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Best Practices for Heart Failure: A Focused Review

doi: 10.1097/NHH.0b013e3182610ea0
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Best Practices for Heart Failure: A Focused Review


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GENERAL PURPOSE: To provide registered professional nurses with information about clinical, self-management support, and care transitions best practices for heart failure care in the homecare environment.

LEARNING OBJECTIVES: After reading this article and taking this test, you should be able to:

  1. Outline the etiology, complications, and other information essential for understanding the issues surrounding the management of heart failure in home care.
  2. Plan the appropriate care for home health patients who have heart failure.
  1. According to the Heart Failure Society of America (HFSA), heart failure (HF) results from
    1. fluid volume deficit.
    2. heart muscle dysfunction.
    3. pulmonary edema.
    4. venous congestion.
  2. Common contributing factors to rehospitalizations of patients who have HF include
    1. pulmonary embolism.
    2. orthostatic hypotension.
    3. fluid restriction.
    4. use of herbal supplements.
  3. According to Rosenberg, nurses should be actively engaged in monitoring which of the following to minimize gaps in care delivery?
    1. Availability of care
    2. Frequency of care
    3. Quality of care
    4. Costs of care
  4. The evidence-based practice guidelines cited here recommend which of the following general limits on alcohol use by patients who have HF?
    1. No alcohol use for men or women
    2. ≤ 1 standard drinks/day in men and in women
    3. ≤ 2 standard drinks/day in men and ≤ 1 in women
    4. ≤ 2 standard drinks/day in men and in women
  5. The evidence-based practice guidelines cited here recommend which of the following limits on alcohol use by patients who have HF with alcohol-induced cardiomyopathy?
    1. No alcohol use for men or women
    2. ≤ 1 standard drinks/day in men and in women
    3. ≤ 2 standard drinks/day in men and ≤ 1 in women
    4. ≤ 2 standard drinks/day in men and in women
  6. It is especially important for home care nurses to recognize which of the following when assessing patients who have systolic HF?
    1. Patterns of manifestations of increasing fluid retention vary widely.
    2. Most changes in condition are expected and do not require reporting.
    3. HF is associated with frequent hospitalizations but low mortality.
    4. Changes are often subtle and may fluctuate.
  7. Friedman and Quinn reported that patients delayed contacting healthcare providers for worsening HF symptoms for
    1. several hours.
    2. 1 to 2 days.
    3. several days.
    4. 1 to 2 weeks.
  8. Patients who had a history of HF reported more of which of the following symptoms than did those who were newly diagnosed?
    1. Fatigue
    2. Dyspnea
    3. Cough
    4. Orthopnea
  9. Which of the following adverse reactions can result from both ACE inhibitors and angiotensin receptor blockers?
    1. Angioedema
    2. Constipation
    3. Hepatic dysfunction
    4. Renal insufficiency
  10. Common adverse effects of beta blockers include
    1. tachycardia.
    2. fluid retention.
    3. muscle pain.
    4. hot flashes.
  11. Which statement about digoxin is accurate?
    1. Digoxin is used routinely for treating patients with HF.
    2. Digoxin may be prescribed for symptomatic patients with late-stage HF on maximal medication therapy.
    3. Digoxin toxicity typically occurs when digoxin levels are greater than 5.5ng/mL.
    4. Hypokalemia sensitizes the myocardium to digoxin and may increase the positive inotropic effects of this medication.
  12. Brain natriuretic peptide (BNP) levels
    1. reflect the clinical severity of HF.
    2. tend to increase during aggressive treatment of HF.
    3. should be measured routinely in the outpatient setting to titrate therapy.
    4. between 100 pg/mL and 300 pg/mL indicate a spectrum from mild to severe HF.
  13. Which of the following types of medications can actually worsen the symptoms of HF?
    1. salicylates
    2. calcium channel blockers
    3. loop diuretics
    4. cardiac glycosides
  14. Based on HFSA recommendations, patients who have moderate to severe HF should limit their sodium intake to no more than how many milligrams per day?
    1. 500
    2. 1,000
    3. 2,000
    4. 3,000
  15. The “Newest Vital Sign” is an assessment nurses can use to measure
    1. depression.
    2. self-efficacy.
    3. cognitive impairment.
    4. health literacy.
  16. According to Rollnick and colleagues, the key to being open and receptive to understanding the patient's own personal goals and aspirations is approaching the patient with
    1. the goal of improving the relationship between the provider and the patient.
    2. resources for assisting home care patients with self-management.
    3. the “curious style” of motivational interviewing.
    4. established categorizations of previous barriers to adherence.
  17. According to Lorig and colleagues, clinicians can facilitate confidence building by structuring opportunities for patients to experience
    1. support.
    2. decision making.
    3. success.
    4. goal setting.
  18. Which of the following care transition models includes clinicians who support the patient with both the immediate transition from hospital to home as well as ongoing self-management beyond the 30 days post discharge?
    1. Coleman Care Transitions Interventions
    2. Naylor Transitional Care Model
    3. Hospital to Home Campaign
    4. Community-Based Transitions Model


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