Pharm Exam 3 - Ch. 47

A patient has been in heart failure shows a decrease in GFR. The patient has been taking digoxin (Lanoxin) and hydrochlorothiazide. Considering the change in the patient's status, what change in the medication regimen would the nurse anticipate?

A change from hydrochlorothiazide to furosemide (Lasix).

The neurohormonal systems, including the SNS and RAAS, greatly affect cardiac remodeling with declining cardiac performance. What is the ultimate effect of this pathology?

A progressive decline in cardiac output.

The potassium-sparing diuretic spironolactone (Aldactone) has been deomstrated to prolong survival and improve heart failure symptoms by:

Blocking receptors for aldosterone.

The nurse is caring for a patient recently admitted to the ICU with heart disease. What symptom is a life-threatening adverse effect of digoxin therapy?

Dysrhythmias.

A patient has been taking digoxin (Lanoxin) 0.25 mg, and fursemide (Lasix) 40 mg daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights." The nurse should perform what action based on this assessment?

Check the patient for other symptoms of digitalis toxicity.

A nurse prepares to administer a scheduled dose of digoxin. The nurse finds new laboratory data showing a plasma digoxin level of 0.7 ng/mL.What action should the nurse take?

Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.

What outcomes can be expected with administration of digoxin (Lanoxin)?

Decreased heart rate, slowed cardiac conduction speed, and strengthened cardiac contractions.

A nurse reviews these lab values: digoxing level, 3 ng/mL; serum potassium, 6.2 mEQ/L. The nurse notifies the prescriber and anticipates administration of what drug?

Digoxing Immune Fab (Digiblind)

The nurse is reviewing medications for heart failure. Th nurse is correct to assume that the front-line therapy for heart failure consists of which regimen?

Diuretics, ACE inhibitors, and beta-blockers.

A patient is taking carvedilol (Coreg) for heart failure. The nurse should monitor the patient carefully for what that would indicate an adverse effect?

Dizziness

A patient is taking enalapril (Vasotec). The nurse understand that patients taking this type of drug for heart failure need to be monitored carefully for:

Hyperkalemia

The nurse is preparing to administer digoxin IV to treat a patient's heart failure. Which action is essential for the nurse to perform?

Use a cardiac monitor during administration and for at least 2 hours afterward.

The nurse in acute care is reviewing a patient's medications and notes that a prescriber's order for the patient has been changes to nesiritide (Natrecor). The nurse understands that the advantage of nesiritide (Natrecor), the synthetic form of natriuretic peptide, in treating heart failure is that:

it reduces both preload and afterload

A newly admitted patient diagnosed with heart failure has just been started on an angiotensin-converting enzyme (ACE) inhibitor. He asks whether the drug will have a long-term effect on his general cardiovascular health. What response from the nurse is more accurate?

"Suppression of angiotensin II seems to diminish over time, but ACE inhibitors also increase kinin release, which has a favorable effect on cardiac remodeling."

The nurse is providing patient education about digoxin (Lanoxin) to a 50 year-old woman. What statement by the patient demonstrates a need for further teaching?

"This medication prolongs life in women."

The ACC/AHA published management guidelines for heart failure. They have defined stage A as including patient with no symptoms or functional cardiac anomalies who have which of the following behaviors or conditions that are strongly associated to the development of heart failure?

Treatment with cardiotoxic drugs, hypertension, and diabetes.