| Question |
Option A |
Option B |
Option C |
Option D |
Answer |
Rationale |
| 1. A 68-year-old patient with left-sided heart failure reports difficulty breathing when lying flat. Which term best describes this symptom? |
Orthopnea |
Dyspnea on exertion |
Paroxysmal nocturnal dyspnea |
Cheyne-Stokes respiration |
A |
Orthopnea is shortness of breath that occurs when lying flat, commonly seen in left-sided heart failure. |
| 2. A patient with heart failure is prescribed furosemide. Which electrolyte imbalance should the nurse monitor closely? |
Hyperkalemia |
Hypokalemia |
Hypercalcemia |
Hypernatremia |
B |
Furosemide increases potassium excretion, so hypokalemia is the primary concern. |
| 3. A nurse is caring for a patient with right-sided heart failure. Which assessment finding is expected? |
Crackles in the lungs |
Ascites |
Pink frothy sputum |
Pulmonary edema |
B |
Right-sided heart failure causes systemic congestion, leading to ascites, hepatomegaly, and peripheral edema. |
| 4. The nurse teaches a patient with chronic heart failure about fluid restriction. Which patient statement indicates correct understanding? |
"I should limit fluids to about 2 liters per day." |
"I can drink as much water as I want since it’s healthy." |
"I should avoid fluids completely." |
"I should drink more fluids to help my kidneys." |
A |
Patients with heart failure are typically advised to restrict fluid intake to around 2 liters per day to prevent fluid overload. |
| 5. A patient with heart failure is receiving digoxin. Which finding requires immediate nursing action? |
Heart rate of 58 bpm |
Nausea and vomiting |
Blood pressure 128/78 mmHg |
Serum potassium 4.0 mEq/L |
B |
Nausea and vomiting may indicate digoxin toxicity, requiring prompt intervention. |
| 6. A nurse assesses a patient with left-sided heart failure. Which finding is most concerning? |
Bilateral crackles in lung bases |
1+ pitting edema in ankles |
Fatigue after minimal exertion |
Nocturia |
A |
Crackles indicate pulmonary congestion, which may progress to pulmonary edema, making it the most concerning finding. |
| 7. The nurse is evaluating teaching for a patient with heart failure prescribed ACE inhibitors. Which statement indicates a need for further teaching? |
"I should rise slowly to avoid dizziness." |
"I may develop a dry cough." |
"I should stop the medication if I feel dizzy." |
"I will have my kidney function checked regularly." |
C |
Dizziness can occur due to hypotension, but the medication should not be stopped abruptly; the provider should be consulted first. |
| 8. A patient with severe heart failure has jugular vein distention, crackles, and peripheral edema. Which priority nursing intervention should the nurse implement? |
Restrict fluid intake |
Elevate legs on pillows |
Administer prescribed diuretics |
Encourage ambulation |
C |
Administering diuretics reduces fluid overload and is the priority intervention for decompensated heart failure. |
| 9. Which dietary teaching is appropriate for a patient with heart failure? |
Increase sodium to maintain fluid balance |
Limit sodium intake to less than 2 grams per day |
Eat high-sodium canned soups for energy |
Restrict potassium-rich foods |
B |
Sodium restriction to less than 2 grams per day helps reduce fluid retention and worsening of heart failure. |
| 10. A patient with decompensated heart failure is receiving IV furosemide. Which assessment finding indicates the medication is effective? |
Decreased peripheral edema |
Increased jugular vein distention |
Increased shortness of breath |
Weight gain of 1 kg in 24 hours |
A |
Diuretics help remove excess fluid, leading to decreased edema, weight loss, and improved breathing. |
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