27 Pharm: Heart failure

What laboratory value does the nurse monitor in a patient taking milrinone (Primacor)? A. Platelet levels B. Sedimentation rate C. Electrolyte levels D. Creatinine

A

Which statement best explains the action of digoxin (Lanoxin)? A. Conduction through the atrioventricular (AV) node is increased B. The heart rate is increased C. Cardiac output is decreased D. The force of contraction is increased

A

A registered nurse (RN) is observing a newly employed licensed practical nurse (LPN) administer medications. Which actions by the LPN require the RN to immediately intervene? (Select all that apply.) A. Mixing milrinone (Primacor) and furosemide (Lasix) B. Administering milrinone and digoxin (Lanoxin) simultaneously C. Injecting inamrinone (Inocor) into the tubing of a running dextrose infusion D. Giving digoxin (Lanoxin) to a patient with a pulse rate of 92 E. Administering nesiritide (Natrecor) orally

A, B, E

The nurse is caring for a 3-year-old girl who has a congenital heart anomaly. The patient's current medications include digoxin and furosemide (Lasix). The apical pulse rate is 100 beats/min. Which action will the nurse take? a. Administer the medication. b. Contact the pediatric cardiologist for further orders. c. Hold the digoxin. d. Request that another unit nurse assess the child.

ANS: A A pulse rate of 100 beats/min in a child who is 3 years old is considered acceptable. Administration of the medication is appropriate. There is no indication for contacting the cardiologist, holding the dose, or requesting further assessment because this is within the expected range.

The nurse transcribes a new order for a daily diuretic on a patient diagnosed with congestive heart failure. The nurse will schedule this medication: a. in the morning. b. after lunch. c. with dinner. d. at bedtime.

ANS: A Diuretics should be taken in the morning to avoid night time diuresis.

Which agents stimulate the heart to increase the force of contractions, thereby increasing cardiac output? a. Inotropic b. Chronotropic c. Isotonic d. Isopropyl

ANS: A Inotropic agents stimulate the heart to increase the force of contractions, thus boosting cardiac output. Chronotropic agents are given to increase heart rate. Isotonic agents have the same pH as body fluids. Isopropyl agents include rubbing alcohol.

Which instruction by the nurse will be included when teaching an adult patient about digoxin (Lanoxin) for management of heart failure? a. "Report nausea and vomiting to your health care provider." b. "Decrease the amount of high potassium foods you eat." c. "Omit your dose of digoxin if your pulse is 60 beats/min." d. "Visual disturbances are common adverse effects."

ANS: A Nausea and vomiting is a serious adverse effect indicative of toxicity. Low potassium levels can cause toxicity; adequate intake of potassium is necessary. The dose is withheld if the pulse rate is less than 60 beats/min in adults. Visual disturbances are not common adverse effects.

Which contributing factor(s) to heart failure is/are modifiable? (Select all that apply.) a. Hypertension b. Addiction to smoking c. Genetic history d. Exercise tolerance e. Age

ANS: A, B, D Hypertension, smoking, and diminished exercise tolerance are contributing factors to atherosclerosis, which can be modified with changes in behavior and the assistance of medications. Genetic history and age are not modifiable factors.

Which statements about vasodilators is/are true? (Select all that apply.) a. They reduce systemic vascular resistance. b. They increase afterload. c. They reduce preload. d. They decrease pulmonary congestion. e. They increase tissue perfusion to muscles and organs. f. They increase the volume of blood returning to the heart.

ANS: A, C, D, E Vasodilators reduce systemic vascular resistance (afterload), decrease preload, relieve pulmonary congestion, and increase tissue perfusion to muscles and vital organs. Vasodilators reduce systemic vascular resistance (afterload) and reduce preload so that the high volume of blood returning to the heart is decreased.

Before administering digoxin (Lanoxin), the nurse takes the adult patient's apical pulse for 1 full minute. What additional nursing consideration(s) will be taken before administration of the medication? (Select all that apply.) a. Review of the digoxin blood level b. Administration of the medication with pulse less than 60 beats/min c. Review of serum electrolytes, liver, and kidney function studies d. Administration of the medication with a pulse of 110 beats/min e. Obtaining baseline patient assessment data, including lung sounds, vital signs, and weight

ANS: A, C, E Before administering digoxin, the nurse should review digoxin levels, review baseline diagnostic data (electrolytes, liver, and kidney function tests), obtain appropriate physical assessments for heart failure patients, and verify that pulse rate is between 60 and 100 beats/min.

Which drug is used to obtain vasodilation in the treatment of chronic heart failure? a. ACTH b. ACE inhibitors c. ARBs d. ANB agents

ANS: B Angiotensin converting enzyme (ACE) inhibitors are the mainstays of oral vasodilator therapy for treating chronic heart failure. ACTH is adrenocorticotropic hormone, secreted by the anterior pituitary to stimulate the adrenal cortex. ARBs are angiotensin reuptake blockers, used for the treatment of hypertension. ANB agents are adrenergic neuron blocking agents, such as guanethidine, given for the treatment of hypertension.

Which nursing assessment is most important to determine fluid status for a patient with heart failure? a. Auscultation of lungs b. Daily weights c. Intake and output d. Measurement of abdominal girth

ANS: B Daily weights are the best indicator of fluid gain or loss. Auscultation of lungs, measurement of intake and output, and measurement of abdominal girth are not the best indicators of fluid status.

The nurse monitors a patient receiving digoxin closely for toxicity when which other medication is prescribed? a. Potassium supplements b. Furosemide (Lasix) c. Acetylsalicylic acid (aspirin) d. Antibiotics

ANS: B Furosemide is a potassium depleting diuretic. Low potassium levels potentiate digoxin toxicity. Taking potassium supplements with a diuretic prevents digoxin toxicity. Aspirin and antibiotics do not affect digoxin levels.

A patient with heart failure has been prescribed nesiritide (Natrecor). Which statement(s) is/are true regarding this medication? (Select all that apply.) a. It increases preload. b. Cardiac ventricles secrete this hormone in response to fluid overload. c. It suppresses aldosterone. d. It promotes norepinephrine secretion. e. It causes vasodilation.

ANS: B, C, E Nesiritide is a hormone normally secreted by the cardiac ventricles in response to fluid and pressure overload, suppresses aldosterone, and causes vasodilation. Nesiritide does not increase preload or promote norepinephrine secretion.

Which action(s) will the nurse take when caring for a patient with heart failure? (Select all that apply.) a. Administer diuretics at bedtime. b. Assess electrolyte levels. c. Report daily weight fluctuations. d. Encourage sodium intake. e. Maintain skin hygiene.

ANS: B, C, E Ongoing assessment of electrolyte levels is critical when caring for a patient with heart failure. Weight gains and losses are the single best indicator of fluid gain or loss. The maintenance of skin care and changing of positions are essential to prevent skin breakdown. Diuretics should be given in the morning and afternoon, not at bedtime, because this would interfere with sleep. Heart failure patients are prone to edema, which interferes with vascular return in the peripheral areas. Sodium restriction is one way of controlling edema.

The nurse is to administer digoxin to an 18 month old patient who weighs 16.5 lb. Guidelines for administration read as follows: 0.0075-0.010 mg/kg/day. Which is a safe medication dosage? a. 0.05 mg b. 0.12 mg c. 0.074 mg d. 0.75 mg

ANS: C 16.5 lb converts to 7.5 kg; 7.5 kg ´ 0.0075 mg = 0.05625; 7.5 kg ´ 0.010 mg = 0.075 mg; 0.074 mg is the only answer within the safe dosage range. Values of 0.05 mg, 0.12 mg, and 0.75 mg are too large.

Which is the initial manifestation of digoxin toxicity in children? a. Hallucinations b. Weakness c. Atrial dysrhythmia d. Diuresis

ANS: C In children, digoxin toxicity is often first detected by the development of atrial dysrhythmias. Hallucinations, weakness, and diuresis are not initial manifestations of digoxin toxicity in children.

An older adult male patient with long term heart failure has presented for an office visit. The nurse obtains information that he has recently begun taking St. John's wort. What results with the use of this herbal supplement? a. Digoxin toxicity b. Altered potassium electrolyte balance c. Reduced therapeutic benefits of digoxin d. Enhanced digoxin effectiveness without producing toxicity

ANS: C St. John's wort is a drug that may reduce therapeutic benefits of digoxin. St. John's wort has the opposite effect on digoxin and does not affect electrolytes.

Which drug will be administered to a patient being admitted with severe digoxin intoxication? a. Amiodarone (Cordarone) b. Spironolactone (Aldactone) c. Digoxin immune Fab (Digibind) d. Digitalis glycoside

ANS: C The antidote for digoxin intoxication is digoxin immune Fab (Digibind). Amiodarone is an antidysrhythmic and would not treat digoxin intoxication. Spironolactone is a diuretic and does not treat digoxin intoxication. Giving more of the same type of drug does not treat drug intoxication.

The nurse is assessing an emergency department patient who was recently discharged following a myocardial infarction (MI). Which symptom(s) would the nurse observe in this patient with left ventricular systolic failure?(Select all that apply.) a. Reports of recent weight loss b. Complaints of peripheral edema c. Diminished exercise tolerance d. Shortness of breath with activity e. Blood pressure elevation

ANS: C, D Early clinical symptoms of left ventricular failure are decreased exercise tolerance and poor perfusion to peripheral tissues. Patients who develop left ventricular systolic failure as a result of MI have acute shortness of breath. Weight gain is more likely to be reported because of edema in diastolic failure. Patients who develop left ventricular systolic failure as a result of MI have shock with little peripheral edema and hypotension.

The nurse is providing education to a patient with altered cardiac function. When instructing this patient the nurse will encourage: (Select all that apply.) a. alcohol consumed in moderation. b. use of salt substitute. c. regular, mild exercise. d. good skin care. e. stress reduction.

ANS: C, D, E Regular, mild exercise; good skin care; and stress reduction should be encouraged with a patient with altered cardiac function. Alcohol intake should be eliminated from the diet. Salt substitutes are high in potassium, so use must be limited.

A patient with altered cardiac function is being assessed by the nurse. When auscultating lung sounds, the nurse will assist this patient into a _____ position. a. prone b. supine c. Sims d. Fowler's

ANS: D Lung fields are assessed in a sitting (Fowler's) position to detect abnormal lung sounds. Prone, supine, and Sims positions are not the best positions to detect abnormal lung sounds.

Which action of ACE inhibitors results in effective treatment of heart failure? a. Increased afterload b. Increased aldosterone c. Increased preload d. Increased cardiac output

ANS: D The therapeutic outcome of ACE inhibitors in heart failure is to improve cardiac output. ACE inhibitors reduce afterload, inhibit the secretion of aldosterone, and reduce preload.

The nurse is providing teaching to a patient with heart failure who has been prescribed nifedipine, a calcium channel blocker. Which statement by the nurse is accurate? a. "This medication dilates your coronary arteries." b. "This medication will help your kidneys get rid of fluid." c. "This medication reduces volume returning to your heart so it doesn't overstretch." d. "This medication reduces the resistance your heart has to pump against."

ANS: D This medication reduces afterload or the resistance against which the heart has to pump. This medication is not used in heart failure for this reason, does not have a diuretic effect, and does not reduce volume.

Which intervention(s) does the nurse perform when administering digoxin (Lanoxin) to an adult patient? (Select all that apply.) A. Hold the drug if the patient's pulse is 90 B. Take an apical pulse for 1 minute before administering the drug C. Draw serum digoxin levels 1 hour after administering a daily dose of the drug D. Give the drug on a patient's empty stomach E. Administer IV digoxin over a 5 minute period F. Administer the drug with an antacid

B, E

Nesiritide (Natrecor) may be administered to a patient with which type of heart failure? A. Moderate heart failure and pitting edema B. Right heart failure and a supraventricular dysrhythmia C. Severe heart failure and dyspnea at rest D. Left heart failure and bundle branch block

C

What is the expected effect of administering a vasodilator to a patient in acute heart failure? A. Reduce preload through its adrenergic agonist effects B. Increase the contractile force and output of the heart C. Decrease vascular resistance and the volume of blood returned to the heart D. Increase the excretion of sodium and water while decreasing pulmonary capillary congestion

C

What is the first clinical manifestation of developing digoxin toxicity for which the nurse monitors in children? A. Increased urine output B. Ventricular dysrhythmias C. High blood pressure D. Atrial dysrhythmias

C

Which herbal supplement may decrease the therapeutic effects of digoxin (Lanoxin)? A. Ginkgo biloba B. Melatonin C. St. John's wort D. Flaxseed

C

Which statement best explains the action of digoxin immune Fab (ovine) (Digibind) when being used for treatment of digoxin toxicity? A. Digoxin immune Fab (ovine) increases the liver's metabolism of digoxin B. After administering digoxin immune Fab, first pass metabolism is increased C. Digoxin immune Fab binds with digoxin to form molecules that can be excreted in the urine D. Absorption of digoxin is blocked by binding digoxin immune Fab with digoxin in the stomach

C

Which statement best explains the action of milrinone (Primacor)? A. Afterload and heart rate are increased B. There is an increase in blood pressure, and vasodilation occurs in the blood vessels C. Milrinone increases the force of cardiac contraction and velocity D. Beta receptors in the heart are blocked, and there is a decrease in the isotropic effects of calcium

C

For which adverse effect will the nurse monitor a patient receiving digoxin (Lanoxin) because it can precipitate digitalis toxicity? A. Hypercalcemia B. Hypermagnesemia C. Hypernatremia D. Hypokalemia

D