Chapter 48: Drugs for Heart Failure

The nurse is caring for a patient prescribed digoxin [Lanoxin] for heart failure. Which finding would require immediate attention by the nurse? Potassium level of 3.7 mEq/L Digoxin level of 0.7 ng/mL Vomiting and diarrhea Heart rate of 68 beats/min

Vomiting and diarrhea

About which patient should the nurse notify the healthcare provider immediately? A patient who takes digoxin [Lanoxin] 0.125 mg orally daily with a serum digoxin level of 0.8 ng/mL A patient who takes oral spironolactone [Aldactone] 25 mg daily and enalapril [Vasotec] 5 mg daily with a serum potassium level of 5.5 mEq/L A patient who takes digoxin [Lanoxin] 0.25 mg orally daily with a serum potassium level of 4.0 mEq/L A patient who takes oral lisinopril [Zestril] 5 mg daily and digoxin 0.125 mg daily with a serum digoxin level of 0.5 ng/mL

A patient who takes oral spironolactone [Aldactone] 25 mg daily and enalapril [Vasotec] 5 mg daily with a serum potassium level of 5.5 mEq/L

The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention? Analyze heart rate and rhythm. Assess for Homans' sign. Check blood pressure. Palpate the pedal pulses.

Analyze heart rate and rhythm.

A patient with heart failure has developed a cough while taking an angiotensin-converting enzyme (ACE) inhibitor. The health care provider discontinued the ACE inhibitor and prescribed an angiotensin II receptor blocker (ARB) as an alternative to the ACE inhibitor. The patient continues to have symptoms of heart failure despite using an ARB. Which medication should the nurse anticipate will be prescribed? Eplerenone [Inspra] Triamterene [Dyrenium] Hydrochlorothiazide [Microzide] BiDil [Isosorbide Dinitrate and Hydralazine]

BiDil [Isosorbide Dinitrate and Hydralazine]

What is the primary benefit of spironolactone [Aldactone] in patients with heart failure? Increase in diuresis and fluid loss Blockage of aldosterone receptors Inhibition of beta activation by norepinephrine Stimulation of the renin-angiotensin-aldosterone system

Blockage of aldosterone receptors

Which patient symptoms should cause the nurse to be concerned about digoxin [Lanoxin] toxicity? (Select all that apply.) Fatigue Vomiting Dizziness Blurred vision Muscle weakness

Fatigue Vomiting Blurred vision

The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. What nursing action is most appropriate? Give the medication. Obtain a serum digoxin level. Notify the healthcare provider. Assess for signs of digoxin toxicity.

Give the medication.

The nurse is caring for a patient who takes spironolactone [Aldactone] and quinapril [Accupril] for treatment of heart failure. What finding indicates a potential interaction between these two drugs? Elevated serum quinapril level Heart rate of 58 beats/min Potassium level of 5.7 mEq/L Glucose level of 180 mg/dL

Potassium level of 5.7 mEq/L

In the failing heart, arterial pressure falls, stimulating the baroreceptor reflex to increase sympathetic nervous system activity. The nurse understands increased sympathetic activity will produce which response? Tachycardia Bradypnea Hypotension Hypoglycemia

Tachycardia

The heart undergoes cardiac remodeling during the initial phase of heart failure. Which cardiac geometric change occurs during heart failure? Ventricular constriction Ventricular wall thickening Ventricular atrophy Ventricles become more cylindric

Ventricular wall thickening

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: a. ACE inhibitors and beta blockers. b. biventricular pacemakers. c. dietary supplements and exercise. d. diuretics and digoxin.

a. ACE inhibitors and beta blockers.

Which medications are included in first-line therapy for heart failure? (Select all that apply.) a. Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) b. Aldosterone antagonists c. Beta blockers d. Cardiac glycosides e. Diuretics

a. Agents that inhibit the renin-angiotensin-aldosterone system (RAAS) c. Beta blockers e. Diuretics

A patient has heart failure and is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart and vessels. The nurse expects the provider to order which medication to counter this development? a. Aldosterone antagonist b. Angiotensin II receptor blocker (ARB) c. Beta blocker d. Direct renin inhibitor (DRI)

a. Aldosterone antagonist

The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival and improves heart failure symptoms by which mechanism? a. Blocking aldosterone receptors b. Increasing diuresis c. Reducing venous pressure d. Reducing afterload

a. Blocking aldosterone receptors

A patient has been taking digoxin [Lanoxin] 0.25 mg, and 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? a. Check the patient for other symptoms of digitalis toxicity. b. Withhold the next dose of furosemide. c. Continue to monitor the patient for heart failure. d. Document the findings and reassess in 1 hour.

a. Check the patient for other symptoms of digitalis toxicity.

A patient with volume overload begins taking a thiazide diuretic. The nurse will tell the patient to expect which outcome when taking this drug? a. Improved exercise tolerance b. Increased cardiac output c. Prevention of cardiac remodeling d. Prolonged survival

a. Improved exercise tolerance

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: a. assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute. b. contact the provider to report digoxin toxicity. c. request an order for a decreased dose of digoxin. d. review the serum electrolyte values and withhold the dose if the potassium level is greater than 3.5 mEq/L.

a. assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per 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, and decreased urine output. The provider orders spironolactone [Aldactone]. The nurse will instruct the patient to: a. avoid potassium supplements. b. monitor for a decreased heart rate. c. take extra fluids. d. use a salt substitute instead of salt.

a. avoid potassium supplements.

A patient newly diagnosed with heart failure is admitted to the hospital. The nurse notes a pulse of 90 beats per minute. The nurse will observe this patient closely for: a. decreased urine output. b. increased blood pressure. c. jugular vein distension. d. shortness of breath.

a. decreased urine output.

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? a. Antidysrhythmic medications b. End-of-life care c. Heart transplantation d. Implantable mechanical assist devices

b. End-of-life care

A nurse is preparing to administer digoxin [Lanoxin] to a patient. The patient's heart rate is 62 beats per minute, and the blood pressure is 120/60 mm Hg. The last serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse do? a. Contact the provider to request an increased dose of digoxin. b. Give the dose of digoxin and notify the provider of the potassium level. c. Request an order for a diuretic. d. Withhold the dose and notify the provider of the heart rate.

b. Give the dose of digoxin and notify the provider of the potassium level.

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? a. "An increase in arteriolar tone to improve tissue perfusion can decrease resistance." b. "An increase in contractility to increase cardiac output can cause pulmonary edema." c. "When the heart rate increases to increase cardiac output, it can prevent adequate filling of the ventricles." d. "When venous tone increases to increase ventricular filling, an increase in arterial pressure occurs."

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

Which are expected effects of cardiac glycosides? (Select all that apply.) a. Decreased cardiac output b. Decreased force of contraction c. Decreased heart rate d. Modulation of neurohormonal systems e. Positive inotropic effects

c. Decreased heart rate d. Modulation of neurohormonal systems e. Positive inotropic effects

A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, a blood pressure of 150/90 mm Hg, bibasilar crackles, 2+ pitting edema of the ankles, and distension of the jugular veins. The nurse will contact the provider to request an order for which medication? a. ACE inhibitor b. Digoxin [Lanoxin] c. Furosemide [Lasix] d. Spironolactone [Aldactone]

c. Furosemide [Lasix]

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: a. adding spironolactone [Aldactone]. b. reducing the dose of digoxin. c. discontinuing the quinidine. d. giving potassium supplements.

c. discontinuing the quinidine.

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: a. hypernatremia. b. hypertension. c. hyperkalemia. d. hypokalemia.

c. hyperkalemia.

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 per minute, and the blood pressure is 130/88 mm Hg. 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: a. has digoxin toxicity. b. is showing signs of renal failure. c. is experiencing worsening of the disease. d. needs a potassium-sparing diuretic.

c. is experiencing worsening of the disease.

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? a. Withhold the drug for an hour and reassess the level. b. Withhold the drug and notify the prescriber immediately. c. Administer Digibind to counteract the toxicity. d. Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.

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

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: a. complete blood count. b. ejection fraction. c. maximal exercise capacity. d. serum electrolyte levels.

d. serum electrolyte levels.