Congestive Heart Failure (41 Questions)

1.1 Ms. Latour, 86 years old, was admitted to the medical unit at 20:00 yesterday with right lower lobe pneumonia. Her history includes heart failure and atrial fibrillation. Her level of medical intervention includes cardiopulmonary resuscitation (full code). An intermittent peripheral IV is in place for antibiotic administration.

At 10:00 the next morning, you observe the following:
*She appears anxious and agitated
*Her skin is cold and pale
*Crackles are heard bilaterally on lung auscultation
*She must pause while speaking

Vital signs:
*BP: 105/54 mmHg
*Pulse: 110 bpm, irregular
*Respiratory Rate: 28/min, shallow
*Oxygen Saturation: 85% on 2 L/min nasal cannula
*Temperature: 37.7°C

You decide to place her in a high Fowler’s position.

Question:
What is the rationale for placing Ms. Latour in high Fowler’s position? *
1.2 You plan to notify the physician, but first, you complete a thorough nursing assessment to gather all critical data.

Question:
What will you do next? *
1.3 At 11:00, an orderly urgently calls for help to Ms. Latour’s room. When you arrive, you find her unresponsive and pulseless. You immediately call a Code Blue. While the orderly begins chest compressions, you initiate 100% oxygen via a venti-mask as outlined in the collective prescription.

Question:
What will you do next? *
2.1 You are a nurse in a seniors' residence. One week ago, Mrs. Tremblay, 70 years old, was admitted due to locomotor issues and progressive loss of autonomy.

Medical History:
*Heart failure (10 years)
*Atrial fibrillation
*Beta-blocker intolerance

Medications:
*Digoxin (Lanoxin) 0.125 mg once daily at suppertime
*Ramipril (Altace) 5 mg BID (08:00 and 22:00)
*Furosemide (Lasix) 40 mg daily at 08:00
*Pravastatin (Pravachol) 40 mg at bedtime
*ASA (Aspirin) 81 mg daily at 08:00

You are about to administer Digoxin at 17:00.

Current vital signs:
*BP: 110/72 mmHg
*Pulse: 60/min, regular
*Respiratory rate: 18/min, regular and normal depth

Question:
Will you administer Mrs. Tremblay’s Lanoxin (Digoxin) based on her current status? *
2.2 Two weeks after her admission to the residence, Mrs. Tremblay, 70 years old, who has a history of heart failure and atrial fibrillation, tells you she has been feeling more breathless than usual over the past few days. She now has difficulty completing some of her activities of daily living (ADLs).

You immediately take her vital signs:
*BP: 95/55 mmHg
*Pulse: 112/min, regular
*Respirations: 22/min, regular, normal depth
*SpO₂: 95% on room air

You suspect a possible deterioration of her heart failure.

Question:
During your clinical examination of Mrs. Tremblay, which two (2) additional findings would most likely confirm a deterioration of her heart condition? *
2.3 Two days ago, her Lasix dose was increased to 80 mg daily due to signs of fluid overload.

This morning, she reports:
*Fatigue
*Loss of appetite (anorexia)
*Dizziness
*Muscle weakness
*Yellow-green visual disturbances

You review her lab results:
*Sodium (Na): 135 mmol/L (Normal: 135–145)
*Potassium (K): 3.4 mmol/L (Normal: 3.5–5.0)
*Chloride (Cl): 99 mmol/L (Normal: 100–106)
*Digoxin level: 2.6 mmol/L (Normal therapeutic range: 1.0–2.6)

Question:
Will you administer this morning’s dose of Digoxin (Lanoxin)? *
2.4 One week later, Mrs. Tremblay, age 70, has recovered well from her previous condition. She is alert, in good spirits, and playing cards in the community room of the seniors’ residence.

Suddenly, she puts a hand to her chest, becomes pale, and collapses in her chair. She is unresponsive to verbal commands and does not react to painful stimuli.
You and another staff member gently place her on her back on a firm surface.

Question:
What is your priority intervention at this moment? *
3.1 Mrs. Riendeau, 75 years old, was admitted this morning following a deterioration in her general condition.

Medical history:
*Myocardial infarction (2004)
*Chronic heart failure (since 2005)
*Weight gain of 3 kg in one week
Hemoglobin today: 70 g/L (N: 120–160 g/L)

She received one unit of blood during the day. A second unit was completed at 21:00. Between units, she received furosemide (Lasix®) 20 mg IV at 17:00.

At 22:00, you find her sitting in a chair, stating she can’t lie down due to shortness of breath.

Vital signs:
BP: 165/85 mmHg
HR: 85 bpm, regular
RR: 26/min, shallow
SpO₂: 93%
T: 36.9°C

Question:
Apart from auscultating for adventitious lung sounds, what clinical information would be most important to assess next to help identify a possible complication? *
3.2 At 22:30, Mrs. Riendeau remains seated in her chair, increasingly anxious and short of breath. You notice that she is using accessory muscles to breathe, and she must pause mid-sentence due to breathlessness.

You auscultate her lungs and hear bilateral crackles in the lower lobes. She appears pale and diaphoretic, and her SpO₂ has dropped to 88% on room air.

You review her fluid balance and note that her total intake exceeds her output by 1,100 mL in the past 24 hours.

Question:
What do you suspect is happening to Mrs. Riendeau? *
3.3 Based on your answer from the previous scenario. You administer oxygen via nasal prongs in accordance with the collective prescription in effect.

Question:
What will your next intervention be? *
4. Mr. Jean-Paul Moreau, 76 years old, has a history of chronic congestive heart failure and hypertension. He is admitted for increasing shortness of breath over the past 2 days.

Current medical orders include:
*Furosemide 40 mg IV BID
*Fluid restriction 1.5 L/day
*Low-sodium diet
*Daily weight
*Oxygen 2 L/min via nasal cannula PRN to maintain SpO₂ ≥92%

During assessment, Mr. Moreau is dyspneic at rest, with bilateral crackles at lung bases and 2+ pitting edema in both ankles. SpO₂ is 90% on room air.

Question:
What is the priority nursing action? *
5. Mme. Claire Dubois, 71 years old, has CHF with preserved ejection fraction. She is stable and preparing for discharge.

Current orders include:
*Furosemide 20 mg PO daily
*Low-sodium diet
*Daily weights

She asks why she must weigh herself every morning at home.

Question:
What is the best explanation? *
6. Mr. Luc Tremblay, 69 years old, is hospitalized for CHF exacerbation.

Orders include:
*Fluid restriction 1.5 L/day
*Furosemide 40 mg IV daily

He states, “I feel very thirsty. I don’t understand why I can’t drink more water.”

Question:
What is the most appropriate nursing response? *
7. Mme. Denise Fortin, 74 years old, with chronic CHF, reports waking at night feeling short of breath and needing to sit upright to breathe.

Orders include:
*Furosemide 20 mg PO BID
*Head of bed elevated

Question:
What does this symptom most likely indicate? *
8. Mr. André Pelletier, 66 years old, has a history of chronic congestive heart failure (reduced ejection fraction) and type 2 diabetes. He is admitted for mild fluid overload that has improved with diuretic therapy.

His current medical orders include:
*Furosemide 40 mg PO daily
*Low-sodium diet (≤2 g/day)
*Fluid restriction 1.5 L/day
*Daily weight

During discharge teaching, Mr. Pelletier states, “I don’t add salt to my food at home, so I don’t understand why I still need a low-sodium diet.” He reports frequently eating canned soups, processed meats, and restaurant meals.

Question:
What is the most appropriate nursing teaching response? *
9. Mme. Hélène Boucher, 79 years old, lives alone and has chronic congestive heart failure. She is stable and preparing for discharge.

Her medical orders include:
*Furosemide 40 mg PO daily at 08:00
*Potassium chloride 20 mEq PO daily
*Daily weight

She asks the nurse, “Wouldn’t it be better if I took my water pill in the evening so I don’t feel rushed in the morning?”

Question:
What is the best nursing response? *
11. Mme. Louise Côté, 70 years old, has NYHA class III congestive heart failure. She reports increasing fatigue with basic activities such as bathing and dressing.

Current medical orders include:
*Activity as tolerated
*Rest periods encouraged
*Furosemide 20 mg PO BID

She becomes short of breath while the nurse is assisting with morning care.

Question:
Which nursing intervention best helps manage her fatigue? *
12. Mr. Raymond Lavoie, 68 years old, has chronic congestive heart failure and is prescribed:

*Furosemide 20 mg PO daily
*Metoprolol 25 mg PO BID
*Ramipril 5 mg PO daily

During follow-up teaching, he admits, “Some days I skip my pills because I feel fine and don’t want to take too many medications.”

Question:
What is the most appropriate nursing response? *
13. Mme. Monique Girard, 75 years old, with chronic CHF, is preparing for discharge. She is prescribed:

*Furosemide 40 mg PO daily
*Fluid restriction 1.5 L/day
*Daily morning weights

She asks, “How will I know if my heart failure is getting worse?”

Question:
Which instruction is most important to include? *
14. Mr. Luc Tremblay, 69 years old, has chronic congestive heart failure with reduced ejection fraction (HFrEF). He was started on Ramipril 5 mg PO once daily two days ago. His other medications include Furosemide 40 mg PO daily and Metoprolol 25 mg PO BID.

This morning, his blood pressure is 102/64 mmHg, heart rate 72 bpm, and he reports mild dizziness when standing. Laboratory results show normal potassium and creatinine levels.

Question:
What is the most important nursing intervention at this time? *
15. Mme. Caroline Bédard, 62 years old, has stable CHF. A new order is written for Metoprolol tartrate 25 mg PO BID. She asks the nurse, “Why would I take something that slows my heart when my heart is already weak?”

Question:
What is the most appropriate explanation? *
16. Mr. Jean-Paul Roy, 75 years old, is admitted for acute CHF exacerbation with bilateral crackles and ankle edema. Orders include:

*Furosemide 40 mg IV BID
*Strict I&O
*Daily weights

After the first dose, the nurse notes urine output of 900 mL in 3 hours and decreased shortness of breath.

Question:
Which assessment finding best indicates the medication is effective? *
17. Mme. Nadia Fournier, 70 years old, with CHF is prescribed:

*Spironolactone 25 mg PO daily
*Ramipril 10 mg PO daily
*Furosemide 40 mg PO daily

Morning labs show potassium 5.6 mmol/L (3.5 to 5.0 mmol/L).

Question:
What is the nurse’s priority action? *
18. Mr. Alain Moreau, 67 years old, presents to the emergency department with shortness of breath, orthopnea, and lower-extremity edema. Orders include laboratory testing. His BNP level is 980 pg/mL (normal <100 pg/mL).

Question:
How should the nurse interpret this result? *
19. Mme. Louise Martel, 78 years old, is prescribed Digoxin 0.125 mg PO daily for CHF. She reports nausea, loss of appetite, and blurred vision with yellow halos.

Question:
What is the priority nursing action? *
20. Mr. Pierre Gauthier, 71 years old, has CHF and is taking Enalapril 10 mg PO daily. His creatinine has increased from 95 to 140 µmol/L since initiation.

Question:
What is the nurse’s most appropriate action? *
21. Mme. Julie Larose, 64 years old, with CHF and angina is prescribed Nitroglycerin transdermal patch 0.4 mg/hr daily, applied in the morning and removed at night.

Question:
What is the purpose of removing the patch at night? *
22. Mr. Denis Laflamme, 74 years old, has CHF and chronic atrial fibrillation. He is prescribed Apixaban 5 mg PO BID.

Question:
What is the primary purpose of this medication? *
23. Mme. Claire Beaulieu, 80 years old, with CHF reports persistent edema despite Furosemide 20 mg PO daily. Daily weights show a 1.8 kg increase in 3 days.

Question:
What is the nurse’s best action? *
24. Mr. Michel Boucher, 68 years old, has chronic congestive heart failure (NYHA class II) secondary to ischemic cardiomyopathy. He is hospitalized for medication adjustment and is preparing for discharge tomorrow. His current medical orders include:

*Low-sodium diet: maximum 2 g/day
*Furosemide 40 mg PO every morning
*Ramipril 10 mg PO once daily
*Daily weights
*Fluid restriction: 1.5 L/day

During discharge teaching, Mr. Boucher states that he does most of the cooking at home and adds:

“Without salt, food tastes terrible. I was thinking of using salt substitutes instead.”

Question:
What is the most appropriate nursing response? *
25. Mr. André Pelletier, 71 years old, has chronic CHF with reduced ejection fraction. He is followed in a heart failure clinic and takes:

*Furosemide 40 mg PO daily
*Metoprolol succinate 50 mg PO daily
*Sacubitril/valsartan 49/51 mg PO BID

He phones the clinic to report that over the past three days, his weight has increased from 78 kg to 80.3 kg, despite taking his medications as prescribed. He also notes mild ankle swelling.

Question:
What is the nurse’s priority action? *
26. Mme. Claire Lavoie, 66 years old, has CHF managed with Furosemide 40 mg PO daily and Bisoprolol 5 mg PO daily. During her morning assessment, she reports that she now sleeps using three pillows and wakes at night feeling short of breath.

Question:
What do these findings most likely indicate? *
27. Mr. Denis Fortin, 70 years old, with CHF attends a nutrition education session. He reviews a canned soup label indicating 480 mg of sodium per serving, with two servings per container.

Question:
What teaching should the nurse reinforce? *
28. Mme. Nathalie Gagnon, 69 years old, with CHF is discharged with a 1.5 L/day fluid restriction. She states she becomes very thirsty in the afternoon.

Question:
Which strategy should the nurse recommend? *
29. Mr. Jacques Morin, 76 years old, with CHF reports extreme fatigue when doing household chores.

Question:
What is the most appropriate nursing recommendation? *
30. Mme. Pauline Roy, 72 years old, with stable CHF asks if she should receive vaccines.

Question:
What is the nurse’s best response? *
31. Mr. Alain Dufour, 65 years old, with CHF asks if drinking wine is acceptable.

Question:
What teaching is appropriate? *
32. Mme. Louise Perron, 78 years old, with CHF is preparing for discharge education.

Question:
Which symptom requires immediate medical attention? *
33.1 You are caring for Monsieur Jean Dupont, a 72-year-old patient in the medical ward known for heart failure. He has a hemoglobin level of 87 g/L. A blood transfusion has been prescribed and is currently in progress, expected to finish in an hour. The attending physician has placed a STAT order for a coronary angiography, and the appointment has been scheduled to occur in 30 minutes.

Question:
What is the best course of action? *
33.1 After the STAT coronary angiography, performed through the left femoral artery, Monsieur Jean Dupont returns to the ward. Upon assessment, you observe a hematoma at the puncture site, and the dressing is 100% soiled with blood.

Question:
What is the appropriate nursing intervention? *