Heart Failure ATI Medication

A nurse is assessing an older adult client who is receiving digoxin. The nurse should recognize that which of the following findings is a manifestation of digoxin toxicity? Anorexia !!! Ataxia Photosensitivity Jaundice

!!! Anorexia, vomiting, confusion, headache, and vision changes are manifestations of digoxin toxicity. Ataxia (lack of muscle coordination) is a manifestation of benzodiazepine toxicity. Digoxin toxicity causes halos around lights. Photosensitivity is a manifestation of NSAID toxicity. Jaundice is a manifestation of sulfonylurea toxicity.

A nurse is caring for a client who is taking digoxin for heart failure and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer? Fab antibody fragments !!! Flumazenil Acetylcysteine Naloxon

!!! Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity. Flumazenil, a benzodiazepine antagonist, reverses the effects of benzodiazepines. Acetylcysteine, a mucolytic, reduces the risk of hepatotoxicity after acetaminophen overdose. Naloxone reverses the effects of opioid analgesics.

A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first? Check the client's vital signs. !!! Request a dietitian consult. Suggest that the client rests before eating the meal. Request an order for an antiemetic.

!!! It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm. While the dietitian might be able to assist the client with making appropriate food choices, this is not the first action the nurse should take. While this intervention might be appropriate, this is not the first action the nurse should take. While this intervention might relieve the client's nausea, this is not the first action the nurse should take.

A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving spironolactone. Which of the following findings should the nurse expect? Decreased sodium level !!! Decreased phosphate level Decreased potassium level Decreased chloride level

!!! The nurse should expect a decreased sodium level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in an increased excretion of sodium. The nurse should not expect a decreased phosphate level. Spironolactone inhibits the action of aldosterone, resulting in the retention of phosphate. The nurse should not expect a decreased potassium level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in the retention of potassium. The nurse should not expect a decreased chloride level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in the retention of chloride.

A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include? Take aspirin if headaches develop. Eat foods that contain plenty of potassium. !!! Expect some swelling in the hands and feet. Take the medication at bedtime.

Furosemide can increase the effects of aspirin and anticoagulants. !!! Furosemide, a high-ceiling (loop) diuretic, can cause potassium loss. The client should add potassium-rich foods to his diet, such as nuts, dried fruits, bananas, and citrus fruits. Furosemide should reduce swelling in the hands and feet. The client should take furosemide early in the day so that the diuretic action will not disturb his sleep.

A nurse is caring for a client who receives furosemide to treat heart failure. Which of the following laboratory values should the nurse monitor for this client due to this medication? Potassium !!! Albumin Cortisol Bicarbonate

Furosemide is a loop diuretic that promotes the excretion of potassium. The nurse should monitor the client's potassium level to watch for hypokalemia. Furosemide does not affect albumin levels. Furosemide does not affect cortisol levels, although it can lower serum sodium levels. Furosemide does not affect bicarbonate levels.

A nurse is providing teaching for a client who has hypertension and a prescription change from metoprolol to metoprolol/hydrochlorothiazide. Which of the following statements by the client indicates an understanding of the teaching? "Now I will not have to diet to lose weight." "With the new medication, I should experience fewer side effects." !!! "I will not have to do anything different because it is the same medication." "The extra letters after the name of medication means it is a stronger dose."

Hydrochlorothiazide (HCTZ) is a diuretic, and the loss of fluid will result in weight loss. The client should be instructed to weigh daily and watch for weight loss, but it is a change in fluid rather than loss of fat that is the cause of the weight loss. Continuing the recommended diet for control of blood pressure can be an additional part of the client's care plan. This client needs further reinforcement of teaching to understand the action of the thiazide diuretic. !!! The client has stated an understanding of the purpose of the addition of the hydrochlorothiazide (HCTZ) to the metoprolol dosage. When used in combination with thiazide diuretics, a lower dose of the beta-blocker can be used. The benefit is there are fewer side effects when beta-blockers (and other antihypertensives) are used in lower dosages. The client does not indicate an understanding that this medication includes a diuretic that requires an increase in potassium in the diet. This statement indicates a need for further teaching on the addition of the diuretic in the combination drug. This statement by the client indicates a need for further reinforcement of teaching. The nurse should clarify that the additional letters indicate a new medication has been combined with the old medication rather than a stronger dose being given.

A nurse is caring for a client who has heart failure and a new prescription for furosemide. For which of the following adverse effects should the nurse monitor? Hypervolemia Hypertension Hypokalemia !!! Hypoglycemia

Hypokalemia Hyperglycemia, not hypoglycemia, is an adverse effect of furosemide.

A nurse is caring for a client who has a heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication? "I can walk a mile a day." "I've had a backache for several days." "I am urinating more frequently." "I feel nauseated and have no appetite." !!!

Improving the client's cardiac output, which in turn will improve the client's exercise tolerance, is a therapeutic response to digoxin. Backaches are not an adverse effect of digoxin. Improving the client's cardiac output, which in turn will increase blood flow to the kidneys and urination, is a therapeutic response to digoxin. !!! Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.

A nurse is caring for a client who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take? Offer the client a light snack. Measure the client's blood pressure. Measure the client's apical pulse. !!! Weigh the client.

The client can take the medication with or without food, although giving it immediately after food can delay absorption slightly. It is not necessary to measure blood pressure immediately before dosing, but the nurse should monitor the client's blood pressure routinely. !!! Digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 min before administering. The nurse should hold the medication and notify the provider if the client's heart rate is below 60/min or if a change in heart rhythm is detected. It is not necessary to weigh the client immediately before dosing, but the nurse should monitor the client's weight routinely.

A client is teaching a client who has a new prescription for hydrochlorothiazide for management of hypertension. Which of the following instructions should the nurse include? "Take this medication before bedtime." "Monitor for leg cramps." !!! "Avoid grapefruit juice.' "Reduce intake of potassium-rich foods."

The client should take this medication in the morning to reduce the risk for nocturia !!! Hydrochlorothiazide can cause hypokalemia. The client should monitor for manifestations of hypokalemia, such as fatigue, tachycardia, leg cramps, and muscle weakness. Clients who take statins, such as atorvastatin, should avoid grapefruit juice because it can reduce the metabolism of the medication and cause toxicity. Hydrochlorothiazide can cause hypokalemia. The client should increase intake of potassium-rich foods, such as spinach and bananas

A nurse is caring for a client who has heart failure and a new prescription for furosemide. Which of the following laboratory values should the nurse review before administering furosemide? Bicarbonate Carbon dioxide Potassium !!! Phosphate

The nurse should check the client's electrolytes and other laboratory results before initiating diuretic therapy; however, furosemide does not generally affect bicarbonate levels. The nurse should check the client's electrolytes and other laboratory results before initiating diuretic therapy; however, furosemide does not generally affect carbon dioxide levels. !!! Furosemide is a loop diuretic and therefore promotes excretion of potassium. The nurse should monitor the client's serum potassium level before administering it to prevent hypokalemia. The nurse should check the client's electrolytes and other laboratory results before initiating diuretic therapy; however, furosemide does not generally affect phosphate levels.

A nurse is providing dietary teaching for a client who takes furosemide. The nurse should recommend which of the following foods as the best source of potassium? Bananas !!! Cooked carrots Cheddar cheese 2% milk

The nurse should determine that bananas are the best food source to recommend because 1 cup of bananas contains 806 mg of potassium. In addition to the potassium supplements the provider might prescribe, the client should increase his daily intake of foods that have high potassium content, such as bananas, orange juice, and spinach.

A nurse is providing teaching to a client who has hypertension and a new prescription for hydrochlorothiazide. Which of the following instructions should the nurse provide? Weigh weekly to monitor therapeutic effect. Take the medication on an empty stomach. Take the medication early in the day. !!! Muscle pain is an expected adverse effect.

The nurse should instruct the client to weigh daily to determine fluid loss. Hydrochlorothiazide can be taken with food or milk. !!! The nurse should instruct the client to take hydrochlorothiazide early in the day to avoid nocturia. The nurse should instruct the client that muscle pain may be an indication of hypokalemia and should be reported to the provider.

A nurse is caring for a client who has heart failure and is receiving IV furosemide. The nurse should monitor the client for which of the following electrolyte imbalances? Hypernatremia Hyperuricemia !!! Hypercalcemia Hyperchloremia

The nurse should monitor the client who is receiving IV furosemide for hyponatremia. !!! The nurse should monitor the client who is receiving IV furosemide for hyperuricemia. The nurse should instruct the client to notify the provider for any tenderness or swelling of the joints. The nurse should monitor the client who is receiving IV furosemide for hypocalcemia. Hyperchloremia The nurse should monitor the client who is receiving IV furosemide for hypochloremia.

A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate? Withholding the medication if the heart rate is above 100/min Instructing the client to eat foods that are low in potassium Measuring apical pulse rate for 30 seconds before administration Evaluating the client for nausea, vomiting, and anorexia !!!

The nurse should withhold the medication if the client's heart rate is below 60/min. The client should eat foods high in potassium to prevent hypokalemia, which increases the risk of digoxin toxicity. The nurse should measure the apical pulse rate for 1 min. !!! Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.

A nurse is assessing a client who has heart failure and is prescribed furosemide. Which of the following findings is an adverse effect of this medication? Weight gain Increased blood pressure Hypoglycemia Leg cramps !!!

Weight gain is not an adverse effect of furosemide. Weight loss can occur with fluid loss; a therapeutic effect of furosemide. Hypotension is an adverse effect of furosemide. Hyperglycemia is an adverse effect of furosemide. !!! Leg cramps is a manifestation of hypokalemia, an adverse effect of furosemide. The nurse should assess the client for hypokalemia and monitor the client's potassium level.