Heart Failure

Every question here, with the answer

1. A client with heart failure calls the clinic and reports that his weight went up 3 pounds since yesterday. His breathing is unchanged. What should the nurse tell him?

   1. This gain needs to be reported to the health care provider.
   2. Skip tomorrow's weigh-in to avoid worry.
   3. Increase fluid intake to flush out extra sodium.
   4. This is expected; weigh again next week.

   Answer: This gain needs to be reported to the health care provider.

   Clients with heart failure should notify the provider if they gain 2–3 pounds in one day or 5 pounds in one week, a sign of fluid overload. Waiting, skipping weights, or drinking more fluid ignores the warning sign.

2. A nurse reviews a sodium-restricted diet with a client who has heart failure. Which food choice shows the client needs more teaching?

   1. Recording daily sodium intake
   2. Using a low-sodium recipe from the American Heart Association
   3. Canned soup for lunch
   4. Reading Nutrition Facts labels for sodium

   Answer: Canned soup for lunch

   Fast food, processed frozen meals, and canned foods all have very high sodium content, so canned soup needs more teaching. Reading labels, using low-sodium recipes, and recording sodium are all recommended.

3. A nurse is assessing a client with suspected heart failure. Which findings are associated with heart failure? Select all that apply.

   1. Exercise intolerance
   2. Slow heart rate from compensation
   3. Edema
   4. Shortness of breath
   5. Fatigue

   Answer: Exercise intolerance, Edema, Shortness of breath, Fatigue

   Symptoms of heart failure include shortness of breath, edema, exercise intolerance, and fatigue. Compensation raises the heart rate rather than slowing it, because the body increases heart rate when stroke volume falls.

4. A client asks why a brain natriuretic peptide (BNP) level was drawn for his heart. What is the nurse's best explanation?

   1. It shows whether the heart muscle is being stretched too far.
   2. It measures how much sodium is in the diet.
   3. It measures the heart's electrical rhythm.
   4. It checks kidney function only.

   Answer: It shows whether the heart muscle is being stretched too far.

   BNP is released when cardiac myocytes are stretched too far, so it shows whether the heart is under increased stretch. Rhythm is checked by an electrocardiogram and kidney function by the basic metabolic profile.

5. A nurse is teaching a client who is going home on heart failure medications. Which statements by the client show understanding? Select all that apply.

   1. "I will get up slowly from the bed or chair."
   2. "If I miss a dose, I will take it when I remember unless it is almost time for the next one."
   3. "I can stop my medication once my ankles stop swelling."
   4. "If I miss a dose, I will take a double dose next time."
   5. "I will ask my provider or pharmacist before taking an herbal supplement."

   Answer: "I will get up slowly from the bed or chair.", "If I miss a dose, I will take it when I remember unless it is almost time for the next one.", "I will ask my provider or pharmacist before taking an herbal supplement."

   Heart failure drugs can cause orthostatic hypotension, so the client changes positions slowly; OTC drugs and herbal supplements need a provider or pharmacist's approval; and a missed dose is taken when remembered unless the next dose is near. Doubling doses and stopping abruptly are both on the list of things not to do.

6. A client with heart failure has been told to avoid high-potassium foods because of one of his medications. He asks about using a salt substitute to cut sodium. What should the nurse say?

   1. Avoid most salt substitutes because they replace sodium with potassium.
   2. Salt substitutes are fine if you also eat bananas daily.
   3. Salt substitutes are the best way to reduce sodium.
   4. Use salt substitutes only with canned foods.

   Answer: Avoid most salt substitutes because they replace sodium with potassium.

   Clients on certain heart failure medications should avoid high-potassium foods such as bananas and watermelon, and salt substitutes, because most substitute potassium for sodium. The other answers add potassium or sodium the client should avoid.