Deck 27: Drugs for Heart Failure

Question 1

Lisinopril (Prinivil) is often used to treat heart failure because it lowers blood volume. Which statement best explains how lisinopril lowers blood volume?

A) It has an antagonistic effect on angiotensin-converting enzyme.
B) It lowers aldosterone secretion, a hormone that increases sodium reabsorption.
C) It causes hypernatremia and increased renal tubule permeability, resulting in a diuretic effect.
D) It causes a diuretic effect by lowering the amount of sodium lost in the urine.

Answer 1

It lowers aldosterone secretion, a hormone that increases sodium reabsorption.

Question 2

Which statement is accurate regarding the use of beta-adrenergic blockers for use in patients with heart failure?

A) Higher doses are used initially until optimal vital signs are achieved.
B) Dosage changes are done on a daily basis for the first 2 weeks.
C) This drug class does not have an effect on the bronchioles of the lungs.
D) They are generally used in combination with other heart-failure drugs.

Answer 2

They are generally used in combination with other heart-failure drugs.

Question 3

The patient who is prescribed furosemide (Lasix) and digoxin (Lanoxin) reports using an over-the-counter antacid for recurrent heartburn. The nurse would assess for which result?

A) Hyponatremia
B) Hypermagnesemia
C) Increased effectiveness of furosemide (Lanoxin)
D) Decreased effectiveness of digoxin (Lanoxin)

Answer 3

Decreased effectiveness of digoxin (Lanoxin)

Question 4

Which individual listed below would be at the greatest risk for developing heart disease?

A) 35-year-old with diabetes mellitus and prehypertension
B) 75-year-old with Parkinson's disease and normal blood pressure
C) 52-year-old with osteoporosis and stage 1 hypertension
D) 68-year-old with stage 2 hypertension and recent myocardial infarction

Question 5

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

A) A 50-year-old African American female who smokes
B) A 75-year-old Caucasian male who is overweight
C) A 69-year-old African American male with hypertension
D) A 52-year-old Caucasian female with asthma

Question 6

Which medication would be of most help to increase myocardial contractility in a patient with heart failure?

A) Digoxin (Lanoxin)
B) Lisinopril (Prinivil)
C) Carvedilol (Coreg)
D) Furosemide (Lasix)

Question 7

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

A) "I will monitor my blood pressure until my next appointment."
B) "I will avoid using salt substitutes for seasoning."
C) "It takes a while for this medication to take effect."
D) "I don't need to worry about having blood tests done."

Question 8

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

A) "I might not need to check my blood sugars as often with metoprolol (Lopressor)."
B) "I might be able to change from insulin to a pill with metoprolol (Lopressor)."
C) "I might need less insulin when I take metoprolol (Lopressor)."
D) "I might need more insulin when I take metoprolol (Lopressor)."

Question 9

Which statement is accurate regarding the physiological changes associated with heart failure?

A) Blood backs up into the lungs due to right ventricular hypertrophy.
B) The walls of the heart shrink, leading to lower cardiac output.
C) Cardiac remodeling occurs after prolonged ventricular hypertrophy.
D) Blood pressure increases, resulting in lowered afterload.

Question 10

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

A) The patient develops a cough.
B) The patient develops diarrhea.
C) The patient develops dehydration.
D) The patient develops facial flushing.

Question 11

The patient comes to the emergency department complaining of coughing and difficulty breathing. The patient'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?

A) "The right side of your heart has weakened and blood has entered your lungs."
B) "The right side of your heart has enlarged and cannot effectively pump blood."
C) "What you have is called congestive heart failure."
D) "The left side of your heart is weak and pumps blood too quickly."
E) "The left side of your heart has weakened and blood has entered your lungs."

Question 12

The nurse teaches the patient about digoxin (Lanoxin) toxicity and determines that learning has occurred when the patient makes which statements?

A) "I should limit my fluids while taking this medication."
B) "It is okay to keep taking my ginseng."
C) "If I have nausea, it means I must stop the medication."
D) "I can drink orange juice every morning."
E) "I must check my pulse and not take the medication if it is less than 60."

Question 13

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

A) "Hypertension causes resistance in your blood vessels, or afterload; your heart works harder, and weakens."
B) "Hypertension limits the ability of your heart to stretch before emptying, or afterload; your heart works harder, and weakens."
C) "Hypertension causes resistance in your aorta, or afterload; your heart works harder and weakens."
D) "Hypertension limits the amount of blood entering your left ventricle, or afterload; your heart works harder, and weakens."

Question 14

Which situation would lead to an increase in cardiac output?

A) Reduced cardiac contractility
B) Hypovolemia
C) Peripheral vascular resistance
D) Increase in preload

Question 15

The physician orders metoprolol (Toprol-XL) for several patients. The nurse will most closely monitor the effects of this drug on which patient?

A) The patient with an apical pulse rate of 100
B) The patient with compensated heart failure
C) The patient with chronic bronchitis
D) The patient with a history of migraines

Question 16

The patient will receive an IV infusion of milrinone (Primacor) as treatment for acute heart failure. What is the priority plan by the nurse?

A) Plan to monitor for atrial fibrillation.
B) Plan to monitor the ECG continuously.
C) Plan to take vital signs every 15 minutes.
D) Plan to monitor for hypertension.

Question 17

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

A) Tachycardia and hypotension
B) Blurred vision and tachycardia
C) Anorexia and nausea
D) Anorexia and constipation

Question 18

The patient 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 patient makes which selection for lunch?

A) Cottage cheese, peach salad, and blueberry pie
B) Baked fish, sweet potatoes, and banana pudding
C) Green bean soup, whole-wheat bread, and an apple
D) Hamburger, French fries, and chocolate chip cookies

Question 19

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

A) Assess the patient for ototoxicity.
B) Assess the patient's blood pressure.
C) Assess the patient for an irregular pulse.
D) Assess the patient for a serious rash.

Question 20

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

A) "Report development of a metallic taste in the mouth."
B) "Report mental changes such as depression."
C) "Stop the medication if your pulse is irregular."
D) "If you miss a dose, take two doses."

Question 21

The nurse is caring for a patient with heart failure. Which assessment findings indicate the patient is currently experiencing class 2 heart failure?

A) Fatigue with physical activity
B) Palpitations with physical activity
C) No symptoms with physical activity
D) Dyspnea with physical activity
E) Angina at rest

Question 22

A nurse has been assigned to provide care for a patient who has class IV heart failure. Which nursing interventions are indicated?

A) Assist nursing support personnel with the patient's bed bath.
B) Accompany the patient on a walk to the courtyard.
C) Monitor that the patient's position is changed every 2 hours.
D) Take vital signs before and after physical therapy weight-bearing exercises.
E) Assist the patient with meals as indicated.

Question 23

Which is the most serious adverse effect associated with milrinone (Primacor)?

A) Ventricular dysrhythmia
B) Nausea
C) Headache
D) Atrial dysrhythmia

Question 24

The nurse is caring for a patient being treated pharmacologically for heart failure. Which laboratory values is the nurse careful to monitor during treatment?

A) Potassium levels
B) BUN
C) Creatinine
D) Liver function tests
E) Serum drug levels

Question 25

The nurse is caring for a patient who has been diagnosed with heart failure. The nurse knows that which conditions may have contributed to the development of heart failure in this patient?

A) Uncontrolled hypertension
B) Coronary artery disease (CAD)
C) Diabetes (DM)
D) HIV
E) Mitral stenosis

Question 26

Which vital sign is of greatest concern to the nurse prior to administering digoxin (Lanoxin)?

A) Heart rate
B) Temperature
C) Blood pressure
D) Respiratory rate

Question 27

The nurse is caring for a patient who is being treated pharmacologically for the symptoms of heart failure. What would be included in the nurse's role of pharmacologic management of this patient?

A) Teaching the patient how to space medications to decrease adverse effects
B) Teaching the patient the long-term benefits of beta blockers
C) Continually monitoring the patient during IV infusions
D) Decreasing medication dosages when the patient complains of adverse effects
E) Changing a medication that is no longer working to decrease the patient's symptoms

Question 28

The nurse is concerned that a patient is developing right heart failure. What did the nurse assess in this patient?

A) Ankle edema
B) Enlarged liver
C) Displaced apical heart rate
D) Shortness of breath
E) Cough

Question 29

The nurse is educating a patient diagnosed with heart failure (HF). The nurse knows that instruction regarding compensatory mechanisms has been effective when the patient states,

A) "My heart enlarged in order to compensate for the effects of heart failure."
B) "My nervous system kicks in to compensate for the effects of heart failure."
C) "My body will decrease blood flow to other organs in order to compensate for heart failure."
D) "My body will increase urine output in order to compensate for the effects of heart failure."
E) "My body will produce anti-inflammatory agents to compensate for heart failure."

Question 30

A patient says, "Ever since I changed jobs I just don't feel as good. I think my heart medicine is not working." What nursing assessment questions are priority?

A) "How well are you sleeping?"
B) "How did your new job change your work schedule?"
C) "How did your new job change your insurance coverage?"
D) "How has your job change affected your home life?"
E) "In what way do you not feel as well?"