Deck 48: Drugs for Heart Failure

Question 1

A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats/min, 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?

A) ACE inhibitor
B) Digoxin [Lanoxin]
C) Furosemide [Lasix]
D) Spironolactone [Aldactone]

Answer 1

Furosemide [Lasix]

Question 2

A patient is recovering from a myocardial infarction but does not have symptoms of heart failure. The nurse will expect to teach this patient about:

A) ACE inhibitors and beta blockers.
B) biventricular pacemakers.
C) dietary supplements and exercise.
D) diuretics and digoxin.

Answer 2

ACE inhibitors and beta blockers.

Question 3

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/min, 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:

A) has digoxin toxicity.
B) is showing signs of renal failure.
C) is experiencing worsening of the disease.
D) needs a potassium-sparing diuretic.

Answer 3

is experiencing worsening of the disease.

Question 4

A patient 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 the first-line therapy for which reason?

A) It causes tachycardia and increases the cardiac workload.
B) It does not correct the underlying pathology of heart failure.
C) It has a wide therapeutic range that makes dosing difficult.
D) It may actually shorten the patient's life expectancy.

Question 5

Which are expected effects of cardiac glycosides?

A) Decreased cardiac output
B) Decreased force of contraction
C) Decreased heart rate
D) Modulation of neurohormonal systems
E) Positive inotropic effects

Question 6

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?

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

Question 7

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:

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

Question 8

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?

A) Withhold the drug for an hour and reassess the level.
B) Withhold the drug and notify the prescriber immediately.
C) Administer Digibind to counteract the toxicity.
D) Check the patient's apical pulse, and if it is within a safe range, administer the digoxin.

Question 9

A nurse is preparing to administer digoxin [Lanoxin] to a patient. The patient's heart rate is 62 beats/min, 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?

A) Contact the provider to request an increased dose of digoxin.
B) Give the dose of digoxin and notify the provider of the potassium level.
C) Request an order for a diuretic.
D) Withhold the dose and notify the provider of the heart rate.

Question 10

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?

A) Antidysrhythmic medications
B) End-of-life care
C) Heart transplantation
D) Implantable mechanical assist devices

Question 11

A patient newly diagnosed with heart failure is admitted to the hospital. The nurse notes a pulse of 90 beats/min. The nurse will observe this patient closely for:

A) decreased urine output.
B) increased blood pressure.
C) jugular vein distension.
D) shortness of breath.

Question 12

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:

A) complete blood count.
B) ejection fraction.
C) maximal exercise capacity.
D) serum electrolyte levels.

Question 13

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 instruct the patient to:

A) avoid potassium supplements.
B) monitor for a decreased heart rate.
C) take extra fluids.
D) use a salt substitute instead of salt.

Question 14

Which medications are included in first-line therapy for heart failure?

A) Agents that inhibit the renin-angiotensin-aldosterone system (RAAS)
B) Aldosterone antagonists
C) Beta blockers
D) Cardiac glycosides
E) Diuretics

Question 15

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?

A) Check the patient for other symptoms of digitalis toxicity.
B) Withhold the next dose of furosemide.
C) Continue to monitor the patient for heart failure.
D) Document the findings and reassess in 1 hour.

Question 16

The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival and improves heart failure symptoms by which mechanism?

A) Blocking aldosterone receptors
B) Increasing diuresis
C) Reducing venous pressure
D) Reducing afterload

Question 17

A patient is taking enalapril [Vasotec]. The nurse understands that patients taking this type of drug for heart failure need to be monitored carefully for:

A) hypernatremia.
B) hypertension.
C) hyperkalemia.
D) hypokalemia.

Question 18

A patient with volume overload begins taking a thiazide diuretic. The nurse will tell the patient to expect which outcome when taking this drug?

A) Improved exercise tolerance
B) Increased cardiac output
C) Prevention of cardiac remodeling
D) Prolonged survival

Question 19

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?

A) Aldosterone antagonist
B) Angiotensin II receptor blocker (ARB)
C) Beta blocker
D) Direct renin inhibitor (DRI)

Question 20

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:

A) adding spironolactone [Aldactone].
B) reducing the dose of digoxin.
C) discontinuing the quinidine.
D) giving potassium supplements.