Pharm - Chapter 24 - Heart Failure Drugs
The nurse suspects that an 80-year-old patient is developing digoxin toxicity. For which symptoms will the nurse monitor? Select all that apply. 1 Anorexia 2 Vomiting 3 Dry cough 4 Muscle twitching 5 Visual disturbances
1 Anorexia 2 Vomiting 4 Muscle twitching 5 Visual disturbances The early symptoms of digoxin toxicity are anorexia, nausea, vomiting, and loss of appetite. The patient may also have visual disturbances such as halo vision. Hypomagnesia can precipitate digoxin toxicity. A symptom of hypomagnesia is muscle twitching. Dry cough is a common side effect associated with angiotensin converting enzyme inhibitors rather than digoxin.
A patient with heart failure and hypothyroidism is prescribed digoxin. Which nursing intervention will prevent digoxin toxicity? 1 Calculate the digoxin dose with correct decimal placement. 2 Administer a higher-than-usual dose of digoxin to the patient. 3 Administer digoxin immune Fab before administering digoxin. 4 Prevent the consumption of large amounts of bran with digoxin.
1 Calculate the digoxin dose with correct decimal placement. Digoxin doses can be lethal if calculated with incorrect decimal placement. Trailing zeros are not to be used after decimal points; this can lead to misinterpretation of the dose calculation (for example, 1.0 can be read as 10). Leading zeroes must be used if a dose is less than a whole number to prevent digoxin toxicity (for example, 0.25 instead of .25). Digoxin must be administered in lower doses to patients with hypothyroidism because it delays renal excretion of the drug. Consequently, administration of digoxin in higher or normal doses to patients with hypothyroidism may lead to digoxin toxicity. Digoxin immune Fab is only administered if the patient has high-serum concentrations of digoxin. Therefore the serum concentrations of digoxin would be checked before administration of digoxin immune Fab. High intake of fiber through foods such as bran binds to digoxin and leads to a decrease in the absorption of the drug. Therefore it does not cause digoxin toxicity.
The nurse who is caring for a patient with a myocardial infarction informs the patient, "This drug will increase the contractions of your heart." Which drug has been prescribed to the patient? 1 Digoxin 2 Carvedilol 3 Verapamil 4 Metoprolol
1 Digoxin Digoxin is a cardiac glycoside that acts as a positive inotropic drug by increasing myocardial contractility. Carvedilol is a beta blocker that acts as a negative inotropic drug that reduces the force of contractions. Verapamil is a calcium channel blocker that is a negative inotropic drug. Metoprolol is a beta blocker that reduces myocardial contractility and thus is a negative inotropic drug.
Which medication is used to treat supraventricular dysrhythmia? 1 Digoxin 2 Nesiritide 3 Milrinone 4 Verapamil
1 Digoxin Digoxin is a cardiac glycoside used to treat supraventricular dysrhythmia. Nesiritide is used to treat acutely decompensated heart failure. Milrinone is used to treat heart failure. Verapamil is used to treat hypertension and angina.
A patient with heart failure taking digoxin reports nausea, vomiting, and visual changes. Which does the nurse include in the plan of care? 1 Obtain digoxin level. 2 Lower the digoxin dose. 3 Discontinue medication. 4 Initiate telemetry monitoring.
1 Obtain digoxin level. The patient is exhibiting signs of digoxin toxicity, so the nurse would plan to obtain a digoxin level. The nurse may hold the dose until the laboratory results are available, but the nurse would never lower the dose or discontinue a medication without consulting the health care provider. The patient receiving digoxin does not need telemetry monitoring.
Which medication can interfere with absorption of digoxin? 1 Sucralfate 2 Verapamil 3 Amiodarone 4 Cyclosporine
1 Sucralfate Sucralfate decreases the absorption of digoxin. Verapamil, amiodarone, and cyclosporine interact with digoxin and decrease the clearance of digoxin. Therefore co-administration of these drugs may result in increased concentration of digoxin in the body.
While reviewing the medical record of a patient who is receiving digoxin therapy, the nurse notes that the patient has atrial tachycardia and impaired renal function. Arrange the order of the nursing interventions for this patient. 1. Administer digoxin immune Fab as prescribed. 2. Administer potassium supplements as prescribed. 3. Monitor cardiac dysrhythmias by electrocardiograph. 4. Determine serum digoxin and electrolyte concentrations. 5. Discontinue administration of digoxin and notify the health care provider.
1. Immediately discontinue digoxin and notify health care provider 2. Monitor cardiac Dysrhythmia by electrocardiograph 3. Determine serum digoxin and electrolytes concentrations 4. Administer potassium supplements as prescribed 5. Administer digoxin immune fab as prescribed Atrial tachycardia indicates of digoxin toxicity, and impaired renal function may predispose patients to increased toxicity. The nurse would immediately discontinue administration of digoxin. Electrocardiograph monitoring would begin to check for cardiac dysrhythmias so an antidysrhythmic drug can be administered accordingly. Serum digoxin and electrolyte concentrations would be monitored to check whether there is an electrolyte imbalance, because digoxin toxicity reduces potassium and magnesium concentrations. Potassium supplements would be administered accordingly after checking the electrolyte balance. Digoxin immune Fab is an antidote for digoxin, so it would be administered after monitoring cardiac dysrhythmia and electrolyte balance.
A patient who is taking digoxin for heart failure has severe vomiting. The spouse prepares ginseng tea for the patient to relieve vomiting. Which symptom may occur as a result of this nursing action? 1 Tachycardia 2 Bradycardia 3 Hypertension 4 Hypermagnesemia
2 Bradycardia Digoxin increases the force of the contractions in the heart and consequently decreases the heart rate. Ginseng increases the serum concentrations of digoxin. Ginseng tea would relieve vomiting but would also rapidly decrease the patient's heart rate. Digoxin toxicity causes bradycardia but not tachycardia. Digoxin, an indirect vasodilator, does not cause hypertension. Increased serum concentrations of digoxin resulting from taking ginseng tea does not cause hypermagnesemia.
The nurse is caring for a patient after a myocardial infarction. The nurse finds that the patient's heart rate has increased to 130 beats/min and the patient's weight has increased by 8.8 lb (4 kg) overnight. Which intravenous combination of drugs will the primary health care provider prescribe to the patient in this condition? 1 Carvedilol and nesiritide 2 Lisinopril and furosemide 3 Milrinone and furosemide 4 Lisinopril and spironolactone
2 Lisinopril and furosemide The patient has a myocardial infarction, and an increased heart rate indicates that the patient is at risk for cardiac arrest. An overnight increase in weight is caused by edema, and thus a diuretic would be prescribed for the patient. Lisinopril is prescribed for heart failure, and furosemide is a diuretic prescribed for edema. Lisinopril and furosemide do not interact and are safe to be administered in combination. Carvedilol is a nonselective beta blocker administered for myocardial infarction, and nesiritide is a natriuretic peptide. Natriuretic peptides would be administered only when heart failure worsens, and they cannot replace diuretics. Milrinone precipitates furosemide when administered intravenously, and the therapeutic effect of the drug does not occur; hence, this combination is not administered. Spironolactone is a potassium-sparing diuretic that may cause complications when administered with lisinopril because lisinopril causes hyperkalemia.
A parent reports that a child has been experiencing shortness of breath and chest pains; the nurse suspects that the child has heart failure (HF). Which signs may the nurse observe in the child that would support this suspicion? Select all that apply. 1 Bradycardia 2 Poor growth 3 Difficulty eating 4 Hypomagnesemia 5 Dyspnea with minimal exertion
2 Poor growth 3 Difficulty eating 5 Dyspnea with minimal exertion Children with HF show poor growth because the heart takes up most of the energy for normal functioning. Also they show poor eating habits because of difficulty eating and are easily tired because of the extra energy required for eating. The lungs of children with HF are filled with fluid, which makes it difficult to breathe even with minimal-exertion activities such as walking. Children with HF do not show bradycardia; instead, they have tachycardia to compensate for the improper working of the heart. HF does not affect concentrations of magnesium; thus hypomagnesemia is not a sign of HF.
A patient with heart failure is prescribed lisinopril. Arrange the order in which lisinopril acts. 1. Decreases the volume of blood 2. Decreases the work of the heart 3. Prevents sodium and water resorption 4. Decreases the end diastolic volume
3, 1, 4, 2 Lisinopril inhibits angiotensin converting enzyme, which is responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and induces aldosterone secretion. So, lisinopril inhibits aldosterone secretion and prevents sodium and water resorption. This results in a decrease in the circulating blood volume. As the circulating blood volume is reduced, the preload or end diastolic ventricular volume reduces. Consequently, the heart has to put forth less effort to pump blood.
A patient's serum digoxin level is noted to be 0.4 ng/mL. Which action would the nurse take? 1 Administer potassium. 2 Hold future digoxin doses. 3 Call the health care provider. 4 Administer the prescribed dose of digoxin.
4 Administer the prescribed dose of digoxin. Therapeutic serum digoxin levels are 0.5 to 2 ng/mL. The patient would receive the next dose to bring the level into therapeutic range. Potassium would never be given without documented potassium deficiency. Because the dose is in the subtherapeutic range, it is not necessary to hold future doses. The level is slightly subtherapeutic, so notifying the health care provider is not the priority action.
A patient is undergoing standard heart failure therapy that does not include a diuretic. The patient's weight has increased by 2 lb (0.9 kg) since yesterday. Which action does the nurse implement first? 1 Explaining how to read food labels 2 Telling the patient to reduce the daily sodium intake 3 Instructing the patient to seek emergency care 4 Asking the patient about the food eaten in the past 24 hours
4 Asking the patient about the food eaten in the past 24 hours An overnight weight gain of 2 lb (0.9 kg) implies that the patient has been nonadherent to the therapy regimen in some manner; the patient has missed some medication, eaten foods containing high levels of sodium, or measured weight differently. Before planning the care, the nurse must complete the patient assessment, which includes asking the patient about the diet the patient was eating in the past 24 hours. The care implemented by the nurse depends on the patient's response. Reduction of sodium consumption is an effective method of controlling total body fluid. Sodium is a component of many foods and is found in all processed foods, so teaching the patient how to read food labels and telling the patient to reduce daily sodium intake could be effective, but these are not the first actions to implement. Emergency treatment is not necessary, but the fluid accumulation must be resolved to prevent exacerbation of the heart failure.
A patient is taking 0.25 mg of digoxin and 40 mg of furosemide daily. When the nurse enters the room, the patient reports seeing yellow halos around the lights. Which action would the nurse take first? 1 Withhold the next dose of furosemide. 2 Administer the medication as prescribed. 3 Document the findings and reassess in 1 hour. 4 Assess the patient for symptoms of digoxin toxicity.
4 Assess the patient for symptoms of digoxin toxicity. A change in vision, such as a yellow halo surrounding the peripheral field, may be reported by patients experiencing digoxin toxicity. In this case the first action the nurse would take is to further assess the patient for additional signs of digoxin toxicity. Furosemide is a potassium-wasting loop diuretic. When furosemide is taken together with digoxin, the patient is at increased risk for digoxin toxicity if the serum potassium levels are low. The nurse would not withhold the next dose of furosemide without first assessing the patient and contacting the health care provider but would have to be aware of this drug interaction. The nurse would not administer medication as prescribed because the patient has a change in status that may be related to the medication(s). The nurse would first fully assess the patient. Documentation and reassessment are a part of the nurse's responsibility, but because the patient has a reported change in status and is at risk for digoxin toxicity, it would not be acceptable for the nurse to wait to take further action. Assessment must be done to determine the source of the patient's reported visual symptomology.
A patient with myocardial infarction is given intravenous milrinone. Which other intravenous medication in the patient's medication prescriptions would the nurse question? 1 Digoxin 2 Lisinopril 3 Carvedilol 4 Furosemide
4 Furosemide Furosemide is a diuretic drug that is prescribed to reduce edema. When taken intravenously, furosemide reacts with milrinone and precipitates it, thereby reducing its therapeutic effect. Therefore it is not usually prescribed in an intravenous formulation. Digoxin does not cause any adverse reaction with milrinone, so they can be administered together. Lisinopril is an angiotensin converting enzyme that is prescribed for myocardial infarction. It does not cause any interaction with milrinone. Carvedilol is a nonspecific beta blocker prescribed for myocardial infarction. It does not cause any reaction with milrinone.
Which condition is a contraindication to safe administration of milrinone? 1 Diabetes 2 Skin disease 3 Ear infection 4 Hypokalemia
4 Hypokalemia Milrinone is a phosphodiesterase inhibitor. Because milrinone decreases serum potassium concentration, the nurse would check the patient's history for hypokalemia. Administration of milrinone to a patient who has hypokalemia may lead to severe complications. Milrinone can be safely administered to patients with diabetes, skin diseases, or ear infections because it does not cause any complications when a patient has these health conditions.
The New York Heart Association's (NYHA) functional classification for cardiac disease classifies patients within class III based on which limitations of physical activity? 1 No limitation of physical activity 2 Slight limitation of physical activity 3 Inability to perform physical activity 4 Marked limitation of physical activity
4 Marked limitation of physical activity Patients with cardiac disease who have a marked limitation in physical activity are classified as class III according to the NYHA's functional classification for cardiac disease. They are comfortable at rest. Activities requiring minimal effort in such patients would cause fatigue, palpitation, dyspnea, or anginal pain. Patients with cardiac disease who have no limitation of physical activity are classified under class I of the NYHA's functional classification. Patients with cardiac disease who are comfortable at rest but in whom ordinary physical activities result in fatigue, palpitation, difficulty breathing, or anginal pain belong to class II of the NYHA's functional classification. Patients with cardiac disease resulting in an inability to perform any physical activity without discomfort are classified in class IV of the NYHA's functional classification. Symptoms of heart failure or anginal syndrome may be present even at rest.
The nurse administers prescribed furosemide and milrinone simultaneously through the same intravenous line. This nursing action will result in which consequence seen in the patient? 1 Toxic effects of milrinone 2 Toxic effects of furosemide 3 No therapeutic effects of milrinone 4 No therapeutic effects of furosemide
4 No therapeutic effects of furosemide When furosemide is administered simultaneously with milrinone through the same intravenous line, furosemide is precipitated. So, the therapeutic actions of furosemide are not seen. Furosemide does not increase the serum concentrations of milrinone, so toxic effects of milrinone will not be seen in the patient. Furosemide is precipitated while being administered, thereby making it unavailable to influence therapeutically. Milrinone would produce its therapeutic actions because it is not precipitated.
