Question 1

The nurse administers isosorbide dinitrate (Isordil, Coronex) sublingually to the client. What is the best instruction to give the client?

Accepted Answer

Isosorbide dinitrate is administered sublingually for rapid absorption, and the patient should not talk or drink while the tablet is dissolving to ensure the medication is fully absorbed through the oral mucosa.

Question 2

The client has heart failure and receives digoxin (Lanoxin). Prior to discharge, what will the best teaching plan of the nurse include?

Accepted Answer

Reporting weight gain of 1 or more kilos per day is important because it may indicate worsening heart failure and could be a sign of fluid retention. Missing a dose should not be made up with an extra dose and should be reported to the healthcare provider. Mental changes such as euphoria can be a sign of toxicity and should be immediately reported to the healthcare provider. Digoxin should not be stopped abruptly, even if the pulse rate is low, without instructions from a healthcare provider.

Question 3

The client receives enalapril (Vasotec) as treatment for heart failure. What is the best nursing assessment following the initial administration of this drug?

Accepted Answer

Enalapril belongs to a class of medications called ACE inhibitors, which are commonly used to manage heart failure. These drugs can cause a rapid and significant drop in blood pressure, especially after the first dose or during the first few days of treatment. Therefore, monitoring the client's blood pressure following the initial administration is important to detect any significant changes and adjust the dose as needed. While rashes, irregular pulse, and ototoxicity are also potential adverse effects of enalapril, they are less common and less urgent to assess in the immediate post-administration period.

Question 4

The client receives furosemide (Lasix) and digoxin (Lanoxin) together. Which laboratory findings will the nurse assess as increasing the client's risk for digoxin (Lanoxin) toxicity?

Accepted Answer

Furosemide (Lasix) is a loop diuretic that can cause hypokalemia and may increase the risk of digoxin toxicity, as hypokalemia enhances the effect of digoxin on the heart. Similarly, hypocalcemia can also increase the risk of digoxin toxicity. Hyponatremia, hypermagnesemia, hypercalcemia, and hyperkalemia are not known to increase the risk of digoxin toxicity.

Question 5

The nurse teaches the client about lisinopril (Zestril) and evaluates that additional teaching is required when the client makes which statement?

Accepted Answer

Blood tests may be required while taking lisinopril to ensure proper kidney function and electrolyte levels.

Question 6

The client has a history of cardiac disease and receives digoxin (Lanoxin). The nurse determines that education about dietary needs with this medication has been effective when the client makes which selection for lunch?

Accepted Answer

The best choice for the client taking digoxin would be baked fish, sweet potatoes, and banana pudding. This is because digoxin can interact with certain foods, such as those high in fiber, and increase the risk of digoxin toxicity. The other options contain foods that are high in fiber (option A), contain dairy products that can interfere with digoxin absorption (option B), or contain high amounts of fat and sodium (option C).

Question 7

The client will receive an IV infusion of milrinone (Apo -Milrinone) as treatment for acute heart failure. What is the priority plan of the nurse?

Accepted Answer

Milrinone can cause potentially serious cardiac arrhythmias, so continuous ECG monitoring is essential to detect any changes in the heart's rhythm. Monitoring for hypertension and taking vital signs are important but not the priority over continuous ECG monitoring. Monitoring for atrial fibrillation may be important, but it is secondary to the need for continuous ECG monitoring.

Question 8

The client has hypertension and asks the nurse how this can lead to heart failure. What is the best response by the nurse?

Accepted Answer

Hypertension causes resistance in blood vessels, specifically the peripheral arteries. This increased afterload makes it harder for the heart to pump blood out to the body. Over time, this increased workload can lead to left ventricular hypertrophy (enlargement of the heart muscle) and eventually heart failure.

Question 9

The client comes to the emergency department complaining of coughing and difficulty breathing. The client's diagnosis is heart failure. He asks the nurse how difficulty breathing could be a heart problem. What is the best response by the nurse? Select all that apply.

Accepted Answer

When the left side of the heart weakens, it can lead to pulmonary congestion as blood backs up into the lungs, causing difficulty breathing. Congestive heart failure is a common term used to describe this condition.

Question 10

The nurse volunteers at a senior citizen centre. The nurse assesses which senior citizen as having the greatest risk of developing heart failure?

Accepted Answer

Hypertension is a major risk factor for heart failure, and the 69-year-old aboriginal male with hypertension has the highest risk among the given options. The other options may also have some risks for heart failure, but they are not as high as having hypertension.

Question 11

The client receives digoxin (Lanoxin). Which assessment findings would indicate adverse effects to this medication?

Accepted Answer

Anorexia and nausea are common adverse effects of digoxin toxicity, along with vomiting, abdominal pain, and visual disturbances (not specifically blurred vision or tachycardia as primary symptoms).

Question 12

The client receives captopril (Capoten) as treatment for heart failure. Which adverse effect will the nurse plan to report to the physician?

Accepted Answer

Captopril is an angiotensin-converting enzyme (ACE) inhibitor that can cause a persistent cough due to the accumulation of bradykinin. This adverse effect needs to be reported to the physician, as it can affect the quality of life for the client and can be a reason to discontinue the medication. Diarrhea, dehydration, and facial flushing are also possible adverse effects of captopril, but they are less severe and may not warrant immediate reporting to the physician.

Question 13

The nurse teaches the client about digoxin (Lanoxin) toxicity and determines that learning has occurred when the client makes which statement(s)? Select all that apply.

Accepted Answer

The answer of The nurse teaches the client about digoxin...

Question 14

The client takes insulin for diabetes mellitus. The physician orders metoprolol (Lopresor) for hypertension. After medication teaching, the nurse determines that learning has occurred when the client makes which statement?

Accepted Answer

Metoprolol can mask the symptoms of hypoglycemia, so the client will need to monitor blood sugar more frequently to avoid this risk. Metoprolol can also cause a decrease in insulin production by the pancreas, so the client may need less insulin, but not more. It is not appropriate to switch from insulin to a pill without further evaluation and management by the physician.

Question 15

The physician orders metoprolol (Lopresor) for several clients. The nurse will hold the medication and contact the physician for which client?

Accepted Answer

Metoprolol is a beta-blocker and can cause bronchoconstriction, so it should be avoided or used with caution in clients with a history of respiratory issues, such as chronic bronchitis. The medication may be safe to administer to clients with an apical pulse rate of 100, compensated heart failure, and a history of migraines, but each of these clients should be assessed and monitored carefully.

Quiz 24: Drugs for Heart Failure