic contraction as "cardiac output." Which revision accurately documents what the measurement represents?

   1. Keep "cardiac output" because the measurement describes blood leaving the heart.
   2. Replace "cardiac output" with "preload" because the measurement concerns ventricular blood volume.
   3. Replace "cardiac output" with "stroke volume" because the measurement describes blood ejected during a systolic contraction.
   4. Replace "cardiac output" with "afterload" because the measurement concerns ventricular contraction.

   Answer: Replace "cardiac output" with "stroke volume" because the measurement describes blood ejected during a systolic contraction.

   Stroke volume describes the amount of blood pumped from the left ventricle during systolic contraction, whereas cardiac output describes output per minute. Preload concerns initial stretch before contraction, and afterload concerns the pressure required during contraction—not the amount ejected.

7. At 10:00, you notice that a draft patient-education note uses "preload" and "afterload" interchangeably. Which replacement accurately documents the distinction taught in the section?

   1. Preload describes initial cardiac-cell stretch before contraction; afterload describes the pressure the heart must exert during ventricular contraction.
   2. Preload describes the pressure the heart must exert during ventricular contraction; afterload describes initial cardiac-cell stretch before contraction.
   3. Preload and afterload both describe cardiac-cell stretch, with preload occurring before contraction and afterload occurring during contraction.
   4. Preload and afterload both describe pressure, with preload occurring before contraction and afterload occurring during contraction.

   Answer: Preload describes initial cardiac-cell stretch before contraction; afterload describes the pressure the heart must exert during ventricular contraction.

   The correct entry distinguishes initial stretch before contraction from pressure exerted during ventricular contraction. The other entries either reverse the terms or incorrectly describe both as measurements of the same property.

8. At 13:00, a patient's teach-back reverses when the aortic and pulmonic valves open and close. You review the two phases again before completing the teaching note. Which statements accurately document the explanation provided? Select all that apply.

   1. The aortic and pulmonic valves close during ventricular filling.
   2. The aortic and pulmonic valves open during ventricular filling.
   3. The aortic and pulmonic valves close during ventricular contraction.
   4. The aortic and pulmonic valves open during ventricular contraction.
   5. The aortic and pulmonic valves alternate, with one opening while the other closes during ventricular filling.

   Answer: The aortic and pulmonic valves close during ventricular filling., The aortic and pulmonic valves open during ventricular contraction.

   Both valves close during ventricular filling and open during ventricular contraction. The other statements reverse those phases or incorrectly assign opposite actions to the two valves.

9. At 15:00, a patient says, "The sinoatrial node is the pacemaker, so nothing elsewhere in the body can influence the heart's nerve impulse." Which clarification should your follow-up teaching note record?

   1. The sinoatrial node generates an impulse; volume changes affect filling but cannot influence the nerve impulse.
   2. The sinoatrial node generates an impulse; adrenal influences, the brain, and changes in volume status can also influence it.
   3. The brain can influence the nerve impulse, but adrenal influences and changes in volume status cannot.
   4. Adrenal influences can affect the nerve impulse, but brain influences and changes in volume status cannot.

   Answer: The sinoatrial node generates an impulse; adrenal influences, the brain, and changes in volume status can also influence it.

   The section identifies the sinoatrial node as the native pacemaker while also describing adrenal, brain, and volume-status influences on the nerve impulse. Each alternative incorrectly excludes one or more of those influences.

10. At 16:30, you are completing a teaching note after reviewing myocardial electrical activity. The draft has blank spaces for the directions of sodium and potassium movement. Which statements can you insert to match the explanation in the section? Select all that apply.

    1. Sodium ions move into the myocardial cell.
    2. Potassium ions move into the myocardial cell.
    3. Both sodium and potassium ions move into the myocardial cell.
    4. Potassium ions move out of the myocardial cell.
    5. Sodium ions move out of the myocardial cell.

    Answer: Sodium ions move into the myocardial cell., Potassium ions move out of the myocardial cell.

    The section describes sodium ions going in and potassium ions going out as part of the exchanges associated with the impulse. The remaining statements reverse one ion's direction or incorrectly place both movements inward.