CAQ: Heart Failure/ Diuretics

Furosemide (Lasix) is prescribed for a patient who is about to be discharged, and the nurse provides instructions to the patient about the medication. Which statement by the nurse is correct? Select one: "Take this medication in the evening." "If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit." "Avoid foods high in potassium, such as bananas, oranges, fresh vegetables, and dates." "Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes."

"Be sure to change positions slowly and rise slowly after sitting or lying so as to prevent dizziness and possible fainting because of blood pressure changes."

A patient on diuretic therapy calls the clinic because he's had the flu, with "terrible vomiting and diarrhea," and he has not kept anything down for 2 days. He feels weak and extremely tired. Which statement by the nurse is correct? Select one: "It's important to try to stay on your prescribed medication. Try to take it with sips of water." "You will need an increased dosage of the diuretic because of your illness. Let me speak to the physician." "Stop taking the diuretic for a few days, and then restart it when you feel better." "Please come into the clinic for an evaluation to make sure there are no complications."

"Please come into the clinic for an evaluation to make sure there are no complications."

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

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

A diabetic patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about: Select one: diuretics and digoxin. dietary supplements and exercise. ACE inhibitors and beta blockers. biventricular pacemakers.

ACE inhibitors and beta blockers.

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? Select one: Angiotensin II receptor blocker (ARB) Aldosterone antagonist Beta blocker Direct renin inhibitor (DRI)

Aldosterone antagonist

The potassium-sparing diuretic spironolactone (Aldactone) prolongs survival and improves heart failure symptoms by which mechanism? Select one: Reducing venous pressure Reducing afterload Increasing diuresis Blocking aldosterone receptors

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? Select one: Document the findings and reassess in 1 hour. Continue to monitor the patient for heart failure. Withhold the next dose of furosemide. Check the patient for other symptoms of digitalis toxicity.

Check the patient for other symptoms of digitalis toxicity.

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

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

When monitoring a patient who is taking hydrochlorothiazide (HydroDIURIL), the nurse notes that which drug is most likely to cause a severe interaction with the diuretic? Select one: Penicillin Potassium supplements Aspirin Digitalis

Digitalis

When monitoring a patient who has diabetes and is receiving a carbonic anhydrase inhibitor for edema, the nurse will monitor for which possible adverse effect? Select one: Hyperkalemia Mental alertness Elevated blood glucose Metabolic alkalosis

Elevated blood glucose

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? Select one: Antidysrhythmic medications Heart transplantation End-of-life care Implantable mechanical assist devices

End-of-life care

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? Select one: Spironolactone (Aldactone) Digoxin (Lanoxin) ACE inhibitor Furosemide (Lasix)

Furosemide (Lasix)

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? Select one: Give the dose of digoxin and notify the provider of the potassium level. Request an order for a diuretic. Contact the provider to request an increased dose of digoxin. Withhold the dose and notify the provider of the heart rate.

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

A 79-year-old patient is taking a diuretic for treatment of hypertension. This patient is very independent and wants to continue to live at home. The nurse will know that which teaching point is important for this patient? Select one: If he feels dizzy while on this medication, he needs to stop taking it and take potassium supplements instead. He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls. He should take the diuretic with his evening meal. He should skip the diuretic dose if he plans to leave the house.

He needs to take extra precautions when standing up because of possible orthostatic hypotension and resulting injury from falls.

A patient with moderate heart failure begins taking a thiazide diuretic. The nurse will tell the patient to expect which outcome when taking this drug? Select one: Prolonged survival Improved exercise tolerance Prevention of cardiac remodeling Increased cardiac output

Improved exercise tolerance

A patient is being discharged to home on a single daily dose of a diuretic. The nurse instructs the patient to take the dose at which time so it will be least disruptive to the patient's daily routine? Select one: At bedtime In the morning With supper At noon

In the morning

When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient's fluid volume status? Select one: Measurements of abdominal girth and calf circumference Serum potassium and sodium levels Intake, output, and daily weight Blood pressure and pulse

Intake, output, and daily weight

Mannitol (Osmitrol) has been ordered for a patient with acute renal failure. The nurse will administer this drug using which procedure? Select one: Intravenously, through a filter By mouth in a single morning dose Through a gravity intravenous drip with standard tubing By rapid intravenous bolus

Intravenously, through a filter

A man asks a nurse why he cannot use digoxin (Lanoxin) for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not first-line therapy for which reason? Select one: It may actually shorten the patient's life expectancy. It does not correct the underlying pathology of heart failure. It has a wide therapeutic range that makes dosing difficult. It causes tachycardia and increases the cardiac workload.

It does not correct the underlying pathology of heart failure.

A patient in the neurologic intensive care unit is being treated for cerebral edema. Which class of diuretic is used to reduce intracranial pressure? Select one: Osmotic diuretics Vasodilators Loop diuretics Thiazide diuretics

Osmotic diuretics

When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about loop diuretics? Select one: They are not effective when the creatinine clearance decreases below 25 mL/min. They are very potent, having a diuretic effect that lasts at least 6 hours. They work by inhibiting aldosterone. They have a rapid onset of action and cause rapid diuresis.

They have a rapid onset of action and cause rapid diuresis.

A patient is started on a diuretic for antihypertensive therapy. The nurse expects that a drug in which class is likely to be used initially? Select one: Potassium-sparing diuretics Thiazide diuretics Osmotic diuretics Loop diuretics

Thiazide diuretics

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

assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute.

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: Select one: jugular vein distension. decreased urine output. increased blood pressure. shortness of breath.

decreased urine output

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: Select one: reducing the dose of digoxin. giving potassium supplements. discontinuing the quinidine. adding spironolactone (Aldactone).

discontinuing the quinidine.

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 make sure that the patient: Select one: uses a salt substitute instead of salt. monitors for a decreased heart rate. takes extra fluids. does not take potassium supplements.

does not take potassium supplements.

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: Select one: is showing signs of renal failure. has digoxin toxicity. is experiencing worsening of the disease. needs a potassium-sparing diuretic.

is experiencing worsening of the disease.

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: Select one: maximal exercise capacity. serum electrolyte levels. ejection fraction. complete blood count.

serum electrolyte levels.

The nurse will monitor a patient for signs and symptoms of hyperkalemia if the patient is taking which of these diuretics? Select one: acetazolamide (Diamox) furosemide (Lasix) spironolactone (Aldactone) hydrochlorothiazide (HydroDIURIL)

spironolactone (Aldactone)