Pharm WK 7 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? "If you experience weight gain, such as 5 pounds or more per week, be sure to tell your physician during your next routine visit." "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." "Take this medication in the evening." "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."
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? "Please come into the clinic for an evaluation to make sure there are no complications." "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." "It's important to try to stay on your prescribed medication. Try to take it with sips of water."
"Please come into the clinic for an evaluation to make sure there are no complications."
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: diuretics and digoxin. biventricular pacemakers. dietary supplements and exercise. ACE inhibitors and beta blockers.
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? Angiotensin II receptor blocker (ARB) Beta blocker Direct renin inhibitor (DRI) Aldosterone antagonist
Aldosterone antagonist
The potassium-sparing diuretic spironolactone (Aldactone) prolongs survival and improves heart failure symptoms by which mechanism? Reducing afterload Blocking aldosterone receptors Reducing venous pressure Increasing diuresis
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? Check the patient for other symptoms of digitalis toxicity. Document the findings and reassess in 1 hour. Withhold the next dose of furosemide. Continue to monitor the patient for heart failure.
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? Withhold the drug for an hour and reassess the level. Withhold the drug and notify the prescriber immediately. Check the patient's apical pulse, and if it is within a safe range, administer the digoxin. 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? Potassium supplements Digitalis Aspirin Penicillin
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? Mental alertness Metabolic alkalosis Hyperkalemia Elevated blood glucose
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? Heart transplantation Implantable mechanical assist devices Antidysrhythmic medications End-of-life care
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? Furosemide (Lasix) Digoxin (Lanoxin) Spironolactone (Aldactone) ACE inhibitor
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? Request an order for a diuretic. Contact the provider to request an increased dose of digoxin. Give the dose of digoxin and notify the provider of the potassium level. 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? He should take the diuretic with his evening meal. He should skip the diuretic dose if he plans to leave the house. 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 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? Improved exercise tolerance Increased cardiac output Prevention of cardiac remodeling Prolonged survival
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? In the morning With supper At noon At bedtime
In the morning
When a patient is receiving diuretic therapy, which of these assessment measures would best reflect the patient's fluid volume status? Intake, output, and daily weight Measurements of abdominal girth and calf circumference Blood pressure and pulse Serum potassium and sodium levels
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? 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? It causes tachycardia and increases the cardiac workload. It has a wide therapeutic range that makes dosing difficult. It may actually shorten the patient's life expectancy. It does not correct the underlying pathology of heart failure.
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? Vasodilators Osmotic diuretics Thiazide diuretics Loop diuretics
Osmotic diuretics
When reviewing the mechanisms of action of diuretics, the nurse knows that which statement is true about loop diuretics? They have a rapid onset of action and cause rapid diuresis. 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.
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? Potassium-sparing diuretics Thiazide diuretics Loop diuretics Osmotic diuretics
Thiazide diuretics
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? "When venous tone increases to increase ventricular filling, an increase in arterial pressure occurs." "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." "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."
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: request an order for a decreased dose of digoxin. assess the heart rate (HR) and give the dose if the HR is greater than 60 beats per minute. contact the provider to report digoxin toxicity. 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.
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: shortness of breath. increased blood pressure. decreased urine output. jugular vein distension.
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: adding spironolactone (Aldactone). discontinuing the quinidine. reducing the dose of digoxin. giving potassium supplements.
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: does not take potassium supplements. uses a salt substitute instead of salt. monitors for a decreased heart rate. takes extra fluids.
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: is experiencing worsening of the disease. is showing signs of renal failure. needs a potassium-sparing diuretic. has digoxin toxicity.
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: serum electrolyte levels. ejection fraction. maximal exercise capacity. 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? hydrochlorothiazide (HydroDIURIL) spironolactone (Aldactone) acetazolamide (Diamox) furosemide (Lasix)
spironolactone (Aldactone)
