Heart failure is one of the most common med-surg diagnoses. These CMSRN questions cover assessment, medications, fluid and weight monitoring, and patient teaching, each with a full rationale.
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Question 1
A patient with heart failure has bilateral pitting edema and crackles in lung bases. Which diuretic combination is most appropriate?
Combination of loop diuretic (furosemide) for acute volume overload plus potassium-sparing diuretic (spironolactone) for aldosterone blockade is most effective in heart failure. This combination prevents hypokalemia and provides synergistic diuresis.
Question 2
A nurse receives a mobile alert that a postoperative patient’s wearable device detects atrial fibrillation with a heart rate of 132 bpm. The telemetry monitor shows normal sinus rhythm at 82 bpm. Which response integrates both technologies effectively?
Discrepancies between wearable tech and hospital monitoring require hands-on validation. Option B follows clinical prioritization by assessing symptoms (e.g., palpitations) and checking pulse/telemetry leads, per AHA arrhythmia protocols. Option A ignores potential intermittent arrhythmia. Option C dismisses useful consumer-grade tech without evaluation. Option D escalates prematurely without assessment. The postoperative setting and sudden rate change demand nurse-led evaluation before intervention.
Question 3
A patient with heart failure and bilateral weakness falls during a nighttime bathroom visit. No injury occurs, but they report fatigue. Which follow-up action best targets prevention?
The timing (nocturnal) and fatigue cue indicate preventable toileting-related risk. Scheduled toileting (B) directly reduces unsupervised attempts, aligning with CMSRN protocols for mobility-compromised patients. Urinalysis (A) might be considered but doesn't address the immediate functional deficit. Protein supplements (C) are unrelated to acute fatigue management. Cardiology consults (D) are for disease management, not fall-specific prevention. The intervention must address the environmental-behavioral pattern revealed by the fall circumstances.
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Question 1
What is the priority nursing intervention for a patient experiencing cardiogenic shock post-MI?
In cardiogenic shock, the heart cannot pump effectively. Intra-aortic balloon pump (IABP) helps augment cardiac output and reduce afterload. Fluid boluses can worsen pulmonary edema. Beta blockers would further decrease cardiac output. While oxygen is important, mechanical support is the priority.
Question 2
A patient with heart failure has a BNP level of 850 pg/mL. What does this indicate?
BNP (B-type Natriuretic Peptide) >400 pg/mL indicates heart failure. Levels >800 suggest significant heart failure requiring hospitalization and aggressive treatment. Normal BNP is <100 pg/mL. This elevation confirms decompensated heart failure.
Question 3
Which finding indicates digoxin toxicity?
Classic signs of digoxin toxicity include visual disturbances (yellow-green halos), GI symptoms (nausea, vomiting), and cardiac effects (bradycardia, heart blocks, arrhythmias). Digoxin causes bradycardia, not tachycardia. Hypokalemia increases toxicity risk.
Question 4
A patient with heart failure is prescribed spironolactone. What lab value requires close monitoring?
Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia. Potassium levels must be monitored closely, especially when combined with ACE inhibitors or ARBs (also increase potassium). Hold if K+ >5.0 mEq/L.
Question 5
What is the primary benefit of ACE inhibitors in heart failure management?
ACE inhibitors reduce preload (venous return) and afterload (arterial resistance), making it easier for the failing heart to pump. They also prevent harmful ventricular remodeling. They do not increase contractility or heart rate. Spironolactone blocks aldosterone.
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What is the priority nursing intervention for a patient experiencing cardiogenic shock post-MI?…
