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Perrin, Understanding the Essentials of Critical Care Nursing, 2/e
Chapter 7
Question 1
Type: MCSA
When teaching a patient with heart failure about ventricular remodeling, the nurse should recognize that
additional teaching is needed if the patient makes which statement? "Remodeling:
1. Leads to progressive worsening of heart function."
2. Can be described as an enlargement of the pumping chamber."
3. Occurs with an increase in blood pressure and results in weight gain."
4. Develops primarily because the heart is pumping harder."
Correct Answer: 4
Rationale 1: This is a correct statement about remodeling and no additional teaching is required.
Rationale 2: This is a correct statement about remodeling and no additional teaching is required.
Rationale 3: The long-term activation of sympathetic nervous system and the renin-angiotensin-aldosterone
system can lead to an increase in blood pressure and weight gain. This is a correct statement about remodeling and
no additional teaching is required.
Rationale 4: The heart is not pumping harder but rather the contractility or elasticity of the left ventricle is
decreased or stiffer in nature. This statement indicates more teaching is required.
Global Rationale:
Cognitive Level: Analyzing

Client Need: Physiological Integrity
Client Need Sub: Reduction of Risk Potential
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 7-1: Explain the pathophysiologic and neurohormonal mechanisms of heart failure.
Question 2
Type: MCMA
The nurse is reviewing a patient's medical history. Which factors in the history most likely contributed to the
patient's development of heart failure?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Perrin, Understanding the Essentials of Critical Care Nursing, 2/e Test Bank
Copyright 2012 by Pearson Education, Inc.
Standard Text: Select all that apply.
1. Hypertension
2. Diabetes mellitus
3. Drinking one or two alcoholic drinks daily
4. Being overweight
5. Ischemic heart disease
Correct Answer: 1,5
Rationale 1: Hypertension is identified as an etiology of heart failure.
Rationale 2: Diabetes is not a known cause of heart failure.
Rationale 3: Drinking moderately is not a known cause of heart failure.
Rationale 4: Being overweight is not a direct contributing factor to the development of heart failure.
Rationale 5: Ischemia to the heart is a known cause of heart failure.
Global Rationale:

Client Need Sub: Physiological Adaptation
Nursing/Integrated Concepts: Nursing Process: Assessment
Question 3
Type: MCSA
The nurse is assessing a patient for heart failure (HF). Which early findings would indicate decreased cardiac
output and a potential for fluid overload from heart failure?
1. Orthopnea, peripheral edema, crackles
2. Dizziness, syncope, palpitations
3. Pallor and/or cyanosis of extremities
4. PAWP of 12 and CVP of 6
Correct Answer: 1
Rationale 1: These symptoms reflect decreasing perfusion and accumulation of fluid in the pulmonary system,
which is not being effectively circulated by a failing heart.
Rationale 2: Dizziness, syncope, and palpitations are symptoms of end-organ hypoperfusion, not fluid overload.
These symptoms represent later symptoms of hypoxia from less blood being carried to distal organs, especially
the brain and the heart. The pulmonary backup of fluid occurs before the hypoxia.
Rationale 3: Pallor and/or cyanosis are seen in end-organ hypoperfusion, not a fluid overload situation. Distal
areas do not receive adequate arterial blood flow and the tissue becomes hypoxic quickly, which causes the pallor
or cyanosis from venous stasis.
Rationale 4: Pulmonary arterial wedge pressure and central venous pressure would increase with fluid overload
because the pressure of additional fluids must be overcome to circulate the blood.
Global Rationale:

Learning Outcome: 7-3: Differentiate between the manifestations of left- and right-sided heart failure.
Question 4
Type: MCSA
Which assessment finding indicates that a patient's heart failure (HF) is worsening?
1. An increase in O2 saturation to greater than 90%
2. A decrease in heart rate to 66 bpm
3. The onset of atrial fibrillation
4. Louder S1 and S2 heart sounds
Correct Answer: 3
Rationale 1: Oxygenation saturations will decline to less than 90% and not increase to more than 90%. Declining
O2 saturation levels reflect deteriorating pulmonary status from a buildup of fluids with pulmonary edema.
Rationale 2: Tachycardia increases to compensate for the decreasing O2 levels by trying to circulate what cells
are present, but at the same time increases the O2 demand by increased cardiac functioning.
Rationale 3: As heart failure continues to progress, less oxygenation occurs all over the body, especially the
myocardium, which is sensitive to the hypoxia and will result in dysrhythmias such as ventricular ectopy or atrial
fibrillation.
Rationale 4: The S1 and S2 sounds remain the same.
Global Rationale:

Question 5
Type: MCSA
A patient is very short of breath. Which finding should cause the nurse to be concerned that the shortness of
breath might be due to heart failure?
1. An echocardiogram that reflected increased right ventricular wall thickening
2. A B-type natriuretic peptide (BNP) of 300 pg/mL
3. A left ventricular ejection fraction (VEF) of 50%
4. A serum sodium of 135
Correct Answer: 2
Rationale 1: Echocardiogram would reflect left ventricular hypertrophy, not right ventricular enlargement.
Rationale 2: A BNP greater than 100 pg/mL suggests heart failure as a cause of dyspnea.
Rationale 3: Many patients with heart failure will have a reduced ejection fraction of less than 40%.
Rationale 4: Hyponatremia is commonly found in the patient with heart failure.
Global Rationale:

Learning Outcome: 7-4: Describe the hemodynamic findings indicative of heart failure
Question 6
Type: MCSA
Which finding would support the diagnosis of heart failure (HF)?

1. RA/CVP of 8 mm Hg
2. PAWP of 20 mm Hg
3. Cardiac index of 3
4. Peripheral vasodilation reflected by normalizing capillary refill times
Correct Answer: 2
Rationale 1: The RA/CVP are increased with rising pressures to push through the inadequate pumping that occurs
with heart failure from systemic venous pressure elevations from ascites and peripheral edema.
Rationale 2: With heart failure the backup of fluid from inadequate pumping results in increased PAWP because
the heart has to pump harder to push through the rising capillary pressures on the venous side from peripheral
edema and ascites.
Rationale 3: Cardiac output is decreased with heart failure because the preload volume continues to rise with a
less efficient pump to remove the blood.
Rationale 4: Peripheral vasoconstriction occurs and capillary refills are sluggish and delayed.
Global Rationale:

Learning Outcome: 7-4: Describe the hemodynamic findings indicative of heart failure.
Question 7
Type: MCSA
After teaching a patient with heart failure about beta blocking agents, the nurse recognizes that additional teaching
is needed when the patient states, "While taking the medication, I will:
1. Weigh myself every day."
2. Check my blood sugar regularly."
3. Notify my health care provider if I become increasingly short of breath."
4. Monitor myself daily for an increased heart rate and blood pressure."
Correct Answer: 4
Rationale 1: This is a correct statement that does not require additional instruction.
Rationale 4: Beta blocking agents will decrease the heart rate and blood pressure. This statement indicates that
additional teaching is needed.
Global Rationale:

Client Need Sub: Pharmacological and Parenteral Therapies
Learning Outcome: 7-5: Explain collaborative management of the patient with heart failure.
Question 8
Type: MCSA
The nurse should explain to a patient in heart failure that an aldosterone antagonist works by:
1. Reducing sodium and water retention
2. Filtering potassium out with the water in the renal tubules
3. Promoting the excretion of the urinary waste products urea and creatinine
4. Retaining calcium to improve the condition of blood vessels in the glomeruli
Correct Answer: 1
Rationale 1: An aldosterone antagonist removes water through the excretion of sodium and water through the
renal tubules.
Rationale 2: This is not the mechanism of an aldosterone antagonist.
Global Rationale:
Cognitive Level: Applying

Nursing/Integrated Concepts: Nursing Process: Implementation
Question 9
Type: MCSA
What would the nurse not expect to find in a patient who was experiencing acute decompensated heart failure
with pulmonary edema?
1. Dyspnea at rest, peripheral edema
2. Hypertension, bradycardia
3. Increased coughing, crackles
4. Decreased O2 saturation, increased PAWP
Correct Answer: 2
Rationale 1: These are symptoms of acute decompensated heart failure with pulmonary edema.
Rationale 2: Hypertension and bradycardia are not symptoms of pulmonary edema.
Rationale 3: Fluid can be heard on chest auscultation and coughing will increase when attempting to try to clear
the passageways of the backed-up fluid.
Rationale 4: Due to fluid in the capillary beds, less perfusion and ventilation occur, which lead to hypoxia and
increased pressures in the pulmonary artery.
Global Rationale:

Learning Outcome: 7-6: Describe the patient with acute decompensated heart failure.
Question 10
Type: MCSA
A patient in heart failure is to be started on an infusion of dobutamine (Dobutrex). What is most important for the
nurse to assess before starting the infusion? The patient's:
1. Breath sounds
2. Blood pressure
3. Level of consciousness
4. Urine output
Correct Answer: 2
Rationale 1: Breath sounds are not the most important for the nurse to assess before starting this infusion.
Rationale 2: Prior to initiation, before each titration, and at the peak action of dobutamine, the nurse must assess
blood pressure, heart rate, respiratory rate, and oxygen saturation. Frequent assessment of these parameters should
continue throughout the infusion period.
Rationale 3: Level of consciousness is not the most important for the nurse to assess before starting this infusion.
Rationale 4: Urine output is not the most important for the nurse to assess before starting this infusion.
Global Rationale:

Learning Outcome: 7-7: Describe collaborative management strategies appropriate for the patient with acute
decompensated heart failure.
Question 11
Type: MCSA
A patient in heart failure is being given a first dose of lisinopril (Prinivil) 10 mg PO. Which finding would cause
the nurse to question the administration of the first dose?
1. Heart rate 92 beats per minute
2. Blood pressure 100/72
3. Potassium 5.7 mEq/dL
4. Urine output 35 mL/hr
Correct Answer: 3
Rationale 1: This would not cause the nurse to question the first dose of the medication.
Rationale 3: Ace inhibitors increase the serum potassium and a further increase from 5.7 could be problematic so
the nurse should question the administration of this medication.
Global Rationale:

Nursing/Integrated Concepts: Nursing Process: Planning
Question 12
Type: MCMA
An 82-year-old patient is readmitted for heart failure (HF) 1 week after being discharged for the same diagnosis.
Which findings most likely contributed to the patient’s readmission?
1. Not knowing how or when to take medications
2. Not prescribed appropriate medications, including ACE inhibitors and beta blockers
3. No record of body weight since discharge
4. Not filling prescribed medications
5. Received the pneumococcal immunization during the last hospitalization
Correct Answer: 1,2,3,4
Rationale 1: Some studies indicate that older patients with heart failure have poor knowledge of appropriate
medication management.
Rationale 2: There is evidence that a significant number of older adults with heart failure do not receive
evidence-based, AHA-recommended care including angiotensin-converting enzymes (ACE) inhibitors and beta
blockers.
Rationale 3: Patient records indicate that daily weights are not consistently obtained.
Rationale 4: Pharmacy records indicate that prescriptions are not promptly refilled.
Rationale 5: Pneumococcal immunization is recommended and would not contribute to a readmission for the
diagnosis of heart failure.
Global Rationale:
Question 13
Type: MCSA
The nurse is caring for a patient with acute decompensated heart failure (HF) receiving BiPAP. While caring for
this patient, the nurse’s priority will be to:
1. Monitor the expiratory time to be sure that it always exceeds the inspiratory time.
2. Ensure that the mask does not fit too tightly on the patient's face to prevent skin breakdown.
3. Prepare for endotracheal intubation because BiPAP is used primarily to buy time for intubation.
4. Assess the patient for the development of gastric distention, nausea, and vomiting.
Correct Answer: 4
Rationale 1: This is not something that the nurse needs to monitor for the patient receiving BiPAP.
Rationale 2: Although important, this is not a priority for the nurse when caring for the patient receiving BiPAP.
Rationale 3: BiPAP provides end-expiratory pressure, further decreasing the work of breathing. It is not used
primarily to buy time for intubation.
Rationale 4: The nurse must assess the patient for complications resulting from this delivery method to include
gastric distention, nausea, vomiting, and aspiration.
Global Rationale:

Question 14
Type: MCSA
What is the most appropriate position for a patient in pulmonary edema with a blood pressure of 194/92?
1. Sitting upright with legs dependent
2. Dorsal recumbent
3. Head of the bed elevated 60 degrees
4. Torso flat, feet elevated
Correct Answer: 1
Rationale 1: A patient with a blood pressure of 194/92 is able to sit upright. Sitting upright with legs dependent
allows the patient to breathe more comfortably and prevents fluid from accumulating as easily in the lungs.
Rationale 2: This position would not aid with respiratory effort.
Rationale 3: Fluid still may accumulate in the lungs with the patient in this position.
Rationale 4: This position will encourage the accumulation of fluid in the patient’s lungs and increase dyspnea.
Global Rationale:

Question 15
Type: MCSA
The nurse notes that the QRS duration of a patient with a biventricular pacemaker is widening? What does this
most likely indicate?
1. Worsening of the patient's underlying cardiomyopathy
2. Loss of ventricular capture
3. Loss of ventricular synchronization
4. Battery failure
Correct Answer: 3
Rationale 1: This is not an indication that the patient’s underlying condition is getting worse.
Rationale 2: This does not indicate loss of ventricular capture.

Rationale 3: Widening of the QRS duration from the baseline may indicate a loss of ventricular synchronization.
Rationale 4: This does not indicate battery failure.
Global Rationale:

Question 16
Type: MCSA
A patient with heart failure has a decreasing cardiac output. The nurse will expect compensatory mechanisms to
be activated in order to:
1. Decrease the heart rate
2. Maintain perfusion to vital organs
3. Cause arteriolar vasodilation in nonessential vascular beds
4. Inhibit the release of aldosterone
Correct Answer: 2
Rationale 1: Compensatory mechanisms will increase the heart rate.
Rationale 2: As the heart function fails and cardiac output decreases, compensatory mechanisms are activated to
maintain perfusion to the vital organs.
Rationale 3: Compensatory mechanisms will cause arteriolar vasoconstriction in nonessential vascular beds.
Rationale 4: Compensatory mechanisms will lead to the release of aldosterone.
Global Rationale:

Question 17
Type: MCMA
While caring for a patient in heart failure, the nurse assesses an elevated blood pressure and significant peripheral
edema. These symptoms are caused by the renin-angiotensin-aldosterone system which:
1. Releases angiotensin II
2. Releases aldosterone
3. Decreases cardiac output
4. Decreases heart rate
5. Causes arteriolar vasodilation
Correct Answer: 1,2
Rationale 1: Activation of the renin-angiotensin-aldosterone system increases vasoconstriction through the

release of angiotensin II, a potent vasoconstrictor.
Rationale 2: Activation of the renin-angiotensin-aldosterone system increases water and sodium reabsorption
through the release of aldosterone.
Rationale 3: Activation of the renin-angiotensin-aldosterone system does not decrease cardiac output.
Rationale 4: Activation of the renin-angiotensin-aldosterone system does not decrease heart rate.
Rationale 5: Activation of the renin-angiotensin-aldosterone system does not cause arteriolar vasodilation.
Global Rationale:

Question 18
Type: MCMA
A patient is diagnosed with left-sided heart failure. When describing this disease process to the patient, the nurse
will include:
1. Pumping action of the heart is impaired.
2. Filling action of the heart is impaired.
3. Blood backs up in the left side of the heart.
4. Extra fluid can build up in the lungs.
5. Extra fluid can build up in the lower extremities.
Rationale 1: In left-sided heart failure, the pumping action or systolic action of the left ventricle is impaired.
Rationale 2: In left-sided heart failure, the ability of the left ventricle to fill or diastolic action of the left ventricle
is impaired.
Rationale 3: In left-sided heart failure, blood backs up from the left ventricle to the left atrium.
Rationale 4: In left-sided heart failure, fluid eventually builds up in the lungs.
Rationale 5: Extra fluid does not build up in the lower extremities in left-sided heart failure.
Global Rationale:

Learning Outcome: 7-2: Compare and contrast systolic and diastolic dysfunction.
Question 19
Type: MCMA
A patient is diagnosed with diastolic heart failure. The nurse realizes this type of heart failure is caused by:

1. Normal sized but hypertrophied left ventricle
2. Blood backing up into the right atrium
3. Loss of ventricular diastolic relaxation
4. Blood backing up into the left atrium
5. Excessive fluid in the lower extremities
Correct Answer: 1,2,3
Rationale 1: Diastolic dysfunction occurs when the ventricle is normal sized by hypertrophied.
Rationale 2: In diastolic heart failure, blood backs up from the right ventricle to the right atrium.
Rationale 3: In diastolic heart failure there is a loss of left ventricular diastolic relaxation.
Rationale 4: Blood does not back up into the left atrium in diastolic heart failure.
Rationale 5: Excessive fluid in the lower extremities does not cause diastolic heart failure.
Global Rationale:

Learning Outcome: 7-2: Compare and contrast systolic and diastolic dysfunction.
Question 20
Type: MCMA
Which finding would cause the nurse to suspect a patient with heart failure was experiencing end organ
hypoperfusion?
1. Confusion
2. Dropping blood pressure
3. Urine output 15 mL per hour
4. Heart rate 124
5. Peripheral edema
Rationale 1: Confusion is a manifestation of end organ hypoperfusion.
Rationale 2: Hypotension is a manifestation of end organ hypoperfusion.
Rationale 3: Decreased urinary output is a manifestation of end organ hypoperfusion.
Rationale 4: Tachycardia is a manifestation of end organ hypoperfusion.
Rationale 5: Peripheral edema is a manifestation of volume overload.
Global Rationale:

Question 21
Type: MCMA
While transferring a patient with heart failure from the bed to a chair the nurse stops and decides to keep the
patient in bed. What patient manifestations indicated to the nurse this patient’s status was deteriorating?
1. Respiratory rate 30
2. Heart rate 134 on the cardiac monitor
3. Gasping for breath
4. Productive cough
5. Jugular vein distention
Rationale 1: Tachypnea is an indication of worsening heart failure.
Rationale 2: Tachycardia is an indication of worsening heart failure.
Rationale 3: Dyspnea is an indication of worsening heart failure.
Rationale 4: A productive cough is not an indication that the heart failure is becoming worse.
Rationale 5: Jugular vein distention is not an indication that the heart failure is becoming worse.
Global Rationale:

Question 22
Type: MCSA
The central venous pressure of a patient with heart failure is slowly increasing. What does this finding suggest to
the nurse?
1. Right heart function is deteriorating.
2. Left heart function is deteriorating.
3. Fluid is backing up in the lungs.
4. Right heart function is improving.
Correct Answer: 1
Rationale 1: Elevations in right filling pressures, such as the central venous pressure, can cause systemic venous
pressure elevations leading to peripheral edema and ascites. These are symptoms of right heart failure.
Rationale 2: Elevated central venous pressure is not an indication of left heart function.
Rationale 3: An elevated central venous pressure does not assess left heart function.
Rationale 4: An elevated central venous pressure would indicate that right heart function is deteriorating and not
improving.
Global Rationale:

Question 23
Type: MCSA
A patient with heart failure begins to cough pink frothy sputum. Which pressure would the nurse assess to
confirm this manifestation?
1. Central venous pressure
2. Pulmonary capillary wedge pressure
3. Arterial pressure
4. Right arterial pressure
Correct Answer: 2
Rationale 1: Central venous pressure would not be used to confirm the patient’s symptom.
Rationale 2: The pulmonary capillary wedge pressure would be elevated in pulmonary edema. This is the
pressure that the nurse would assess to confirm the patient’s symptom.
Rationale 3: The arterial pressure would not be used to confirm the patient’s symptom.
Rationale 4: The right arterial pressure would not be used to confirm the patient’s symptom.
Global Rationale:

Question 24
Type: MCMA
The nurse is teaching a patient with heart failure nonpharmacological strategies to improve quality of life. What
will be included in these instructions?
1. Importance of smoking cessation
2. Reduce salt intake to 1 gram per day
3. Restrict caloric intake to attain recommended body weight
4. Attend cardiac rehabilitation sessions as prescribed
5. Ingest no more than three alcoholic drinks per day
Rationale 1: One nonpharmacological strategy to improve the quality of life in a patient with heart failure is to
stop smoking.
Rationale 2: Salt intake should be restricted to 2 to 3 grams per day.
Rationale 3: Weight reduction in obese patients is a nonpharmacological strategy to improve the quality of life in
the patient with heart failure.
Rationale 4: One nonpharmacological strategy to improve the quality of life in the patient with heart failure is to
attend cardiac rehabilitation.
Rationale 5: To improve the quality of life in patients with heart failure, alcohol intake should be restricted.
Global Rationale:

Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Teaching and Learning
Question 25
Type: MCMA
A patient a history of type 2 diabetes mellitus and heart failure is prescribed carvedilol (Coreg). What will the
nurse assess prior to administering this medication to the patient?
1. Blood pressure
2. Pulse
3. Blood glucose level
4. Lung sounds
5. Potassium level
Rationale 1: Prior to administering a beta blocker, the nurse should assess the patient’s blood pressure to ensure it
is adequate.
Rationale 2: Prior to administering a beta blocker, the nurse should assess the patient’s pulse to ensure it is
adequate.
Rationale 3: The blood glucose level should be monitored in the patient with diabetes because a beta blocker can
worsen glucose control and blunt symptoms of hypoglycemia.
Rationale 4: Lung sounds should be assessed in the patient with asthma and COPD prior to administering a beta
block because of bronchoconstriction effects. The patient does not have asthma or COPD.
Rationale 5: The potassium level does not need to be assessed prior to administering a beta blocker to the patient.
Global Rationale:

Question 26
Type: MCMA
What findings identified by the nurse on an assessment of a patient being treated for heart failure would cause the
nurse to notify the patient’s health care provider that the patient’s status was deteriorating?
1. S3 and S4 heart sounds
2. Oxygen saturation 80% on 4 liters oxygen nasal cannula
3. Urine output 10 mL over the last hour
4. Onset of production cough
5. Weight loss of 3 lbs from previous weight
Rationale 1: S3 and S4 heart sounds indicate the patient’s cardiac status is deteriorating.
Rationale 2: Reduced oxygen saturation is an indication that the patient’s pulmonary status is deteriorating.
Rationale 3: Poor urine output is an indication that the patient’s systemic status is deteriorating.
Rationale 4: Worsening cough is an indication that the patient’s pulmonary status is deteriorating.
Rationale 5: Weight loss is not an indication that the patient’s health status is deteriorating.
Global Rationale:

Question 27
Type: MCSA
A patient with heart failure is experiencing increased fatigue and has a weight gain of 1 kg. The nurse realizes this
patient is demonstrating signs of:
1. Systemic deterioration
2. Pulmonary deterioration
3. Cardiac deterioration
4. Renal deterioration
Correct Answer: 1
Rationale 1: Signs of systemic deterioration include weight gain and fatigue.
Rationale 2: Weight gain and fatigue are not signs of pulmonary deterioration.
Rationale 3: Weight gain and fatigue are not signs of cardiac deterioration.
Rationale 4: The renal status is not specifically assessed in the patient with heart failure.
Global Rationale:

Question 28
Type: MCMA
The nurse is preparing medications for the patient experiencing acute decompensated heart failure. Which
medications will be administered first to improve gas exchange for the patient?
1. Morphine sulfate
2. Nitroglycerin
3. Nesiritide (Natrecor)
4. Dobutamine (Dobutrex)
5. Milrinone (Primacor)
Correct Answer: 1,2
Rationale 1: This medication is used to reduce patient anxiety during acute decompensated heart failure.
Rationale 2: This medication is used to reduce preload and pulmonary wedge pressure.
Rationale 3: This medication is used for the patient with acute decompensated heart failure who has dyspnea at
rest and is not a medication that would be provided first.
Rationale 4: This medication is used to treat cardiogenic shock.
Rationale 5: This medication is used to treat cardiogenic shock.
Global Rationale:
Question 29
Type: MCMA
A patient has been receiving milrinone (Primacor) for cardiogenic shock from acute decompensated heart failure.
What findings indicate that this medication has been effective in the patient?
1. Increased cardiac output
2. Reduced pulmonary arterial wedge pressure
3. Dropping blood pressure
4. Onset of ventricular dysrhythmias
5. Respiratory rate 28 and regular
Correct Answer: 1,2
Rationale 1: An expected action of this medication is an increase in cardiac output.
Rationale 2: An expected action of this medication is a decrease in pulmonary arterial wedge pressure.
Rationale 3: Hypotension is a side effect of this medication and does not necessarily indicate that the medication
has been effective in the patient.
Rationale 4: Ventricular dysrhythmias are side effects of this medication and do not necessarily indicate that the
medication has been effective in the patient.
Rationale 5: This medication does not affect respiratory rate.
Global Rationale:

Question 30
Type: MCSA
A patient with heart failure is scheduled for an echocardiogram and cardiac catheterization. The nurse would
document that these diagnostic tests fulfill which heart failure core measure?
1. Evaluation of LVS
2. Discharge education
3. ACE-I or ARB for LVSD
4. Adult smoking cessation advice/counseling
Correct Answer: 1
Rationale 1: To fulfill this measure, the patient will have had left ventricular systolic function evaluated through
the use of an echocardiogram or cardiac catheterization before hospitalization, during hospitalization, or is
planned for after discharge.
Rationale 2: Tests to assess left ventricular systolic function are not included in the discharge education measure.
Rationale 3: Tests to assess left ventricular systolic function are not included in the ACE-I or ARB for LVSD
measure.
Rationale 4: Tests to assess left ventricular systolic function are not included in the adult smoking cessation
advice/counseling measure.
Global Rationale:

Nursing/Integrated Concepts: Communication and Documentation
Learning Outcome: 7-8: Define the core measures for heart failure management.
Question 31
Type: MCSA
The nurse is preparing adult smoking cessation material for a patient admitted with heart failure. What criteria did
the nurse use to determine that the patient should receive this material?
1. Patient smoked cigarettes any time during the last year prior to hospitalization
2. Patient uses chewing tobacco
3. Patient smokes five cigars a week
4. Patient stopped smoking five years prior to hospitalization
Correct Answer: 1
Rationale 1: For the Adult Smoking Cessation Advice/Counseling heart failure core measure, a smoker is defined
as someone who has smoked cigarettes anytime during the year prior to hospital arrival.
Rationale 2: The use of chewing tobacco is not included in the criteria for the Adult Smoking Cessation
Advice/Counseling for heart failure core measure.
Rationale 3: Smoking cigars is not included in the criteria for the Adult Smoking Cessation Advice/Counseling
for heart failure core measure.
Rationale 4: This is not the definition of a smoker for the Adult Smoking Cessation Advice/Counseling for heart
failure core measure.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Question 32
Type: MCMA
The nurse is preparing discharge instructions for a patient admitted with heart failure. What will the nurse include
in this teaching?
1. Permitted activity level
2. Diet
3. Prescribed medications
4. Importance of daily weight monitoring
5. Stress reduction strategies
Rationale 1: Permitted activity level should be included in discharge education for the patient with heart failure.
Rationale 2: Diet should be included in discharge education for the patient with heart failure.
Rationale 3: Medications should be included in discharge education for the patient with heart failure.
Rationale 4: Weight monitoring should be included in discharge education for the patient with heart failure.
Rationale 5: Stress reduction strategies are not identified as part of discharge education for the patient with heart
failure.
Global Rationale:

Client Need Sub:
Nursing/Integrated Concepts: Teaching and Learning
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no related content on Scribd:
7. Grundtvig, followed by Edzardi, thinks a line has been lost
between lines 3 and 4. [198]
9. Concerning the blind Hoth, who, at Loki’s instigation, cast the fatal
mistletoe at Baldr, cf. Voluspo, 32–33 and notes. In the manuscript
the last line is abbreviated, as also in stanza 11.
10. In the manuscript lines 1–2 are abbreviated, as also in stanza 12.
11. Rind: mentioned by Snorri as one of the goddesses. Concerning

her son Vali, begotten by Othin for the express purpose of avenging
Baldr’s death, and his slaying of Hoth the day after his birth, cf.
Voluspo, 33–34, where the lines of this stanza appear practically
verbatim. Vestrsalir (“The Western Hall”): not elsewhere mentioned
in the poems. [199]
12. The manuscript marks the third line as the beginning of a stanza;
something may have been lost. Lines 3–4 are thoroughly obscure.
According to Bugge the maidens who are to weep for Baldr are the
daughters of the sea-god Ægir, the waves, whose grief will be so
tempestuous that they will toss the ships up to the very sky. “Yards of
the sails” is a doubtfully accurate rendering; the two words, at any
rate in later Norse nautical speech, meant respectively the “tack” and
the “sheet” of the square sail.
13. Possibly two separate stanzas. Enchanter: the meaning of the

original word is most uncertain. [200]
14. Concerning Loki’s escape and his relation to the destruction of

the gods, cf. Voluspo, 35 and 51, and notes. While the wise-woman
probably means only that she will never speak again till the end of
the world, it has been suggested, and is certainly possible, that she
intends to give Loki her counsel, thus revenging herself on Othin.
[201]
[Contents]
RIGSTHULA
The Song of Rig
[Contents]
Introductory Note
The Rigsthula is found in neither of the principal codices. The only
manuscript containing it is the so-called Codex Wormanius, a
manuscript of Snorri’s Prose Edda. The poem appears on the last
sheet of this manuscript, which unluckily is incomplete, and thus the
end of the poem is lacking. In the Codex Wormanius itself the poem
has no title, but a fragmentary parchment included with it calls the
poem the Rigsthula. Some late paper manuscripts give it the title of
Rigsmol.
The Rigsthula is essentially unlike anything else which editors have

agreed to include in the so-called Edda. It is a definitely cultural
poem, explaining, on a mythological basis, the origin of the different
castes of early society: the thralls, the peasants, and the warriors.
From the warriors, finally, springs one who is destined to become a
king, and thus the whole poem is a song in praise of the royal estate.
This fact in itself would suffice to indicate that the Rigsthula was not
composed in Iceland, where for centuries kings were regarded with
profound disapproval.
Not only does the Rigsthula praise royalty, but it has many of the
earmarks of a poem composed in praise of a particular king. The
manuscript breaks off at a most exasperating point, just as the
connection between the mythical “Young Kon” (Konr ungr, konungr,
“king”; but cf. stanza 44, note) and the monarch in question is about
to be established. Owing to the character of the Norse settlements in
Iceland, Ireland, and the western islands generally, search for a
specific king leads back to either Norway or Denmark; despite the
arguments advanced by Edzardi, Vigfusson, Powell, and others, it
seems most improbable that such a poem should have been
produced elsewhere than on the Continent, the region where
Scandinavian royalty most flourished. Finnur Jonsson’s claim for
Norway, with Harald the Fair-Haired as the probable king in question,
is much less impressive than Mogk’s ingenious demonstration that
the poem was in all probability composed in Denmark, in honor of
either Gorm the Old or Harald Blue-Tooth. His proof is based chiefly
on the evidence provided by stanza 49, and is summarized in the
note to that stanza. [202]
The poet, however, was certainly not a Dane, but probably a

wandering Norse singer, who may have had a dozen homes, and
who clearly had spent much time in some part of the western island
world chiefly inhabited by Celts. The extent of Celtic influence on the
Eddic poems in general is a matter of sharp dispute. Powell, for
example, claims almost all the poems for the “Western Isles,” and
attributes nearly all their good qualities to Celtic influence. Without
here attempting to enter into the details of the argument, it may be
said that the weight of authoritative opinion, while clearly recognizing
the marks of Celtic influence in the poems, is against this view;
contact between the roving Norsemen of Norway and Iceland and
the Celts of Ireland and the “Western Isles,” and particularly the
Orkneys, was so extensive as to make the presumption of an actual
Celtic home for the poems seem quite unnecessary.
In the case of the Rigsthula the poet unquestionably had not only
picked up bits of the Celtic speech (the name Rig itself is almost
certainly of Celtic origin, and there are various other Celtic words
employed), but also had caught something of the Celtic literary spirit.
This explains the cultural nature of the poem, quite foreign to Norse
poetry in general. On the other hand, the style as a whole is
vigorously Norse, and thus the explanation that the poem was
composed by an itinerant Norse poet who had lived for some time in
the Celtic islands, and who was on a visit to the court of a Danish
king, fits the ascertainable facts exceedingly well. As Christianity was
introduced into Denmark around 960, the Rigsthula is not likely to
have been composed much after that date, and probably belongs to
the first half of the tenth century. Gorm the Old died about the year
935, and was succeeded by Harald Blue-Tooth, who died about 985.
The fourteenth (or late thirteenth) century annotator identifies Rig

with Heimdall, but there is nothing in the poem itself, and very little
anywhere else, to warrant this, and it seems likely that the poet had
Othin, and not Heimdall, in mind, his purpose being to trace the
origin of the royal estate to the chief of the gods. The evidence
bearing on this identification is briefly summed up in the note on the
introductory prose passage, but the question involves complex and
baffling problems in mythology, and from very early times the status
of Heimdall was unquestionably confusing to the Norse mind.
[Contents]
[203]
They tell in old stories that one of the gods, whose

name was Heimdall, went on his way along a certain
seashore, and came to a dwelling, where he called
himself Rig. According to these stories is the
following poem:
1. Men say there went | by ways so green

Of old the god, | the aged and wise,
Mighty and strong | did Rig go striding.
. . . . . . . . | . . . . . . . .
[204]
2. Forward he went | on the midmost way,

He came to a dwelling, | a door on its posts;
In did he fare, | on the floor was a fire,
Two hoary ones | by the hearth there sat,
Ai and Edda, | in olden dress.
3. Rig knew well | wise words to speak,

Soon in the midst | of the room he sat,
And on either side | the others were.
4. A loaf of bread | did Edda bring,

Heavy and thick | and swollen with husks;
Forth on the table | she set the fare,
And broth for the meal | in a bowl there was.
(Calf’s flesh boiled | was the best of the dainties.)

Thence did he rise, | made ready to sleep;
Soon in the bed | himself did he lay,
[205]
6. Thus was he there | for three nights long,

Then forward he went | on the midmost way,
And so nine months | were soon passed by.
7. A son bore Edda, | with water they sprinkled

him,
With a cloth his hair | so black they covered;
Thræll they named him, | . . . . . . . .
8. The skin was wrinkled | and rough on his hands,

Knotted his knuckles, | . . . . . . . .
Thick his fingers, | and ugly his face,
Twisted his back, | and big his heels.
9. He began to grow, | and to gain in strength,

Soon of his might | good use he made; [206]
With bast he bound, | and burdens carried,
Home bore faggots | the whole day long.
10. One came to their home, | crooked her legs,

Stained were her feet, | and sunburned her arms,
Flat was her nose; | her name was Thir.
11. Soon in the midst | of the room she sat,

By her side there sat | the son of the house;
They whispered both, | and the bed made ready,
Thræll and Thir, | till the day was through.
12. Children they had, | they lived and were happy,

Fjosnir and Klur | they were called, methinks,
Hreim and Kleggi, | Kefsir, Fulnir,
Drumb, Digraldi, | Drott and Leggjaldi,
Lut and Hosvir; | the house they cared for,
Ground they dunged, | and swine they guarded,
Goats they tended, | and turf they dug.
[207]
13. Daughters had they, | Drumba and Kumba,

Ökkvinkalfa, | Arinnefja,
Ysja and Ambott, | Eikintjasna,
Totrughypja | and Tronubeina;
And thence has risen | the race of thralls.
14. Forward went Rig, | his road was straight,

To a hall he came, | and a door there hung;
In did he fare, | on the floor was a fire:
Afi and Amma | owned the house.
15. There sat the twain, | and worked at their

tasks:
The man hewed wood | for the weaver’s beam;
His beard was trimmed, | o’er his brow a curl,
His clothes fitted close; | in the corner a chest.
16. The woman sat | and the distaff wielded,

At the weaving with arms | outstretched she
worked;
On her head was a band, | on her breast a smock;
On her shoulders a kerchief | with clasps there
was.
[208]

18. Then took Amma | . . . . . . . .

The vessels full | with the fare she set,
Calf’s flesh boiled | was the best of the dainties.

He rose from the board, | made ready to sleep;
Soon in the bed | himself did he lay,

21. A son bore Amma, | with water they sprinkled

him,
Karl they named him; | in a cloth she wrapped him,
He was ruddy of face, | and flashing his eyes.
[209]
22. He began to grow, | and to gain in strength,

Oxen he ruled, | and plows made ready,
Houses he built, | and barns he fashioned,
Carts he made, | and the plow he managed.
23. Home did they bring | the bride for Karl,

In goatskins clad, | and keys she bore;
Snör was her name, | ’neath the veil she sat;
A home they made ready, | and rings exchanged,
The bed they decked, | and a dwelling made.
24. Sons they had, | they lived and were happy:

Hal and Dreng, | Holth, Thegn and Smith,
Breith and Bondi, | Bundinskeggi,
Bui and Boddi, | Brattskegg and Segg.
[210]
25. Daughters they had, | and their names are

here:
Snot, Bruth, Svanni, | Svarri, Sprakki,
Fljoth, Sprund and Vif, | Feima, Ristil:
And thence has risen | the yeomen’s race.
26. Thence went Rig, | his road was straight,

A hall he saw, | the doors faced south;
The portal stood wide, | on the posts was a ring,
Then in he fared; | the floor was strewn.
27. Within two gazed | in each other’s eyes,

Fathir and Mothir, | and played with their fingers;
There sat the house-lord, | wound strings for the
bow,
Shafts he fashioned, | and bows he shaped.
28. The lady sat, | at her arms she looked,

She smoothed the cloth, | and fitted the sleeves;
Gay was her cap, | on her breast were clasps,
Broad was her train, | of blue was her gown, [211]
Her brows were bright, | her breast was shining,
Whiter her neck | than new-fallen snow.

30. Then Mothir brought | a broidered cloth,

Of linen bright, | and the board she covered;
And then she took | the loaves so thin,
And laid them, white | from the wheat, on the cloth.
31. Then forth she brought | the vessels full,

With silver covered, | and set before them,
Meat all browned, | and well-cooked birds;
In the pitcher was wine, | of plate were the cups,
So drank they and talked | till the day was gone.

Soon did he rise, | made ready to sleep;
So in the bed | himself did he lay,
[212]

34. A son had Mothir, | in silk they wrapped him,

With water they sprinkled him, | Jarl he was;
Blond was his hair, | and bright his cheeks,
Grim as a snake’s | were his glowing eyes.
35. To grow in the house | did Jarl begin,

Shields he brandished, | and bow-strings wound,
Bows he shot, | and shafts he fashioned,
Arrows he loosened, | and lances wielded,
Horses he rode, | and hounds unleashed,
Swords he handled, | and sounds he swam.
36. Straight from the grove | came striding Rig,

Rig came striding, | and runes he taught him;
By his name he called him, | as son he claimed
him, [213]
And bade him hold | his heritage wide,
His heritage wide, | the ancient homes.
37. . . . . . . . . | . . . . . . . .
Forward he rode | through the forest dark,
O’er the frosty crags, | till a hall he found.
38. His spear he shook, | his shield he brandished,

His horse he spurred, | with his sword he hewed;
Wars he raised, | and reddened the field,
Warriors slew he, | and land he won.
39. Eighteen halls | ere long did he hold,

Wealth did he get, | and gave to all,
Stones and jewels | and slim-flanked steeds,
Rings he offered, | and arm-rings shared.
40. His messengers went | by the ways so wet,

And came to the hall | where Hersir dwelt;
His daughter was fair | and slender-fingered,
Erna the wise | the maiden was.
[214]
41. Her hand they sought, | and home they

brought her,
Wedded to Jarl | the veil she wore;
Together they dwelt, | their joy was great,
Children they had, | and happy they lived.
42. Bur was the eldest, | and Barn the next,

Joth and Athal, | Arfi, Mog,
Nith and Svein, | soon they began—
Sun and Nithjung— | to play and swim;
Kund was one, | and the youngest Kon.
43. Soon grew up | the sons of Jarl,

Beasts they tamed, | and bucklers rounded,
Shafts they fashioned, | and spears they shook.
44. But Kon the Young | learned runes to use,

Runes everlasting, | the runes of life; [215]
Soon could he well | the warriors shield,
Dull the swordblade, | and still the seas.
45. Bird-chatter learned he, | flames could he

lessen,
Minds could quiet, | and sorrows calm;
. . . . . . . . | . . . . . . . .
The might and strength | of twice four men.
46. With Rig-Jarl soon | the runes he shared,

More crafty he was, | and greater his wisdom;
The right he sought, | and soon he won it,
Rig to be called, | and runes to know.
47. Young Kon rode forth | through forest and

grove,
Shafts let loose, | and birds he lured;
There spake a crow | on a bough that sat:
“Why lurest thou, Kon, | the birds to come?
[216]
48. “’Twere better forth | on thy steed to fare,

. . . . . . . . | and the host to slay.
49. “The halls of Dan | and Danp are noble,

Greater their wealth | than thou hast gained;
Good are they | at guiding the keel,
Trying of weapons, and giving of wounds.”
* * * * * * [201]
[Contents]
NOTES
[203]
Prose. It would be interesting to know how much the annotator
meant by the phrase old stories. Was he familiar with the tradition in
forms other than that of the poem? If so, his introductory note was
scanty, for, outside of identifying Rig as Heimdall, he provides no
information not found in the poem. Probably he meant simply to refer
to the poem itself as a relic of antiquity, and the identification of Rig
as Heimdall may well have been an attempt at constructive criticism
of his own. The note was presumably written somewhere about
1300, or even later, and there is no reason for crediting the annotator
with any considerable knowledge of mythology. There is little to favor
the identification of Rig with Heimdall, the watchman of the gods,
beyond a few rather vague passages in the other poems. Thus in
Voluspo, 1, the Volva asks hearing “from Heimdall’s sons both high
and low”; in Grimnismol, 13, there is a very doubtful line which may
mean that Heimdall “o’er men holds sway, it is said,” and in “the
Short Voluspo” (Hyndluljoth, 40) he is called “the kinsman of men.”
On the other hand, everything in the Rigsthula, including the phrase
“the aged and wise” in stanza 1, and the references to runes in
stanzas 36, 44, and 46, fits Othin exceedingly well. It seems
probable that the annotator was wrong, and that Rig is Othin, and
not Heimdall. Rig: almost certainly based on the Old Irish word for
“king,” “ri” or “rig.”
1. No gap is indicated, but editors have generally assumed one.

Some editors, however, add line 1 of stanza 2 to stanza 1. [204]
2. Most editions make line 5 a part of the stanza, as here, but some
indicate it as the sole remnant of one or more stanzas descriptive of
Ai and Edda, just as Afi and Amma, Fathir and Mothir, are later
described. Ai and Edda: Great-Grandfather and Great-Grandmother;
the latter name was responsible for Jakob Grimm’s famous guess at
the meaning of the word “Edda” as applied to the whole collection
(cf. Introduction).
3. A line may have been lost from this stanza.

4. Line 5 has generally been rejected as spurious.
5. The manuscript has lines 1–2 in inverse order, but marks the word
“Rig” as the beginning of a stanza. [205]
6. The manuscript does not indicate that these lines form a separate
stanza, and as only one line and a fragment of another are left of
stanza 7, the editions have grouped the lines in all sorts of ways,
with, of course, various conjectures as to where lines may have been
lost.
7. After line 1 the manuscript has only four words: “cloth,” “black,”
“named,” and “Thræll.” No gap is anywhere indicated. Editors have
pieced out the passage in various ways. Water, etc.: concerning the
custom of sprinkling water on children, which long antedated the
introduction of Christianity, cf. Hovamol, 159 and note. Black: dark
hair, among the blond Scandinavians, was the mark of a foreigner,
hence of a slave. Thræll: Thrall or Slave.
8. In the manuscript line 1 of stanza 9 stands before stanza 8,

neither line being capitalized as the beginning of a stanza. I have
followed Bugge’s rearrangement. The manuscript indicates no gap in
line 2, but nearly all editors have assumed one, Grundtvig supplying
“and rough his nails.”
9. The manuscript marks line 2 as the beginning of a stanza. [206]
10. A line may well have dropped out, but the manuscript is too
uncertain as to the stanza-divisions to make any guess safe.
Crooked: the word in the original is obscure. Stained: literally, “water
was on her soles.” Thir: “Serving-Woman.”
12. There is some confusion as to the arrangement of the lines and

division into stanzas of 12 and 13. The names mean: Fjosnir, “Cattle-
Man”; Klur, “The Coarse”; Hreim, “The Shouter”; Kleggi, “The Horse-
Fly”; Kefsir, “Concubine-Keeper”; Fulnir, “The Stinking”; Drumb, “The
Log”; Digraldi, “The Fat”; Drott, “The Sluggard”; Leggjaldi, “The Big-
Legged”; Lut, “The Bent”; Hosvir, “The Grey.” [207]
13. The names mean: Drumba, “The Log”; Kumba, “The Stumpy”;
Ökkvinkalfa, “Fat-Legged”; Arinnefja, “Homely-Nosed”; Ysja, “The
Noisy”; Ambott, “The Servant”; Eikintjasna, “The Oaken Peg” (?);
Totrughypja, “Clothed in Rags”; Tronubeina, “Crane-Legged.”
14. In the manuscript line 4 stands after line 4 of stanza 16, but
several editors have rearranged the lines, as here. Afi and Amma:
Grandfather and Grandmother.
15. There is considerable confusion among the editors as to where

this stanza begins and ends.
16. The manuscript marks line 3 as the beginning of a stanza. [208]
17. The manuscript jumps from stanza 17, line 1, to stanza 19, line
2. Bugge points out that the copyist’s eye was presumably led astray
by the fact that 17, 1, and 19, 1, were identical. Lines 2–3 of 17 are
supplied from stanzas 3 and 29.
18. I have followed Bugge’s conjectural construction of the missing

stanza, taking lines 2 and 3 from stanzas 31 and 4.
19. The manuscript marks line 2 as the beginning of a stanza.
20. The manuscript omits line 2, supplied by analogy with stanza 6.

[209]
21. Most editors assume a lacuna, after either line 2 or line 3.

Sijmons assumes, on the analogy of stanza 8, that a complete
stanza describing Karl (“Yeoman”) has been lost between stanzas 21
and 22.
22. No line indicated in the manuscript as beginning a stanza. Cart:

the word in the original, “kartr,” is one of the clear signs of the Celtic
influence noted in the introduction.
23. Bring: the word literally means “drove in a wagon”—a mark of the
bride’s social status. Snör: “Daughter-in-Law.” Bugge, followed by
several editors, maintains that line 4 was wrongly interpolated here
from a missing stanza describing the marriage of Kon.
24. No line indicated in the manuscript as beginning a stanza. The

names mean: Hal, “Man”; Dreng, “The Strong”; Holth, “The Holder of
Land”; Thegn, “Freeman”; Smith, “Craftsman”; Breith, “The Broad-
Shouldered”; Bondi, “Yeoman”; Bundinskeggi, “With Beard Bound”
(i.e., not allowed to hang unkempt); Bui, “Dwelling-Owner”; Boddi,
“Farm-Holder”; Brattskegg, “With Beard Carried High”; Segg, “Man.”
[210]
25. No line indicated in the manuscript as beginning a stanza. The

names mean: Snot, “Worthy Woman”; Bruth, “Bride”; Svanni, “The
Slender”; Svarri, “The Proud”; Sprakki, “The Fair”; Fljoth, “Woman”
(?); Sprund, “The Proud”; Vif, “Wife”; Feima, “The Bashful”; Ristil,
“The Graceful.”
26. Many editors make a stanza out of line 4 and lines 1–2 of the
following stanza. Strewn: with fresh straw in preparation for a feast;
cf. Thrymskvitha, 22.
27. Fathir and Mothir: Father and Mother. Perhaps lines 3–4 should
form a stanza with 28, 1–2.
28. Bugge thinks lines 5–6, like 23, 4, got in here from the lost
stanzas describing Kon’s bride and his marriage. [211]
31. The manuscript of lines 1–3 is obviously defective, as there are

too many words for two lines, and not enough for the full three. The
meaning, however, is clearly very much as indicated in the
translation. Gering’s emendation, which I have followed, consists
simply in shifting “set before them” from the first line to the second—
where the manuscript has no verb,—and supplying the verb

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Medical Surgical Nursing Critical Thinking in Patient

1. Leads to progressive worsening of heart function."

2. Can be described as an enlargement of the pumping chamber."

3. Occurs with an increase in blood pressure and results in weight gain."

4. Develops primarily because the heart is pumping harder."

Cognitive Level: Analyzing

3. Drinking one or two alcoholic drinks daily

5. Ischemic heart disease

Correct Answer: 1,5

Rationale 1: Hypertension is identified as an etiology of heart failure.

Rationale 2: Diabetes is not a known cause of heart failure.

Rationale 3: Drinking moderately is not a known cause of heart failure.

Rationale 5: Ischemia to the heart is a known cause of heart failure.

Cognitive Level: Analyzing

1. Orthopnea, peripheral edema, crackles

2. Dizziness, syncope, palpitations

3. Pallor and/or cyanosis of extremities

4. PAWP of 12 and CVP of 6

Cognitive Level: Analyzing

1. An increase in O2 saturation to greater than 90%

2. A decrease in heart rate to 66 bpm

3. The onset of atrial fibrillation

4. Louder S1 and S2 heart sounds

Cognitive Level: Analyzing

1. An echocardiogram that reflected increased right ventricular wall thickening

2. A B-type natriuretic peptide (BNP) of 300 pg/mL

3. A left ventricular ejection fraction (VEF) of 50%

4. A serum sodium of 135

Rationale 4: Hyponatremia is commonly found in the patient with heart failure.

Cognitive Level: Analyzing

Which finding would support the diagnosis of heart failure (HF)?

4. Peripheral vasodilation reflected by normalizing capillary refill times

Cognitive Level: Analyzing

1. Weigh myself every day."

2. Check my blood sugar regularly."

3. Notify my health care provider if I become increasingly short of breath."

Cognitive Level: Analyzing

1. Reducing sodium and water retention

2. Filtering potassium out with the water in the renal tubules

4. Retaining calcium to improve the condition of blood vessels in the glomeruli

Rationale 2: This is not the mechanism of an aldosterone antagonist.

Rationale 3: This is not the mechanism of an aldosterone antagonist.

Rationale 4: This is not the mechanism of an aldosterone antagonist.

Cognitive Level: Applying

1. Dyspnea at rest, peripheral edema

3. Increased coughing, crackles

4. Decreased O2 saturation, increased PAWP

Rationale 2: Hypertension and bradycardia are not symptoms of pulmonary edema.

Cognitive Level: Analyzing

Cognitive Level: Applying

1. Heart rate 92 beats per minute

2. Blood pressure 100/72

3. Potassium 5.7 mEq/dL

4. Urine output 35 mL/hr

Cognitive Level: Applying