Pharm PrepU Ch 30 Heart Failure

A nurse is caring for a client who is taking digoxin and a loop diuretic. Which would be most important for the nurse to monitor? Electrocardiogram results Potassium levels Sodium levels Liver enzymes

Potassium levels

A female client's drugs include a furosemide, digoxin, and hydralazine. She is unable to afford all of her medications, so she takes them intermittently to make them last longer. In addition to making a referral to social service, what should the home care nurse tell this client? "Different types of drugs have different actions and produce different responses." "Over-the-counter drugs may be viable substitutes for the more expensive medications." "Your plan is acceptable if the health care provider is aware and laboratory studies are done more frequently." "Changes in doses may be better than alternating medications."

"Different types of drugs have different actions and produce different responses."

A client admitted with digitalis toxicity has taking the same dose for more than 10 years. What question should the nurse ask to assess for the possible cause of the increased serum level of the medication? "Do you take regular doses of antacids?" "Have you been feeling dizzy lately?" "Has it felt like your heart skips a beat?" "Do you think your heart beats too rapidly?"

"Do you take regular doses of antacids?" *Decreased absorption of digoxin can result in digoxin toxicity or digitalis toxicity. Factors that decrease the absorption of digoxin include the presence of food in the GI tract, malabsorption syndromes, and the concurrent administration of antacids or cholestyramine. The administration of digoxin should take place at least 1 hour before the administration of an antacid*

The nurse suggests which dietary habits for the client with heart failure? (Select all that apply.) -Use canned soups to decrease the work of cooking. -Only salt food once with every meal. -Decrease calories to lose weight if needed. -Avoid unsaturated fats and include saturated fats in every meal. -Try to include vegetables, protein, and carbohydrates in each meal.

-Decrease calories to lose weight if needed. -Try to include vegetables, protein, and carbohydrates in each meal. *The nurse teaches the client to avoid salt, so added salt should not be used. The client should lose weight if needed and avoid saturated fats. The client should also be encouraged to eat a balanced diet and to avoid high-sodium foods.*

The nurse identifies the therapeutic range for digoxin as:

0.8 to 2 ng/mL.

A 6-year-old child weighing 60 pounds has been prescribed Lanoxin 30 mcg/kg PO daily. How many mcg will the child be given?

0.818 mg

A nurse obtains the serum digoxin level and immediately reports a level greater than which value?

2.0 ng/ml

A client experiences nausea and visual disturbances when taking digoxin (Lanoxin). The nurse would anticipate the client's digitalis level to be: 0.2 nanograms/mL 1.3 nanograms/mL 2.7 nanograms/mL 1.7 nanograms/mL

2.7 nanograms/mL

A nurse is administering digoxin intravenously as ordered. The nurse would administer the drug over which time frame?

5 minutes

After administering an IV dose of digoxin, the nurse would expect to see effects within what period of time?

5-30 minutes

The nurse is caring for a client with heart failure who has been prescribed ivabradine 5 mg PO b.i.d. Before administering the drug, the nurse's assessment reveals temperature 97.2°F (36.2°), blood pressure 106/63 mm Hg, apical heart rate 68 beats/min with regular rhythm and respiratory rate of 21 breaths/min. What is the nurse's best action? -Contact the healthcare provider to report the assessment findings and seek clarification. -Withhold the medication and reassess the client in 90 minutes. -Withhold the medication and reassess the client in 30 minutes. -Administer the medication as prescribed and monitor the client.

Administer the medication as prescribed and monitor the client.

In a discussion of heart failure, the nursing instructor is explaining preload and afterload. Which of the following statements regarding preload and afterload is accurate? -Afterload is related to the ejection of blood from the ventricle, and preload is related to the filling of the ventricle. -Preload is related to the ejection of blood from the ventricle, and afterload is related to the filling of the ventricle. -Preload is related to the filling of the left ventricle, and afterload is related to the filling of the right ventricle. -Preload is related to the filling of the right ventricle, and afterload is related to the filling of the left ventricle.

Afterload is related to the ejection of blood from the ventricle, and preload is related to the filling of the ventricle.

What is the most accurate method for preventing adverse effects associated with the use of digoxin? Teach clients to take their digoxin in divided doses with each meal. Assess the client's heart rate and hold administration if it is less than 60. Teach clients the signs and symptoms of heart failure. Monitor therapeutic effects based on echocardiogram results.

Assess the client's heart rate and hold administration if it is less than 60.

A female client presents to the emergency department with nausea, vomiting, and a heart rate of 45 beats per minute. Her husband states that she takes digoxin, Lasix, and nitroglycerin for chest pain. Laboratory results confirm digoxin toxicity. The nurse would expect the health care provider to order what medication to treat the bradycardia?

Atropine *Atropine or isoproterenol, used in the management of bradycardia or conduction defects, may be administered to clients with digoxin toxicity.*

The nurse is administering milrinone to a client with heart failure. The nurse should prioritize what assessment when monitoring the client for common adverse effects?

Blood pressure

The nurse is preparing digoxin for an infant. What is the nurse's priority intervention? Performing hand hygiene Confirming drug dosage calculations Checking the infant's blood pressure Educating the infant's parents about therapeutic effects

Confirming drug dosage calculations

The 96-year-old client is receiving digoxin and furosemide. In the morning, the client reports having a headache and feeling nauseated. What should the nurse do first?

Check the client's laboratory values and vital signs. *The nurse will check the client's digoxin level and electrolytes. Assessing vital signs is important because the risk of cardiac arrhythmias could increase due to the client's receiving furosemide, which is a potassium-wasting diuretic. The adverse effects most frequently seen with the cardiac glycosides include headache, weakness, drowsiness, and vision changes (a yellow halo around objects is often reported). Gastrointestinal (GI) upset and anorexia also commonly occur.*

Before discharge from the cardiac step-down (status post-MI), a client questions the prescription for beta-blockers. What should the client be told about the purpose for taking beta-blockers? (Select all that apply.) Decrease mortality rates over several years. Protect the heart from reinfarction. Temporarily increase cardiac workload. Increase cardiac output.

Decrease mortality rates over several years. Protect the heart from reinfarction.

The nurse teaches the client that antacids when taken with digoxin may have which interactions? Nausea and vomiting Increased digoxin levels Decreased digoxin levels Anorexia

Decreased digoxin levels

A client asks the nurse about how his prescribed digoxin helps his heart. The nurse would include which response? Select all that apply. Increases force of contraction Slows the conduction velocity through the atrioventricular (AV) node Decreases heart rate Decreases cardiac output Increases heart rate

Decreases heart rate Slows the conduction velocity through the atrioventricular (AV) node Increases force of contraction

A client's most recent digoxin level is reported to be 2.2 ng/mL. What conclusion should the nurse draw?

Digitalis toxicity is a possibility.

Which would the nurse identify as a cardiac glycoside?

Digoxin

A 58-year-old man is admitted to the emergency department. A diagnosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which drug? Furosemide Digoxin immune fab Captopril Dopamine

Digoxin immune fab

A male client is diagnosed with heart failure. The health care provider orders a loading dose of digoxin. Loading doses are necessary for what reason? Digoxin's short half-life increases the risk for toxicity. The client is at risk for dysthymia with titrated doses. Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. Oral digoxin is ineffective for the treatment of heart failure

Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading.

A nurse is administering morning medications to a number of clients on a medical unit. Which medication regimen is most suggestive that the client has a diagnosis of heart failure? Antihypertensive, diuretic, antiplatelet aggregator Diuretic, ACE inhibitor, beta-blocker Anticoagulant, antihypertensive, calcium supplement Beta-blocker, potassium supplement, anticoagulant

Diuretic, ACE inhibitor, beta-blocker

The nurse is teaching a female patient about newly prescribed digoxin. The patient tells the nurse that she occasionally uses herbal therapies. The nurse should caution the patient against using therapies that involve which herbs? Black cohosh Ginseng Saw palmetto Valerian

Ginseng *Patients taking digoxin should avoid licorice, ginseng, or hawthorn because concomitant use of those products can increase drug effects or cause toxicity.*

When describing the action of beta blockers to a client, the nurse would emphasize that the majority of drug action involve stimulation of the receptors in which organ?

Heart

A 65-year-old client presents to the health care provider's office with reports of shortness of breath on exertion, edema in the ankles, and waking up in the middle of the night unable to breathe. The nurse suspects that the symptoms are indicative of which condition?

Heart failure *Cardinal manifestations of HF are dyspnea and fatigue, which can lead to exercise intolerance and fluid retention resulting in pulmonary congestion and peripheral edema.*

The nurse recognizes that treatment for digitalis toxicity includes which of the following? Intravenous potassium Intravenous magnesium Holding the medication Decreasing the dosage

Holding the medication

Increased cardiac workload with left-sided heart failure can result in which change to the myocardial cells?

Hypertrophy

The nursing instructor is discussing digoxin-induced arrhythmias. What risk factor would the instructor identify as increasing risk of arrhythmia in a client taking digoxin? Obesity Diabetes mellitus Hypokalemia Hypertension

Hypokalemia

A nurse is monitoring a patient who is prescribed milrinone for heart failure. Which sign in the patient indicates that the nurse should withhold the drug? Edema Hypotension Bradycardia Cyanosis

Hypotension

Which adverse effect might occur in a client receiving milrinone? Hypoglycemia Confusion Hypotension Hyperkalemia

Hypotension

The nurse prepares to administer a phosphodiesterase inhibitor by what route?

IV

What does the use of cardiotonics lead to? (Select all that apply.) Improved myocardial contractility Increased myocardial efficiency Increase in blood pressure Increase in peripheral edema Improved perfusion to all body tissues

Improved perfusion to all body tissues Increased myocardial efficiency Improved myocardial contractility

What are cardiac glycosides used for?

Increase the force of the contraction of the heart

An instructor is describing positive inotropic activity. Which would the instructor include as a result of this activity?

Increased cardiac output

What assessment finding indicates that a client's left-sided heart failure is worsening? Increased jugular venous pressure Liver enlargement Increased crackles in lung fields Increased pulse rate

Increased crackles in lung field

Which would be considered a therapeutic effect of digoxin?

Increased force of contraction

The nursing instructor explains to students that positive inotropic action affects the heart in which way?

Increased myocardial contraction *Positive inotropic activity occurs with an increase in the force of the contraction. Conduction is slowed through the heart and there is a decrease, not an increase, in the heart rate.*

What is the priority nursing assessment for a client who is about to begin digoxin therapy? Blood glucose levels Neurological function Kidney function Liver function

Kidney function *Digoxin is primarily excreted unchanged in the urine, so caution should be exercised if renal impairment is present.*

The client's digoxin level is 0.125. How does the nurse interpret this level? Normal Elevated Toxic Low

Low *The therapeutic serum digoxin level is 0.8 to 2.0 ng/mL.*

A group of students are reviewing the drugs used to treat heart failure. The students demonstrate understanding of the information when they identify which agent as a phosphodiesterase inhibitor? Milrinone Captopril Digoxin Hydrochlorothiazide

Milrinone

Which drug is in the class of drugs called human B-type natriuretic peptides? Bosentan Milrinone Digoxin Nesiritide

Nesiritide *Nesiritide is the only drug currently available in a class of drugs called human B-type natriuretic peptides.*

The student nurses are learning about drugs that act on the ANS. The students should learn that adrenergic blocking agents prevent which neurotransmitters from being released and causing SNS effects to be blocked?

Norepinephrine= *Adrenergic blocking agents prevent norepinephrine from being released from the adrenal medulla or from the nerve terminal from activating the receptor, which blocks SNS effects.*

A patient has been admitted to a health care center with reports of dyspnea. Which signs should the nurse monitor for when assessing the patient for left ventricular dysfunction? Nocturia Pitting edema Weight gain Orthopnea

Orthopnea *The other features of left ventricular failure include a hacking cough or wheezing, restlessness, or anxiety*

Which would a nurse expect to assess if a client is experiencing right-sided heart failure?

Peripheral edema

The pharmacology instructor is discussing effects on the heart of different medication. What is the term the instructor would use to describe the effect of a medication that increases the force of the contractions of the heart?

Positive inotropic

The pharmacology instructor is describing medications that increase the contractile force of the heart. Which term describes this effect? Positive chronotropic Positive inotropic Negative inotropic Negative dromotropic

Positive inotropic *A positive inotropic effect improves the contractility and pumping ability of the heart.*

The nurse reviews the laboratory results of a client taking digoxin. What finding creates a risk for digoxin toxicity? Chloride 98 mmol/L (98 mEq/L) Potassium 3.3 mmol/L (3.3 mEq/L) Sodium 144 mmol/L (144 mEq/L) Hemoglobin 133 g/L (13.3 g/dL)

Potassium 3.3 mmol/L (3.3 mEq/L)

Which condition would *least* likely contribute to the development of heart failure?

Renal failure

A male client takes natural licorice for his arthritis. The client reports being short of breath. The nurse understands that licorice blocks the effects of spironolactone by which mechanism? Sodium retention and potassium loss Increased cardiac afterload Renal insufficiency Potassium retention and arrhythmia

Sodium retention and potassium loss

A nurse is providing medication education to a client with a new prescription for digoxin. What herb should the nurse identify as having the tendency to decrease the effects of the medication? ginseng hawthorn licorice St. John's wort

St. John's wort

An older adult client reports fatigue. Upon evaluation, the nurse notes decreased breath sounds, jugular vein distension, and 2+ pedal edema. The nurse suspects which complication? Unstable angina Pulmonary edema Symptomatic decompensated heart failure Acute inferior wall MI

Symptomatic decompensated heart failure *Clients with heart failure usually have no symptoms at rest and no edema; dyspnea and fatigue occur only with activities involving moderate or higher levels of exertion. Symptoms that occur with minimal exertion or at rest and are accompanied by ankle edema and distention of the jugular vein (from congestion of veins and leakage of fluid into tissues) reflect decompensation (symptomatic HF).*

A patient with congestive heart failure has been digitalized. The patient requires long-term digoxin therapy. Which instructions should the nurse provide the patient on discharge? Take the drug with high fiber meals. Report to the center if the pulse is less than 70 bpm. Take antacids promptly to avoid gastric problems. Take the drug regularly without skipping a dose.

Take the drug regularly without skipping a dose

When heart failure occurs, one of the results is increased preload. What is this?

The amount of blood returning to the heart

A client has been prescribed spironolactone therapy for the treatment of heart failure. What treatment goal related to the medication will the nurse include in the care plan? The client will experience a decrease in edema. The client will not require inotropes or beta-blockers. The client will resume prediagnosis levels of stamina. The client will exhibit increased serum potassium levels.

The client will experience a decrease in edema.

The nurse monitors which client for an increased risk of digoxin toxicity? The client with liver dysfunction The client with renal dysfunction The client with an integumentary dysfunction The client with a peripheral vascular dysfunction

The client with renal dysfunction

The nurse is caring for a client with heart failure who has been prescribed ivabradine. What assessment finding would best indicate therapeutic effect? *The client's respiratory rate is 19 breaths per minute and rales are absent. The client's potassium level rises from 3.7 mmol/L (3.7 mEq/L) to 4.1 mmol/L (4.1 mEq/L). The client's blood pressure changes from 144/93 to 138/90 mmHg The client's heart rate changes from 97 to 79 beats per minute.*

The client's heart rate changes from 97 to 79 beats per minute.

The nurse is caring for a client with heart failure who has been prescribed ivabradine. What assessment finding would best indicate therapeutic effect? The client's respiratory rate is 19 breaths per minute and rales are absent. The client's potassium level rises from 3.7 mmol/L (3.7 mEq/L) to 4.1 mmol/L (4.1 mEq/L). The client's blood pressure changes from 144/93 to 138/90 mmHg The client's heart rate changes from 97 to 79 beats per minute.

The client's heart rate changes from 97 to 79 beats per minute.

Mrs. Houston is a 78-year-old woman who resides in an assisted living facility. Her provider prescribed digoxin at her last visit to the clinic and she has approached the nurse about this new drug. What teaching point should the nurse emphasize to Mrs. Houston? The importance of having required laboratory work performed on time The need to take the medication at the same time each day regardless of her heart rate The correct technique for using a home blood pressure cuff Timing household activities to coincide with the administration times of her digoxin

The importance of having required laboratory work performed on time

A 77-year-old man's chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect? The man's glomerular filtration rate and creatinine levels are within reference ranges. The man's heart rate is between 60 and 70 beats per minute with a regular rhythm. The man's potassium and sodium levels remain with reference ranges. The man's chest sounds are clear and his ankle edema is lessened.

The man's chest sounds are clear and his ankle edema is lessened.

A triage nurse in the emergency department suspects that a 78-year-old patient is experiencing severe digoxin toxicity with significant cardiac arrhythmia. If the nurse is correct, which action is likely to be taken?

The patient will be given digoxin immune fab.

A client admitted with digitalis toxicity has been taking the same dose for more than 20 years. The family asks the nurse how someone can develop a toxic level while taking the usual dose. How would the nurse respond? -Toxicity can occur even on low-dose therapy due to various factors including advanced age -Toxicity is usually due to incorrect prescription strength. -The client must have been taking the wrong dose. -The client probably has severe renal impairment.

Toxicity can occur even on low-dose therapy due to various factors including advanced age

The nurse evaluates an improvement in the client's heart failure (HF) status on the basis of what assessment finding? Using fewer pillows to sleep Increased skin turgor Heart rate regular Improved mental status

Using fewer pillows to sleep *he degree of HF is often calculated by the number of pillows required to get relief (e.g., one-pillow, two-pillow, or three-pillow orthopnea)*

The nurse is caring for a client admitted with severe heart failure. The health care provider orders IV digoxin. When would the nurse expect the drug to begin having an effect?

Within 30 minutes *Intravenous digoxin has an onset of action of ten to thirty minutes. The onset of action for oral digoxin is thirty minutes to two hours.*

A nurse is caring for a patient who is admitted into the cardiac care unit with acute, decompensated heart failure. Nesiritide (Natrecor) has been ordered. When preparing for administration of the drug, the nurse will

administer the initial IV bolus over approximately 60 seconds.

A nurse is caring for a patient who is admitted into the cardiac care unit with acute, decompensated heart failure. Nesiritide (Natrecor) has been ordered. When preparing for administration of the drug, the nurse will: add the reconstituted vial of medication to a 1,000 mL IV bag. shake the vial vigorously to mix the medication for reconstitution. administer the initial IV bolus over approximately 60 seconds. use the reconstituted solution within a 36-hour period.

administer the initial IV bolus over approximately 60 seconds. *Nesiritide must be reconstituted and then further diluted for infusion. Reconstitute one vial by adding 5 mL of diluent that has been removed from a 250-mL plastic IV bag. Do not shake the vial. Rock the vial gently so that all surfaces, including the stopper, are in contact with the diluent. Add the entire contents of the reconstituted vial back to the 250-mL plastic IV bag and invert the bag several times to ensure complete mixing. Use the reconstituted nesiritide solution within 24 hours. The initial IV bolus must be drawn from the prepared infusion bag and administered over approximately 60 seconds through an IV port.*

The nurse is caring for a client who is taking an adrenergic blocking agent. What assessment would be among the nurse's priorities? monitoring respiratory rate checking blood glucose level measuring urine output assessing heart rate

assessing heart rate *The most serious adverse effect would be severe bradycardia, so the nurse's priority would be assessing the heart rate. If the client were identified as having diabetes, then monitoring blood glucose levels would become important because these drugs can aggravate diabetes by blocking sympathetic response including masking the usual signs and symptoms of hypoglycemia and hyperglycemia. Respiratory rate could be impacted if the client was identified as having a condition causing bronchospasm and diabetes because the combination could worsen both conditions.*

A client is receiving digoxin and experiences severe bradycardia. Which medication would the nurse anticipate administering if prescribed? atropine milrinone (Primacor) activated charcoal propafenone

atropine

The nurse is providing medication education to a client prescribed an adrenergic blocker. Which nervous system is the specific focus of this classification of medications?

sympathetic

What is the first drug of choice for treatment of a client with a history of a myocardial infarction (MI) 2 years ago?

beta-blockers

A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart?

decrease heart rate

The nurse administers an adrenergic blocking agent to a client. When assessing the client after administration, the nurse should expect evidence of what physiologic effect?

inhibition of norepinephrine release

A client newly diagnosed with heart failure questions why the therapy with digoxin will begin with four doses of digoxin rather than the usual one dose, in a 24-hour period. How would the nurse respond? it more accurately gauges the effect of digoxin on your cardiac function it rapidly brings your serum digoxin levels up to therapeutic levels it helps confirm that you don't have a hypersensitivity to digoxin it helps mitigate the potential for adverse effects

it rapidly brings your serum digoxin levels up to therapeutic levels

After teaching a group of students about conditions that can lead to heart failure, the instructor determines that additional teaching is needed when the students identify: renal failure. valvular disease. coronary artery disease. hypertension.

renal failure.

A client presents to the ED with wheezing and blood-tinged sputum. The nurse suspects the client is experiencing pulmonary edema. The nurse should suspect the cause of the pulmonary edema is most likely: cardiomyopathy. right ventricular failure. valvular heart disease. left ventricular failure.

left ventricular failure.

The nursing students are learning about digoxin therapy in their pharmacology class. The students will learn that there is a higher risk of digoxin toxicity in clients with: low serum chloride levels. low serum potassium levels. low serum sodium levels. low serum calcium levels.

low serum potassium levels.

A client diagnosed with acute-onset pulmonary edema has not experienced a response to digitalization. The nurse should expect what drug to be prescribed for this client? nitroglycerin furosemide verapamil milrinone

milrinone *Milrinone is the most commonly used cardiotonic-inotropic agent for short-term management of acute, severe HF that is not controlled by digoxin, diuretics, and vasodilators. Milrinone also relaxes vascular smooth muscle to produce vasodilatation and decrease preload and afterload.*

A client is hospitalized for heart failure and is scheduled to receive oral digoxin at 8 AM. The nurse will withhold the medication and notify the prescriber if the client's: weight is over 300 pounds. respiratory rate is 24. pulse is 52 beats per minute. blood pressure is 140/86.

pulse is 52 beats per minute.