Frandsen Ch. 24- Drug Therapy for Heart Failure

Increases in neurohormonal activity cause which of the following to occur in clients with heart failure? Select all that apply:

• Remodeling of the cardiac muscle cells • Hypertrophy of the heart • Increased need for oxygen • Cardiac necrosis

After teaching a class of students about heart failure and drug therapy, the instructor determines that the teaching has been successful when the students identify which drug as most often used as treatment?

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 of the following drugs?

Digoxin immune fab

Non-pharmacological management of acute heart failure includes all of the following EXCEPT:

Encourage physical activity in patients with symptomatic HF.

A patient presents to the Emergency Department (ED) with rales, wheezing, and blood-tinged sputum. The nurse suspects that the patient is in congestive heart failure (CHF). What would the nurse suspect the patient is experiencing?

Pulmonary edema

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

Heart failure

A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessments?

Heart rate and blood pressure

The nursing instructor is discussing digoxin-induced dysrhythmias. What risk factor would the instructor identify as increasing risk of dysrhythmia in a client taking digoxin?

Hypokalemia

Milrinone (Primacor) is a miscellaneous inotropic drug used in the short term management of heart failure. What is the only way this drug is approved to be administered? (Choose one)

Intravenously

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

Low

The teaching priority for a diabetic patient being treated with a non-specific beta-blocker would be what?

To understand signs and symptoms of hypo- or hyperglycemic reaction

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

Peripheral edema

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.

You have provided patient teaching for a patient who has a new order for nadolol (Corgard) to treat their hypertension. What statement by the patient concerning nadolol (Corgard) would indicate that your teaching has been effective?

"I should never stop taking this drug abruptly, but will taper the doses gradually."

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

0.818 mg

A pregnant woman has severe hypertension. The doctor orders a beta blocker to treat her hypertension. The client wants to know if it is safe for the fetus. How should the nurse respond?

"Beta blockers are recommended for pregnant women because the risk to the fetus is less than with other drugs."

Which patient statement indicates the need for additional teaching about propranolol?

"I can stop the drug once my blood pressure is controlled."

A patient is receiving digoxin. The nurse monitors the patient's digoxin level. Which finding would the nurse interpret as therapeutic?

1.5 ng/mL

While taking digoxin, serum potassium levels should be maintained at which level?

3.5-5.0 mEq/L

In what patient is propranolol (Inderal) contraindicated?

35-year-old post-MI female with heart rate 42

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

5 minutes

In which of the following patients is metoprolol mostly likely contraindicated?

A 35-year-old post-MI female with a heart rate of 42 bpm

A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of:

An adrenergic antagonist.

A priority nursing assessment for a patient who is to receive an alpha- or beta- adrenergic blocking agent would be what?

Assess heart rate

When caring for a patient who has been digitalized for his heart failure, the nurse observes that the patient is experiencing bradycardia. Which of the following drugs should be administered to patients who develop bradycardia?

Atropine

A patient is prescribed a cardiotonic medication. Which of the following pre-administration assessments should the nurse perform on this patient?

Check for jugular vein distention.

Your 96-year-old patient is receiving digoxin (Lanoxin) and furosemide (Lasix). In the morning the patient complains of a headache and nausea. What will you do first?

Check her laboratory values and vital signs

Your patient is a 72-year-old Asian male, status post-MI, with a 10-year history of cardiovascular disorder. During your pre-discharge patient teaching on his new medications, you discuss his prescribed clonidine and its major clinical effect. Because the drug is an alpha2-adrenergic agonist, the expected effect is:

Decreased blood pressure.

A nurse is providing discharge instructions to a patient who is taking atenolol (Tenormin) for hypertension. What would the nurse teach the patient regarding the possible drug-to-drug interactions and what the patient is advised to avoid?

NSAIDs

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

Nesiritide (Natrecor)

The pharmacology instructor is describing medications that increase the contractile force of the heart. Which of the following terms describes this effect?

Positive inotropic

A patient with congestive heart failure has been digitalized. The patient requires long-term digoxin therapy. Which of the following instructions should the nurse provide the patient on discharge?

Take the drug regularly without skipping a dose.

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

The patient will be given digoxin immune fab

Which of the following observations might indicate that timolol is achieving the desired effect in a patient?

The patient's intraocular pressure decreases.