CHAPTER 30: Drug Therapy for Heart Failure

A patient is diagnosed with acute myocardial infarction. Which of the following medications may precipitate the development of heart failure in this patient? A. ibuprofen B. furosemide C. gabapentin D. fexofenadine

A. A client who has had an acute myocardial infarction is at risk for developing left-sided heart failure. If the client takes nonsteroidal anti-inflammatory agents, such as ibuprofen routinely, this may increase the risk of developing left-sided heart failure due to the retention of sodium.

The home care nurse is visiting a patient who has a history of heart failure. The patient is taking digoxin 0.125 mg orally each day. During the assessment, the patient states he has been nauseated since the home care visit 3 days ago. The nurse suspects he has developed digoxin toxicity. Which of the following factors makes this patient more prone to the development of digoxin toxicity? A. creatinine level of 2.0 mg/dL B. potassium level of 4.0 mEq/L C. calcium level of 8.5 mg/100 mL D. magnesium level of 2.0 mg/100 mL

A. A creatinine level of 2.0 mg/dL is indicative of impaired renal function. Impaired renal function requires the dosage of digoxin to be reduced to prevent toxicity.

A 35-year-old woman has been prescribed enalapril maleate. What should the nurse teach the patient? A. Use effective contraception. B. Double the dose if one is missed. C. If dizziness occurs, it is not a concern. D. There is no change in dose with impaired renal function.

A. Enalapril maleate is teratogenic and can cause birth defects or fetal demise. Because this client is of childbearing age, she should be instructed to use effective contraception.

During the administration of milrinone, the patient's blood pressure decreases from 170/96 to 96/60 mm Hg. What is the most appropriate nursing intervention? A. Call the physician. B. Administer a vasoconstrictor. C. Reduce the infusion rate. D. Reassess the blood pressure.

A. If a client receiving milrinone lactate experiences a significant decrease in blood pressure, the infusion rate should be reduced, and then the physician should be notified.

Which of the following best describes the action of milrinone? A. It relaxes the smooth muscles of the blood vessels to make the vessels wider. B. It provides an inotropic effect. C. It produces vasoconstriction to increase both preload and afterload. D. It decreases the levels of cyclic adenosine monophosphate (cAMP).

A. Milrinone lactate causes vasodilation by relaxing the vascular smooth muscle. In addition, milrinone lactate increases the force of contraction of the ventricles by inhibiting phosphodiesterase, an enzyme that metabolizes cyclic adenosine monophosphate (cAMP). Increased cAMP in the myocardial cells enhances myocardial contractility by relaxing the cardiac smooth muscle.

How does digoxin exert a negative chronotropic effect? A. Digoxin has a direct depressant effect on cardiac conduction tissue. B. Digoxin increases electrical impulses through the ventricles. C. Digoxin depresses the vagal nerve to increase contractility. D. Digoxin prevents calcium from entering the myocardial cell.

A. Negative chronotropic effects are probably caused by several factors. First, digoxin has a direct depressant effect on cardiac conduction tissue, decreasing the number of electrical impulses that are allowed to reach the ventricles from supraventricular sources. Second, digoxin indirectly stimulates the vagus nerve. Increased efficiency of myocardial contraction and vagal stimulation decreases compensatory tachycardia, which results from the sympathetic nervous system response to inadequate circulation.

A patient is diagnosed with heart failure. Which of the following nonpharmacological interventions will be a priority in decreasing edema? A. Administer a diuretic agent. B. Limit dietary sodium. C. Place the patient on bed rest. D. Increase dietary protein.

B. Limiting dietary sodium decreases fluid volume and assists in decreasing edema.

A patient being digitalized in the cardiac intensive care unit is noted to have frequent PVCs. What should the nurse suspect in this patient? A. myocardial infarction B. pulmonary embolism C. digitalis toxicity D. hyperkalemia

C. The development of premature ventricular contractions in a client who is being digitalized is a sign of developing digitalis toxicity.

A patient is taking furosemide, 40 mg daily, to decrease extracellular fluid related to heart failure. During patient teaching, which of the following points is most important for the nurse to convey? A. Sodium intake should be increased due to fluid loss. B. Administration of the medication with food will decrease absorption. C. The skin should be protected from sun exposure using sunscreen. D. Foods that contain potassium should be encouraged to prevent hyperkalemia.

D. Because furosemide is potassium-depleting, a potassium-rich, low-sodium diet is recommended, and the nurse should instruct the patient on symptoms of hypokalemia such as weakness, fatigue, muscle cramps, and palpitations.

An elderly patient is admitted to the cardiac intensive care unit with symptoms associated with the right side of the heart. Which of the following blood values is most important to monitor based on the patient's risk factors? A. complete blood count (CBC) B. blood glucose C. bleeding and clotting time D. liver enzymes

D. It is important to assess the liver enzymes because an elderly client with right-sided heart failure is at risk for developing a hypoxic liver injury. In addition, most medications are metabolized in the liver. Any elevation in the liver enzymes places the elderly client at risk for medication toxicity due to inadequate metabolism of the medications.

A patient is being treated for hypothyroidism. She is also taking digoxin for chronic heart failure. Which of the following factors places the patient at risk for digoxin toxicity? A. impaired renal function B. impaired liver function C. tachycardia D. decreased metabolic rate

D. A client who is being treated for hypothyroidism has a decreased metabolic rate. A decreased metabolic rate places the client at risk for digitalis toxicity.

What is the purpose of administering an angiotensin II receptor blocker to a patient with heart failure? A. It will increase vasoconstriction to increase myocardial contractility. B. It will block the influx of calcium across the sinoatrial node. C. It will inhibit the enzyme that catalyzes cholesterol synthesis. D. It will block the renin-angiotensin II system to increase vasodilation.

D. Angiotensin II receptor blockers, such as losartan potassium, block the renin-angiotensin II system to decrease vasoconstriction and allow for increased myocardial output.

A patient is taking digoxin for atrial fibrillation. Which of the following assessment findings would indicate that the digoxin should be held and the health care provider should be notified? A. respiratory rate of 20 breaths/min B. pulse rate of 80 beats/min C. respiratory rate of 12 breaths/min D. pulse rate of 52 beats/min

D. Digoxin decreases the heart rate to increase myocardial contractility and output. If the client's heart rate is less than 60 beats/min, the digoxin should be withheld and the health care provider should be notified due to potential toxicity.