Heart Failure Ch.24 Evolve
Which assessment is most important before administering digoxin?
Apical pulse
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 should the nurse expect the primary health care provider to prescribe?
Digoxin immune fab AKA Digibind [antidote]
The nurse is teaching a group of nursing students about cardiac glycosides. Which condition indicates an excess dose of cardiac glycosides? [digoxin]
Halo Vision
Which medication blocks angiotensin II receptors?
Valsartan
Which medication will enhance the negative inotropic effect of digoxin?
Calcium Channel Blockers [quinidine; verapamil; dilitiazem; amlodipine]
A patient who has heart failure is prescribed digoxin. The patient also has hypothyroidism. What is the best nursing intervention to prevent digoxin toxicity?
Calculate the digoxin dose with correct decimal placement. [Digoxin doses can be lethal if calculated with incorrect decimal placement. Digoxin must be administered in lower doses to patients with hypothyroidism, because it delays renal excretion of the drug. Consequently, administration of digoxin in higher or normal doses to patients with hypothyroidism may lead to digoxin toxicity. ]
The nurse who is caring for a patient with a myocardial infarction informs the patient, "This drug will increase the contractions of your heart." Which drug has been prescribed to the patient?
Digoxin [Digoxin is a cardiac glycoside that acts as a positive inotropic drug by increasing myocardial contractility. Carvedilol is a beta blocker that acts as a negative inotropic drug that reduces the force of contractions. Verapamil is a calcium channel blocker that is a negative inotropic drug. Metoprolol is a beta blocker that reduces myocardial contractility and thus is a negative inotropic drug.]
Which patients with heart disease would be classified within class III of the New York Heart Association's (NYHA) functional classification for cardiac disease?
Patients with a marked limitation of physical activity
A patient is prescribed digoxin for supraventricular dysrhythmia. The nurse instructs the patient to avoid consuming bran. What is the reason behind this instruction?
Bran decreases digoxin absorption.
Which medication is used to treat supraventricular dysrhythmia? [SVD]
Digoxin
A patient with myocardial infarction is given intravenous milrinone. Which other intravenous medication in the patient's medication prescriptions should the nurse question?
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.]
Which complication may be experienced by a patient who is prescribed lisinopril? [ARB]
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.]
The nurse is monitoring an adult patient who has been administered digoxin. The nurse suspects that the patient is developing digoxin toxicity. What symptoms will the nurse monitor? Select all that apply.
Anorexia Vomiting Visual disturbances
A patient is undergoing standard heart failure therapy that does not include a diuretic. The patient's weight has increased by 2 lb (0.9 kg) since yesterday. What action does the nurse implement first?
Asking the patient about the food eaten in the past 24 hours [An overnight weight gain of 2 lb (0.9 kg) implies that the patient has been nonadherent to the therapy regimen in some manner; the patient has missed some medication, eaten foods containing high levels of sodium, or measured weight differently. Before planning the care, the nurse must complete the patient assessment, which includes asking the patient about the diet the patient was eating in the past 24 hours. The care implemented by the nurse depends on the patient's response. Reduction of sodium consumption is an effective method of controlling total body fluid. Sodium is a component of many foods and is found in all processed foods, so teaching the patient how to read food labels could be effective, but it is not the first action to implement. Emergency treatment is not necessary, but the fluid accumulation must be resolved to prevent exacerbation of the heart failure.]
The nurse is teaching a group of nursing students about beta blockers. Which statement by the student indicates understanding of the teaching? [atenolol, metoprolol, propanolol]
Beta blockers decrease sympathetic stimulation of the heart. [Beta-blockers reduce or block the effect of the sympathetic nervous system on the heart muscles and the conduction system. This results in a reduced heart rate, delayed atrioventricular node conduction, reduced myocardial contractility, and decreased myocardial automaticity.]
A patient is diagnosed with congestive heart failure and is prescribed intravenous digoxin. What interventions will the nurse include when administering the drug to the patient? Select all that apply.
Check the pulse rate before administering Check the electrolyte levels before administering Checks its compatibility with other drugs being administered
Which drug would reduce the therapeutic effect of digoxin if it is taken concurrently?
Cholestyramine [Cholestyramine interacts with digoxin by decreasing its absorption, which results in a reduced therapeutic effect. Quinidine, when given along with digoxin, blocks the calcium channels in the myocardium, resulting in enhanced bradycardic and negative inotropic effects of digoxin. Verapamil and cyclosporine decrease the clearance of digoxin, which then increases digoxin levels, resulting in digoxin toxicity]
After reviewing laboratory reports, the nurse finds that a patient has hyponatremia. Which symptoms will the nurse observe in the patient? Select all that apply.
Confusion Increased 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. A decrease in the sodium concentration in the body does not affect blood glucose and therefore does not cause hypoglycemia.]
Which finding would the nurse expect to see in a patient who is prescribed milrinone? [Phosphodiesterase inhibitor]
Decreased platelet count
Which finding would the nurse expect to see in a patient who is prescribed milrinone? [Phosphodiesterase inhibitor aka PDI]
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]
A patient experiencing acute decompensated heart failure is prescribed nesiritide by the primary health care provider. Which other drug prescription should the nurse question?
Diuretics
For what side effects should the nurse monitor after administering lisinopril to a patient? Select all that apply. [ACE]
Dry cough Hyperkalemia
The nurse prepares to administer digoxin to a patient who has heart failure. The nurse should evaluate the serum potassium level if the patient is taking which other drug?
Furosemide [loop diuretic] [Furosemide is a loop diuretic, which acts to prevent the reabsorption of sodium; as a result, the patient excretes sodium, water, and potassium. For this reason, the nurse checks the patient's serum potassium before administering digoxin, because hypokalemia increases the risk of digoxin toxicity and related dysrhythmias.]
The nurse is teaching a patient about the safe administration of digoxin. Which statement by the patient indicates a need for additional teaching? [cardiac Glycosides]
I should take the medication 5 hours before going to bed [Digoxin is a cardiac glycoside that acts like a positive inotropic drug. It has many adverse effects, so a patient should be taught about safe administration methods. It is not a sedative, so it is not administered 5 hours before sleep; it is administered consistently at the same time every day. A pulse rate that fluctuates from the normal range of 60 to 100 beats/min indicates an adverse effect of digoxin. Nausea and fatigue are common side effects of digoxin. Pulse should be measured for 1 minute before administering the medication to assess the improvement in the patient's condition]
A patient who receives digoxin therapy states, "I missed one dose of the drug." The nurse learns that the patient hasn't taken the drug for the past 12 hours. What should the nurse do next?
Immediately inform the primary care provider
A patient is receiving nesiritide. Which symptoms would indicate an overdose? Select all that apply. [B-Type Natriuretic Peptide]
Insomnia Dysrhythmia Abdominal pain
The nurse is caring for a patient after a myocardial infarction. The nurse finds that the patient's heart rate has increased to 130 beats/min and the patient's weight has increased by 8.8 lb (4 kg) overnight. Which combination of drugs will the primary health care provider prescribe to the patient in this condition?
Intravenous lisinopril and furosemide [The patient has a myocardial infarction, and an increased heart rate indicates that the patient is at a risk of cardiac arrest. An overnight increase in weight is caused by edema, and thus a diuretic should be prescribed to the patient. Lisinopril is prescribed for heart failure, and furosemide is a diuretic prescribed for edema. Lisinopril and furosemide do not interact and are safe to be administered in combination.]
Which assessment finding will alert the nurse to suspect digitalis toxicity?
Loss of appetite with slight bradycardia [Symptoms of digitalis toxicity include anorexia, nausea and vomiting, diarrhea, loss of appetite, bradycardia, hypotension, headache, fatigue, confusion, convulsions, and colored vision. Dehydration and constipation, blood pressure of 100/60 mm Hg, and heart rate of 110 beats per minute are not indications of digitalis toxicity.]
A patient is being treated for short-term management of heart failure with milrinone. What is the primary nursing action? [Phosphodiesterase Inhibitor]
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 should be closely monitored. Digoxin is not administered with the milrinone but is usually tried before treatment with milrinone. Furosemide is not necessarily administered after the milrinone, although it could be. It is not, however, administered routinely via intravenous infusion. Lactated Ringer solution does not have to be administered with milrinone.]
What are the therapeutic effects of digoxin?
Positive inotropic, negative chronotropic, and negative dromotropic [Digoxin increases cardiac contractility (positive inotropic effect), decreases heart rate (negative chronotropic effect), and decreases conductivity (negative dromotropic effect). The other options are not applicable.]
A patient is prescribed digoxin to treat heart failure. Which biochemical parameter should be assessed to ensure safe drug administration?
Serum potassium concentration [Digoxin is a cardiac glycoside. The serum potassium concentration is assessed before digoxin is administered, because low concentrations of potassium (hypokalemia) may precipitate digoxin toxicity. Digoxin does not have any effect on liver enzymes, blood glucose, or serum calcium. Therefore, assessment of these parameters is not necessary before administering digoxin.]
While assessing a patient who has heart failure, the nurse finds that the patient has been taking lisinopril for hypertension. Which drug in the patient's prescription should the nurse question?
Spirinolactone
A patient is prescribed milrinone for the treatment of heart failure. After checking the patient's history, the nurse finds that the patient is taking an antacid. The nurse instructs the patient to avoid taking the antacid 2 hours before or after administering milrinone. What is the reason for this instruction? [Phosphodiesterase inhibitor]
To prevent alterations in milrinone absorption [Milrinone is a phosphodiesterase inhibitor. Antacids should not be administered with milrinone, because they interfere with the absorption of milrinone, resulting in the decreased absorption of milrinone. Because antacids decrease the serum concentrations of milrinone, they do not cause milrinone toxicity. Milrinone and antacids do not affect sodium or magnesium concentrations in the blood.]
A patient with digoxin toxicity is prescribed digoxin immune Fab. What is the correct nursing intervention when giving this medication?
Administer the medication parenterally over 30 minutes the drug.
A patient who is taking digoxin for congestive heart failure (CHF) has severe vomiting. The nurse prepares ginseng tea for the patient to relieve vomiting. What symptom may occur as a result of this nursing action?
Bradycardia
A patient with heart failure is prescribed lisinopril. Arrange the order in which lisinopril acts.
1. Prevents sodium-water absorption 2. Decrease volume of blood 3. Decreases end Diastolic volume 4. Decrease the work of the heart [Lisinopril inhibits angiotensin-converting enzyme, which is responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and induces aldosterone secretion. So, lisinopril inhibits aldosterone secretion and prevents sodium and water resorption. This results in a decrease in the circulating blood volume. As the circulating blood volume is reduced, the preload or end diastolic ventricular volume reduces. Consequently, the heart has to put forth less effort to pump blood.]
A patient with congestive heart failure (CHF) is prescribed hydralazine/isosorbide dinitrate. To minimize side effects, what instruction will the nurse give to the patient? [Vasodiltor also the 1st drug just for African Americans]
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 should be checked before taking digoxin, because it reduces heart rate. Digoxin and loop diuretics reduce the potassium levels. This makes it important to eat a potassium-rich diet while taking them. Also, magnesium levels are reduced when taking digoxin and loop diuretics. This necessitates eating a magnesium-rich diet and taking magnesium supplements to compensate for the loss.]
A patient experiencing acute decompensated heart failure is prescribed nesiritide by the primary health care provider. Which other drug prescription should the nurse question? [b-Type Natriuretic Peptide]
Diuretics [Nesiritide should not be coadministered with drugs that reduce blood pressure, because it produces hypotension. Diuretics increase the urinary output and thus decrease the blood volume, resulting in hypotension. Stimulants act like adrenergic drugs and cause hypertension. Antihistamines block the vasodilation caused by histamine, resulting in hypertension. Sodium antacids do not cause hypotension; instead, they cause hypertension by increasing sodium and fluid levels. Thus, they can be safely administered with nesiritide.]
A patient is prescribed milrinone. Which is a contraindication to safe administration of milrinone?
Hypokalemia [Milrinone is a phosphodiesterase inhibitor. Because milrinone decreases serum potassium concentration, the nurse should check the patient's history for hypokalemia. Administration of milrinone to a patient who has hypokalemia may lead to severe complications. Milrinone can be safely administered to patients with diabetes, skin diseases, or ear infections because it does not cause any complications when a patient has these health conditions.]
Which medication is appropriate for a patient who is diagnosed with heart failure who is experiencing dyspnea at rest?
Nesiritide [B-Type Natriuretic Peptide] [Nesiritide is a synthetic version of human B-type natriuretic peptide. It has vasodilating effects on both arteries and veins and is used to treat heart failure that is accompanied by dyspnea at rest. Carvedilol is used to treat heart failure and angina. Captopril is used to treat hypertension and congestive heart failure. Metoprolol is used to treat heart failure]
What adverse cardiac effect is likely to occur in a patient receiving intravenous milrinone? [Phosphdiesterase inhibitor]
Ventricular Dysrhythmia [Administration of intravenous milrinone causes ventricular dysrhythmia, because it decreases the electrical conduction velocity of the heart.]
A patient with congestive heart failure (CHF) is prescribed hydralazine/isosorbide dinitrate. What instruction should the nurse give the patient to minimize side effects? [Vasoldilator]
"Change position carefully while taking the medication.
While reviewing the medical record of a patient who is receiving digoxin therapy, the nurse notes that the patient has atrial tachycardia and impaired renal function. Arrange the order of the nursing interventions for this patient.
1. Immediately discontinue digoxin and notify health care provider 2. Monitor cardiac Dysrhythmia by electrocardiograph 3. Determine serum digoxin and electrolytes concentrations 4. Administer potassium supplements as prescribed 5. Administer digoxin immune fab as prescribed [The nurse should immediately discontinue administration of digoxin. Electrocardiograph monitoring should begin to check for cardiac dysrhythmias so an antidysrhythmic drug can be administered accordingly. Serum digoxin and electrolyte concentrations should be monitored to check whether there is an electrolyte imbalance, because digoxin toxicity reduces potassium and magnesium concentrations. Potassium supplements should be administered accordingly after checking the electrolyte balance. Digoxin immune Fab is an antidote for digoxin, so it should be administered after monitoring cardiac dysrhythmia and electrolyte balance. ]
What hypertensive/heart failure drug classes cause dizziness when standing up?
ACE inhibitors (Angiotensin-Converting Enzyme)-drugs ending in -pril, ARBs (Angiotensin 2 Receptor Blockers)-drugs ending in -sartan, and Beta Blockers-drugs ending in -olol.
A patient is taking 0.25 mg of digoxin and 40 mg of furosemide daily. When the nurse enters the room, the patient reports seeing yellow halos around the lights. What is the nurse's first action?
Assess the patient for Digoxin toxicity
The nurse is teaching a patient about the proper diet while taking drugs to treat heart failure. What will the nurse include in the teaching?
Avoid consuming milk products 2 hours before and after taking the medication." [Milk products such as cheese, yogurt, and ice cream decrease the absorption of heart failure drugs, so they should not be taken 2 hours before and after taking the medication. Drinking large amounts of water increases blood pressure and increases the workload on the heart in patients with heart failure. Bran, rich in fiber and protein, should be avoided only 2 hours before or after the medication, not completely. Bran slows down the absorption of the medication only if taken within 2 hours of taking the medication. Antacids form complexes with the medication and render it unavailable for absorption. Also, antacids may increase the blood sodium and fluid levels, resulting in hypertension]
A patient has a serum digoxin level of 0.4 ng/mL. What can the nurse interpret from the scenario?
It is below therapeutic level. [A serum digoxin level of 0.4 ng/mL is below the normal therapeutic level of 0.5 to 2 ng/mL. Any value over 2 ng/mL is considered above the therapeutic level. The toxic level can only be attained through an extensive application of digoxin administration, for example 5 mEq/L.]
The nurse is assessing a patient who is taking a correct dose of digoxin but is not experiencing the desired therapeutic effects. What will the nurse assess while reviewing the patient's medication history?
Wether the patient is taking sucralfate
The nurse assesses a patient's pulse before administering digoxin and notes a rate that is slower than 50 beats/min. What is the priority intervention by the nurse?
Withhold the dose and notify the primary health care provider [bradycardia]
What is the intravenous loading dose of milrinone for an adult patient?
50 mg [Milrinone is a phosphodiesterase inhibitor with an intravenous loading dose of 50 mcg/kg. A pediatric intravenous dose of digoxin is 35 mcg/kg, divided into three doses. A pediatric oral dose of digoxin is 40 mcg/kg, and is divided into three doses. An intravenous continuous infusion dose of milrinone is 0.75 mcg/kg/min for an adult patient.]
What is the elimination half-life of valsartan?
6 hours
Which drugs are referred to as positive chronotropic drugs?
Drugs that affect heart rate [Drugs that affect heart rate by accelerating the rate of impulse formation in the sinoatrial node are referred to as positive chronotropic drugs. Drugs that affect blood pressure are referred as vasopressor drugs. Drugs that increase the rate of conduction of electrical impulses through the myocardium are referred to as positive dromotropic drugs. Drugs that increase the force of myocardial contraction are referred to as positive inotropic drugs.]
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?
Digoxin immune Fab [Digoxin immune Fab is specifically prescribed for severe digoxin overdose and for the reversal of such life-threatening cardiotoxic effects as severe bradycardia, advanced heart block, ventricular tachycardia or fibrillation, and severe hyperkalemia. Atropine is used as an antidote for anticholinesterase inhibitor toxicity or poisoning. Epinephrine is considered a potent vasoconstrictor. Potassium supplements help in the production of electrolytes in the intracellular fluid.]
Which complication may be experienced by a patient who is prescribed lisinopril?
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 is prescribed digoxin reports eating licorice to treat inflammation. Why should the nurse advise the patient to stop eating licorice?
Licorice may increase the risk of cardiac toxicity. [Licorice is an herbal drug. Licorice and digoxin produce a drug-drug interaction. Licorice may increase the risk of cardiac toxicity because of potassium loss. Licorice does not affect the serum sodium concentration; therefore, it does not cause hyponatremia. Licorice does not affect the absorption of digoxin. Licorice has no effect on serum magnesium concentration; therefore, it does not cause hypomagnesemia.]
A parent reports that a child has been experiencing shortness of breath and chest pains, the nurse suspects that the child has congestive heart failure (CHF). What signs may the nurse observe in the child that would support this suspicion? Select all that apply.
Poor growth Difficulty eating Dyspnea with minimal exertion Children with CHF 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. The lungs of children with CHF are filled with fluid, which makes it difficult to breathe even with minimal-exertion activities such as walking. Children with CHF do not show bradycardia; instead, they have tachycardia to compensate for the improper working of the heart. CHF does not affect concentrations of magnesium. Thus, hypomagnesemia is not a sign of CHF.]
Which are expected clinical manifestations of hypomagnesemia? Select all that apply.
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. Edema can be caused by many factors but is not a clinical manifestation of low magnesium levels. Anorexia is sometimes associated with low levels of potassium, but not low levels of magnesium. Insomnia is a side effect of nesiritide but is not caused by low magnesium.]
A patient with acute heart failure is prescribed a phosphodiesterase inhibitor drug. Which actions of the drug are beneficial for patients with heart failure? Select all that apply.
Vasodilation, 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.]
