Heart Failure Drugs - evolve

A patient with heart failure is prescribed hydralazine/isosorbide dinitrate. To minimize side effects, which instruction will the nurse give to the patient? "Measure your pulse rate before taking the medication." "Eat a potassium-rich diet while taking the medication." "Change position carefully while taking the medication." "Eat a magnesium-rich diet while taking the medication."

"Change position carefully while taking the medication." Using hydralazine/isosorbide dinitrate may cause syncope, which makes patients unable to maintain postural tone. Therefore it is important that the nurse instruct the patient to change position carefully. Pulse rate would be checked before taking digoxin because it reduces heart rate.

A patient with digoxin toxicity is prescribed digoxin immune Fab. Which nursing intervention would the nurse implement when giving this medication? Store any unused medication at room temperature. Assess the radial pulse for bradycardia after administering the drug. Monitor hemoglobin levels after administering the drug. Administer the medication parenterally over 30 minutes.

Administer the medication parenterally over 30 minutes. if toxicity occurs and digoxin rises to a life-threatening level, the nurse would administer the antidote digoxin immune Fab, as ordered. It is given parenterally over 30 minutes, and in some scenarios, it is given as an intravenous bolus (e.g., if cardiac arrest is imminent).

A patient's serum digoxin level is noted to be 0.4 ng/mL. Which action would the nurse take? Administer potassium. Hold future digoxin doses. Call the health care provider. Administer the prescribed dose of digoxin.

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.

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? Tachycardia Bradycardia Hypertension Hypermagnesemia

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.

A patient is prescribed digoxin for supraventricular dysrhythmia. The nurse instructs the patient to avoid consuming bran. Which reason is behind this instruction? Bran decreases digoxin absorption. Bran and digoxin cause constipation. Bran and digoxin cause urinary retention. Bran increases the digoxin concentration in the body.

Bran decreases digoxin absorption. Bran is a high-fiber food. It binds to the digoxin and affects the absorption and bioavailability of the drug. Bran decreases the absorption of digoxin, so the patient would avoid consuming bran while taking digoxin. Bran is a high-fiber food, and fiber treats constipation.

Which drug would reduce the therapeutic effect of digoxin if it is taken concurrently? Quinidine Verapamil Amiodarone Cholestyramine

Cholestyramine interacts with digoxin by decreasing its absorption, which results in a reduced therapeutic effect. Quinidine, verapamil, and amiodarone increases digoxin levels by 50%, resulting in digoxin toxicity.

Which symptoms indicate hyponatremia? Select all that apply. Twitching Confusion Hypoglycemia Increase in thirst Cold, clammy skin

Confusion Increase in thirst Cold, clammy skin A decrease in the sodium concentration in the body causes confusion, an increase in thirst, and cold, clammy skin. A decrease in the sodium concentration in the body does not affect muscle contraction; hence, there is no twitching. Agitation and twitching are symptoms of hypomagnesemia.

Which finding would the nurse expect to see in a patient who is prescribed milrinone? Decreased platelet count Decreased liver enzyme levels Increased serum potassium levels Increased serum magnesium levels

Decreased platelet count Milrinone is a phosphodiesterase inhibitor. It decreases the number of platelets in the blood and results in thrombocytopenia. It increases, not decreases, liver enzyme levels. It decreases, not increases, serum potassium levels, which leads to hypokalemia. It does not interfere with serum magnesium levels.

A patient has dilated cardiomyopathy with clinical indications of heart failure. Which medications would the nurse expect to administer to assist the patient's heart to compensate for this disorder? Select all that apply. Digoxin Valsartan Milrinone Lisinopril Carvedilol

Digoxin Milrinone The patient's heart lacks effective myocardial contraction because a dilated heart lacks the muscle tone found in a normal heart. The nurse will administer medication that will improve myocardial contractility, such as digoxin or milrinone. Valsartan helps prevent vasoconstriction. Lisinopril is used to prevent sodium and water retention and to lower the blood pressure. Carvedilol is used in heart failure to slow the progression of heart failure and to reduce myocardial oxygen consumption.

The nurse reviews a patient's laboratory values, including a digoxin level of 10 ng/mL and serum potassium value of 6.2. Which drug does the nurse ask the primary health care provider to prescribe? Atropine Epinephrine Digoxin immune Fab Potassium supplements

Digoxin immune Fab Digoxin immune Fab is specifically prescribed for severe digoxin overdose and for the reversal of life-threatening cardiotoxic effects such as severe bradycardia, advanced heart block, ventricular tachycardia or fibrillation, and severe hyperkalemia.

A patient who is receiving digoxin reports headache, dizziness, nausea, and blurred vision. After assessing the patient, the nurse finds that the patient's pulse rate is 48 beats/min. Which medication would the nurse expect the primary health care provider to prescribe? Milrinone Nesiritide Dobutamine Digoxin immune Fab

Digoxin immune Fab Headache, dizziness, nausea, blurred vision, and slowed pulse are symptoms of digoxin toxicity. Digoxin immune Fab would be administered to the patient to manage the digoxin toxicity.

A patient with myocardial infarction is given intravenous milrinone. Which other intravenous medication in the patient's medication prescriptions would the nurse question? Digoxin Lisinopril Carvedilol Furosemide

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.

The nurse is teaching a group of nursing students about cardiac glycosides. Which condition indicates an excess dose of cardiac glycosides? Polyuria Dizziness Halo vision Photophobia

Halo vision Cardiac glycosides cause halo vision, a condition in which colored or luminous rings are seen around lights. Intake of diuretics inhibits sodium and water resorption, thereby causing frequent urination. Angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and beta blockers cause dizziness when patients stand up. Amiodarone, an antidysrhythmic drug, causes abnormal intolerance to light, called photophobia.

A patient develops syncope after receiving a drug for heart failure. Which drug was administered to the patient? Milrinone Nesiritide Hydralazine Spironolactone

Hydralazine Syncope is a condition of brief loss of consciousness caused by a sudden decrease in blood pressure. Hydralazine is a vasodilator drug that may cause hypotension, leading to lightheadedness or syncope.

Which complication may be experienced by a patient who is prescribed lisinopril? Insomnia Hyperkalemia Abdominal pain Cardiac dysrhythmia

Hyperkalemia Lisinopril is an angiotensin converting enzyme inhibitor, which causes the kidney to retain potassium, leading to hyperkalemia. Insomnia and abdominal pain are known side effects of nesiritide, not lisinopril. Cardiac dysrhythmia is a side effect of milrinone, not lisinopril.

A patient who receives digoxin reports muscle weakness, lethargy, loss of appetite, and nausea. The electrocardiogram (ECG) report shows a cardiac arrhythmia. Which patient problem will the nurse interpret from the assessment? Hypokalemia Digoxin toxicity Hypomagnesemia Thrombocytopenia

Hypokalemia

Which condition is a contraindication to safe administration of milrinone? Diabetes Skin disease Ear infection Hypokalemia

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.

The nurse is providing care to a patient who is prescribed both digoxin and verapamil. Which side effect would the nurse expect the patient to experience? Increased risk for bradycardia Increased serum levels of digoxin Decreased risk for digoxin toxicity Reduced therapeutic effect of digoxin

Increased serum levels of digoxin Concurrent administration of digoxin and verapamil increases the serum level of digoxin by 50%. Digoxin that is administered concurrently with a beta blocker would increase the risk for bradycardia. Taken together, digoxin and verapamil increase, not decrease, the risk for digoxin toxicity. Colestipol, not verapamil, interacts with digoxin, thereby reducing its therapeutic effect.

A patient is receiving nesiritide. Which symptoms would indicate an overdose? Select all that apply. Insomnia Dysrhythmia Hypertension Hyperglycemia Abdominal pain

Insomnia Dysrhythmia Abdominal pain Nesiritide is recombinant human B-type natriuretic peptide. Insomnia, dysrhythmia, and abdominal pain are adverse effects of nesiritide. The drug decreases blood pressure and causes hypotension; it does not cause hypertension. Nesiritide does not have any effect on blood glucose concentrations; therefore it does not cause hyperglycemia.

A patient with acute heart failure is admitted to the emergency department of a hospital. The patient's medical reports indicate that the patient has asthma and takes telithromycin. Which prescription does the nurse need to obtain from the primary health care provider? Lisinopril Milrinone Eplerenone Hydralazine

Lisinopril is an angiotensin-converting-enzyme inhibitor (ACE) inhibitor that prevents the left ventricular dysfunction that arises in the acute period after a myocardial infarction and is thus used to treat acute heart failure. ACE inhibitors are the drugs of choice to initiate treatment for heart failure.

A patient is being treated for short-term management of heart failure with milrinone. Which is the primary nursing action? Monitor blood pressure continuously. Administer digoxin via intravenous infusion with the milrinone. Administer furosemide via intravenous infusion after the milrinone. Maintain an infusion of lactated Ringer's solution with the milrinone infusion.

Monitor blood pressure continuously. Milrinone lactate is a phosphodiesterase inhibitor administered intravenously for short-term treatment in patients with heart failure not responding adequately to digoxin, diuretics, or other vasodilators. Blood pressure and heart rate would be closely monitored.

Which medication has a sole indication for class IV acutely decompensating heart failure with dyspnea at rest? Captopril Nesiritide Carvedilol Metoprolol

Nesiritide is a synthetic version of human B-type natriuretic peptide. It has vasodilating effects on both arteries and veins and is only used to treat class IV acutely decompensating heart failure that is accompanied by dyspnea at rest. Carvedilol, captopril, and metoprolol are used to treat heart failure but also have other indications such as hypertension.

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? Toxic effects of milrinone Toxic effects of furosemide No therapeutic effects of milrinone No therapeutic effects of furosemide

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.

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. Bradycardia Poor growth Difficulty eating Hypomagnesemia Dyspnea with minimal exertion

Poor growth Difficulty eating 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.

Which medication will increase digoxin levels in the body by 50%? Select all that apply. Quinidine Colestipol Sucralfate Verapamil Amiodarone

Quinidine, verapamil, & amiodarone decrease digoxin clearance and increase digoxin levels in the body by 50%. Colestipol and sucralfate decrease the oral absorption of digoxin and reduce the therapeutic effect of digoxin.

Which medication can interfere with absorption of digoxin? Sucralfate Verapamil Amiodarone Cyclosporine

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.

Which statement is true about positive dromotropic medications? They accelerate conduction in the heart. They inhibit angiotensin converting enzyme. They increase the rate at which the heart beats. They increase the force of myocardial contraction.

They accelerate conduction in the heart. Positive dromotropic medications accelerate conduction. Angiotensin converting enzyme (ACE) inhibitors inhibit angiotensin converting enzyme. Positive chronotropic medications increase the heart rate. Positive inotropic medications increase the force of myocardial contraction.

Which are expected clinical manifestations of hypomagnesemia? Select all that apply. Edema Anorexia Insomnia Twitching Hyperactive reflexes

Twitching Hyperactive reflexes Hypomagnesemia is the medical term for low levels of serum magnesium. It causes involuntary muscle contraction and relaxation, resulting in twitching. Hypomagnesemia can also cause central nervous system excitability and result in hyperactive reflexes.

Which medication blocks angiotensin II receptors? Valsartan Lisinopril Metoprolol Eplerenone

Valsartan is an angiotensin II receptor blocker. It prevents angiotensin II from binding with angiotensin II receptors, thereby blocking the action of angiotensin II. Lisinopril is an angiotensin converting enzyme (ACE) inhibitor. Metoprolol is a beta blocker. Eplerenone is an aldosterone inhibitor.

Which actions of a phosphodiesterase inhibitor drug are beneficial for patients with acute heart failure? Select all that apply. Vasodilation effect Decreased heart rate Increased blood pressure Positive inotropic effects Positive chronotropic effects

Vasodilation effect Positive inotropic effects Positive chronotropic effects Phosphodiesterase inhibitor drugs exert both a positive inotropic effect and a vasodilatory effect. Hence, these classes of drugs are referred as inodilators. These drugs also affect the heart rate by accelerating the rate of impulse formation in the sinoatrial node and therefore exhibit a positive chronotropic effect. Cardiac glycosides cause a negative chronotropic effect by reducing the heart rate. The vasodilation effect produced by these drugs decreases blood pressure.

Which medication is contraindicated for a patient with heart failure who is taking digoxin? Valsartan Phenytoin Verapamil Furosemide

Verapamil is contraindicated for use in heart failure because it increases the serum digoxin level, enhances the bradycardic effects of digoxin, and aggravates the patient's heart condition.