WK 5 Chapter 42: Drugs for Heart Failure

A patient newly diagnosed with heart failure is admitted to the hospital. The nurse notes a pulse of 90 beats/minute. The nurse will observe this patient closely for:

Decreased urine output.

A nurse is discussing heart failure with a group of nursing students. Which statement by a student reflects an understanding of how compensatory mechanisms can compound existing problems in patients with heart failure?

"When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles."

Which medications are included in first-line therapy for heart failure?

- Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) - Beta blockers - Diuretics

Which are expected effects of cardiac glycosides?

-Decreased heart rate - Modulation of neurohormonal systems - Positive inotropic effects

A patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about:

ACE inhibitors & beta blockers.

A patient has heart failure & is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart & vessels. The nurse expects the provider to order which medication to counter this development?

Aldosterone Antagonist

A patient with heart failure who has been given digoxin [Lanoxin] daily for a week complains of nausea. Before giving the next dose, the nurse will:

Assess the heart rate (HR) & give the dose if the HR is greater than 60 beats/minute.

A patient with Stage C heart failure (HF) who has been taking an ACE inhibitor, a beta blocker, and a diuretic begins to have increased dyspnea, weight gain, &decreased urine output. The provider orders spironolactone [Aldactone]. The nurse will instruct the patient to:

Avoid potassium supplements.

The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival & improves heart failure symptoms by which mechanism?

Blocking aldosterone receptors

A patient has been taking digoxin [Lanoxin] 0.25 mg, & furosemide [Lasix] 40 mg, daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which 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 a new laboratory report 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.

A patient is taking a thiazide diuretic for hypertension and quinidine to treat a dysrhythmia. The prescriber orders digoxin 0.125 mg to improve this patient's cardiac output. The nurse should contact the provider to request:

Discontinuing the quinidine.

An 88-year-old patient with heart failure has progressed to Stage D and is hospitalized for the third time in a month. The nurse will expect to discuss which topic with the patient's family?

End-of-life care

A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats/minute, a blood pressure of 150/90 mmHg bibasilar crackles, 2+ pitting edema of the ankles, and distention of the jugular veins. The nurse will contact the provider to request an order for which medication?

Furosemide [Lasix]

A nurse is preparing to administer digoxin [Lanoxin] to a patient. The patient's heart rate is 62 beats/minute, and the blood pressure is 120/60 mmHg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do?

Give the dose of digoxin & notify the provider of the potassium level.

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

Hyperkalemia.

A patient with volume overload begins taking a thiazide diuretic. The nurse will tell the patient to expect which outcome when taking this drug?

Improved exercise tolerance

A patient with heart failure who takes a thiazide diuretic and digoxin [Lanoxin] is admitted for shortness of breath. The patient's heart rate is 66 beats/minute, and the blood pressure is 130/88 mmHg. The serum potassium level is 3.8 mEq/L, and the digoxin level is 0.8 ng/mL. The nurse admitting this patient understands that the patient:

Is experiencing worsening of the disease.

A patient asks a nurse why he cannot use digoxin [Lanoxin] for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not the first-line therapy for which reason?

It does not correct the underlying pathology of heart failure.

A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate:

Serum Electrolyte Levels.