Review Practice Questions 1

Drugs Used to Treat Heart Failure > Pharmacology

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Practice Questions 1

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Total Questions : 3

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Question 1:

Scenario

Before treatment is started, the nurse gathers assessment data for the client and recognizes which of the following symptoms are related to this condition? Select all that apply

A. Decreased exercise tolerance B. Bradycardia C. Edema present around the ankles D. Anorexia and nausea E. Hepatomegaly F. Widening pulse pressure G. Splenomegaly H. Poor perfusion to the peripheral tissues

Answer and Explanation

Choice A:

Impaired cardiac output and poor skeletal muscle perfusion lead to significant exercise intolerance and exertional dyspnea in failure patients. The heart cannot meet the increased metabolic demands of physical activity, resulting in rapid onset of fatigue. This symptom is a hallmark of both systolic and diastolic ventricular dysfunction. It represents the functional decline associated with reduced hemodynamic reserve.

Choice B:

Heart failure typically triggers a compensatory sympathetic nervous system response, resulting in tachycardia rather than bradycardia to maintain cardiac output. A slow heart rate is usually an adverse effect of medications like beta blockers or digitalis rather than a primary symptom of the disease. Tachycardia helps compensate for a decreased stroke volume according to the CO = HR x SV equation. Bradycardia would further compromise an already failing heart.

Choice C:

Increased hydrostatic pressure in the systemic venous circulation causes fluid extravasation into the interstitium, appearing as dependent edema around the ankles. This peripheral swelling is a primary sign of right-sided heart failure and fluid volume excess. It often worsens throughout the day as gravity promotes fluid accumulation in the lower extremities. Monitoring for pitting edema is a critical nursing assessment for volume status.

Choice D:

Systemic venous congestion extends to the gastrointestinal tract, causing vascular engorgement of the stomach and intestines that results in anorexia and nausea. This congestion impairs normal digestion and leads to a feeling of fullness or abdominal discomfort. These symptoms can contribute to cardiac cachexia in advanced stages of the disease. The nurse must assess nutritional intake as an indicator of visceral congestion severity.

Choice E:

Right-sided heart failure causes backward pressure into the hepatic veins, leading to venous congestion of the liver, known as hepatomegaly or liver enlargement. The liver may become tender to palpation, and chronic congestion can eventually lead to cardiac cirrhosis or impaired hepatic function. This finding confirms the presence of systemic venous hypertension and right ventricular dysfunction. It is a classic physical sign of advanced congestive failure.

Choice F:

Clients with heart failure often exhibit a narrowed rather than a widening pulse pressure due to a significant reduction in stroke volume. A wide pulse pressure is more characteristic of conditions like aortic regurgitation or severe atherosclerosis in the elderly. In heart failure, the systolic pressure drops while diastolic pressure may rise due to vasoconstriction. This narrowing reflects the heart's inability to eject blood forcefully into the aorta.

Choice G:

While the liver is frequently enlarged due to its direct venous connection via the hepatic veins, splenomegaly is not a common or standard finding in heart failure. Spleen enlargement is more typically associated with portal hypertension from primary liver disease or hematological malignancies. Although severe right-sided failure can cause some splenic congestion, it does not routinely present as palpable splenomegaly. Hepatomegaly remains the more reliable indicator of systemic venous backup.

Choice H:

Reduced stroke volume and compensatory peripheral vasoconstriction result in poor perfusion to the skin and skeletal muscles. This manifests clinically as cool extremities, delayed capillary refill, and peripheral cyanosis in severe cases of low-output failure. The body shunts blood to vital organs, sacrificing blood flow to the distal tissues and skin. Assessing skin temperature and color provides immediate data on the adequacy of cardiac output. Rationale for incorrect answers

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Question 2:

Scenario

An elderly client with known heart failure, who has previously been stable with lisinopril and metoprolol XL, comes into the clinic with an increase in weight and peripheral edema extending halfway up the left calf.
The client in the scenario with chronic heart failure asks the nurse what else they can do besides drug therapy to control the disease process. Which statement by the nurse would be appropriate? Select all that apply

A. “You need to remain active and continue to participate in the types of exercises you have done in the past, as tolerated.” B. “The type of diet that is recommended is one with limited calories, low in fat, and low in sodium.” C. “It is important to conserve energy and avoid becoming fatigued.” D. “If you find that not being able to use salt is hard, you can use salt substitutes on a salt-restricted diet.”

Answer and Explanation

Choice A:

Physical activity helps maintain functional capacity and prevents the rapid deconditioning common in elderly cardiac patients. The nurse correctly advises the client to remain active and participate in regular exercise as tolerated by their hemodynamic status. Consistent movement improves peripheral oxygen extraction and reduces the workload on the failing myocardium during daily activities. Exercise should be paced to avoid acute symptomatic exacerbation.

Choice B:

Medical nutrition therapy focusing on sodium restriction is essential to prevent the expansion of extracellular fluid volume and worsening edema. A diet low in fat and calories helps manage metabolic demand and reduces the risk of atherosclerotic progression in chronic heart failure. Restricting sodium intake to < 2000 mg per day is a standard clinical guideline for these patients. These dietary modifications directly support the efficacy of prescribed diuretic and antihypertensive medications.

Choice C:

Myocardial efficiency is severely compromised in heart failure, necessitating careful balance between activity and rest to prevent cardiac exhaustion. The nurse emphasizes the importance of energy conservation to ensure that the patient does not reach a state of overwhelming fatigue. Avoiding excessive physical stress helps maintain a stable cardiac output and prevents acute decompensation episodes. This lifestyle adjustment is a cornerstone of self-management for chronic cardiovascular disease.Rationale for incorrect answers

Choice D:

Salt substitutes often contain high concentrations of potassium chloride, which can lead to life-threatening levels of serum potassium. Since the client is already taking lisinopril, an ACE inhibitor that causes potassium retention, adding salt substitutes increases the risk of hyperkalemia. Excessive potassium can cause cardiac standstill or lethal ventricular dysrhythmias in elderly patients with reduced renal clearance. The nurse must warn against these substitutes to maintain electrolyte homeostasis.

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Question 3:

Scenario

An elderly client with known heart failure, who has previously been stable with lisinopril and metoprolol XL, comes into the clinic with an increase in weight and peripheral edema extending halfway up the left calf.
The client asks the nurse to explain the idea of what is meant by the body’s compensatory mechanisms that occur in response to decreases in heart function. The nurse responds with which correct statement?

A. “When patients have heart failure the body compensates with an increase in energy.” B. “Patients with heart failure often have an increase in urination as a compensatory response.” C. “The body tries to compensate by increasing heart rate and blood pressure, but eventually cannot compensate leading to shortness of breath and fatigue” D. “Patients in heart failure will have an increase in their peripheral perfusion as a compensatory response.”

Answer and Explanation

Choice A:

Heart failure is characterized by a significant decrease in energy availability for cellular processes rather than an increase. The body’s metabolism is strained by the high oxygen demands of a failing heart and low systemic oxygen delivery. Patients typically experience profound lethargy and exhaustion as the cardiac output fails to meet metabolic needs. There is no biological mechanism in the failure syndrome that generates extra energy for the patient.

Choice B:

Compensation in heart failure involves the activation of the renin-angiotensin-aldosterone system, which causes fluid retention rather than increased urination. The kidneys respond to low perfusion by conserving sodium and water, which expands the intravascular volume and increases preload. Increased urination is typically a result of diuretic therapy rather than a natural compensatory response of the body. Reduced urine output or oliguria is more common as renal perfusion pressure declines during decompensation.

Choice C:

Decreased cardiac output triggers the baroreceptor reflex, which activates the sympathetic nervous system to elevate the heart rate and systemic vascular resistance. This immediate response maintains blood pressure and vital organ perfusion in the short term. However, the resulting increase in myocardial oxygen demand and afterload eventually exhausts the heart's functional reserve. Persistent activation leads to clinical decompensation, manifesting as pulmonary congestion and severe exertional fatigue. This physiological trade-off explains the transition from compensated to overt clinical heart failure.Rationale for incorrect answers

Choice D:

In heart failure, the body prioritizes blood flow to the brain and heart, leading to a decrease in peripheral perfusion to the skin and limbs. Systemic vasoconstriction shunts blood away from the periphery, causing symptoms like cool extremities and delayed capillary refill. An increase in peripheral blood flow would contradict the body's survival mechanism of maintaining central perfusion pressure. Chronic low flow to the periphery contributes to the muscle wasting seen in advanced stages.

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Practice Questions 1

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