Chapter 24 Heart Failure

Question 1

Heart failure is a clinical syndrome caused by numerous

cardiac disorders. It is a pathologic state in which the heart is unable to?

Answer 1

pump blood in sufficient amounts from the ventricles to meet the body’s metabolic needs, or can do so only at elevated filling pressures. The signs and symptoms typically associated with this insufficiency make up the syndrome of heart failure.

Question 2

Heart failure occurs due to a?

Answer 2

reduced ratio of ejection fraction to left ventricular end-diastolic volume.

Question 3

The physical defects causing heart failure are of two types:

Answer 3

(1) a myocardial defect such as myocardial infarction or
valve insufficiency, which leads to inadequate cardiac contractility and ventricular filling
(2) a defect outside the myocardium (e.g., coronary artery disease, pulmonary hypertension, or diabetes), which results in an overload on an otherwise normal heart.

Question 4

The best way to prevent heart failure is to control risk factors associated with heart failure including?

Answer 4

hypertension, coronary artery disease, obesity, and diabetes.

Question 5

(An inotrope is an agent that alters the force or energy of muscular contractions)

• Inotropic drugs affect the force of myocardial contraction
  1) positive inotropics
  2) negative inotropics

Answer 5

• positive inotropics (e.g., digoxin) increase the force of contractions,
• negative inotropics (e.g., beta blockers, calcium channel blockers) decrease myocardial contractility.

Question 6

Chronotropics affect heart rate per minute, with positive

chronotropics and negative chronotropics

Answer 6

• positive chronotropics increasing heart rate

- negative chronotropics decreasing the heart rate

Question 7

Dromotropic drugs affect the conduction of electrical
impulses through the heart;
- positive dromotropic drugs
-negative dromotropic drugs

Answer 7

• positive dromotropic drugs increase the speed of electrical impulses through the heart
• negative dromotropic drugs have the opposite effect.

Question 8

Be aware of the important physiologic concepts such as ejection fraction. A patient’s ejection fraction reflects the?

Answer 8

contractility of the heart and is about 65% (0.65) in a normal heart. This value decreases as heart failure progresses; therefore, patients with heart failure have low ejection fractions because their hearts are failing to pump effectively.

Question 9

American Heart Association and American College of Cardiology Guidelines for the Diagnosis and Management of Heart Failure in Adults (2005, updated in 2013) approach to the treatment of chronic heart failure revolves around?

Answer 9

reducing the effects of the renin-angiotensin-aldosterone system and the sympathetic nervous system (SNS).

Question 10

Drugs of choice at the start of therapy are?

Answer 10

1) angiotensin converting enzyme (ACE) inhibitors (lisinopril, enalapril, captopril, and others)
2) angiotensin receptor blocker (ARBs; valsartan, candesartan, losartan, and others)
3) certain beta blockers (metoprolol, a cardioselective beta blocker; carvedilol, a nonspecific beta blocker).

Question 11

Loop diuretics (furosemide) are used to?

Answer 11

reduce the symptoms of heart failure secondary to fluid overload, and the aldosterone inhibitors (spironolactone, eplerenone) are added as the heart failure progresses.

Question 12

The newest class of medications for heart failure, the B-
type natriuretic peptides, currently includes only one drug

Answer 12

nesiritide.

Question 13

Nesiritide is a synthetic B-type natriuretic hormone that has what effects?

Answer 13

vasodilating effects on both arteries and veins. This vasodilation takes place in the heart itself and throughout the body.
The effects of nesiritide have been shown to include diuresis, natriuresis (urinary sodium loss), and vasodilation. These properties lead to an indirect increase in cardiac output and suppression of neurohormonal systems such as the renin-angiotensin system.

Question 14

Nesiritide is a synthetic version of human B-type natriuretic peptide. B-type natriuretic peptide (BNP) is a stubstance secreted from the ventricles of the heart in response to changes in pressure that occur when heart failure develops. The level of BNP in the blood increases when heart failure symptoms worsen. Nesiritide is a synthetic b-type natriuretic hormone that is used in the?

Answer 14

intensive care setting as a final effort to treat severe, life-threatening heart failure, often in combination with several other cardiostimulatory medications. Its use is no longer recommended as a first-line drug for heart failure due to worsened renal function and mortality reported

Question 15

Nesiritide-human B-type natriuretic peptide contraindication

Answer 15

known drug allergy, not recommended for use in pt’s with low cardiac filling pressures

Question 16

Nesiritide-B-type natriuretic peptide AEs

Answer 16

hypotension, cardiac dysrhythmias, insomnia, HA, abdominal pain

Question 17

Nesiritide-B-type natriuretic peptide Interactions

Answer 17

additive hypotensive effects w/coadministration w/ACE inhibitors & diuretics

Question 18

Phosphodiesterase inhibitors (PDIs) are a group of inotropic drugs that work by?

Answer 18

inhibiting the action of an enzyme called phosphodiesterase

Question 19

Phosphodiesterase inhibitors (PDIs) drug

Answer 19

Presently milrinone (Primacor) is the only drug in this category available in the United States.

Question 20

Phosphodiesterase inhibitors (PDIs) mechanism of action

Answer 20

Differs from other inotropic drugs such as digoxin and the catecholamines.
-Inhibit action of phosphodiesterase, resulting in an increase in intracellular cyclic adenosine monophosphate (cAMP). However milrinone is more specific for phosphodiesterase type III, which is common in the heart and vascular smooth muscles

Question 21

Milrinone causes an intracellular increase in cyclic adenosine monophosphate (cAMP), which results in two beneficial effects in a patient with heart failure

Answer 21

(1) a positive inotropic response

2) vasodilation. For this reason, this class of drugs may also be referred to as inodilators (inotropics and dilators

Question 22

Milrinone has a 10-100 times greater affinity for?

Answer 22

Smooth muscle fibers surrounding pulmonary and systemic blood vessels than they do for cardiac muscle. This suggests that the primary beneficial effects of inodilators come from their vasodilating effects, causing a reduction in the force against which the heart must pump to eject its volume of blood

Question 23

Inhibition of phosphodiesterase results in the?

Answer 23

Availability of more Ca+ for myocardial muscle contraction>increase in force of contraction (positive inotropic effect)

• increased Ca+ present in heart muscle is taken back up into its storage sties at faster rate than normal. As a result, the heart muscle relaxes more than normal and is also more compliant
• PDIs have positive inotropic and vasodilatory effects. May also increase HR in some instances & therefore may also have positive chronotropic effects as well

Question 24

Phosphodiesterase Inhibitors (PDIs) are primarily used in?

Answer 24

the intensive care setting for the short-term management of acute heart failure
-Not recommended for long-term infusion

Question 25

Phosphodiesterase Inhibitors (PDIs) Contraindications

Answer 25

- known drug allergy - severe aortic or pulmonary valvular disease - heart failure resulting from diastolic dysfunction

Question 26

Phosphodiesterase Inhibitors (PDIs) Adverse effects

Answer 26

ventricular dysrhythmia - Milrinone-induced dysrhythmias are mainly ventricular. Ventricular dysrhythmias occur in approximately 12% of pt's treated w/this drug - hypotension, angina (chest pain), hypokalemia, thremor, thrombocytopenia, elevated liver enzymes

Question 27

Phosphodiesterase Inhibitors (PDIs) Toxicity and Management

Answer 27

- No antidote - hypotension secondary to vasodilation seen w/excessive doses - Recommendation is to reduce dosage or temporarily discontinue drug of excessive hypotension occurs. Do this until pt's condition stabilizes - can also start initiation of general measures for circulatory support

Question 28

Phosphodiesterase Inhibitors (PDIs) Interactions

Answer 28

1) Concurrent administration of diuretics may cause significant hypovolemia and reduced cardiac filling pressure. Appropriately monitor the patient in an intensive care setting to detect and respond to these problems. 2) Additive inotropic effects may be seen w/coadministration of digoxin 3) Furosemide (Loop) must NOT be injected into IV lines with milrinone because it will precipitate immediately

Question 29

Nursing Process for heart failure drugs: • Perform a thorough assessment, including assessment of the patient’s past and present medical history, drug allergies, and family medical history with emphasis on?

Answer 29

history of cardiac, hypertensive, or renal diseases.

Question 30

ACE Inhibitors require thorough assessment of cautions, contraindications, and drug interactions. What is an adverse effect?

Answer 30

Hyperkalemia is an adverse effect; therefore, perform an assessment of serum potassium before giving these drugs and administer potassium supplementation and/or potassium- sparing diuretics with caution.

Question 31

Assess respiratory history, specifically any previous problems of?

Answer 31

cough. ACE inhibitors may cause a dry cough, which is | not harmful but may be annoying. Pt's may be switched to ARB (Valsartan) if cough becomes problematic

Question 32

Metoprolol is the beta blocker most commonly used to Tx heart failure. Carvedilol also has many therapeutic effects & is commonly added to existing regimens of digoxin, furosemide (loop), & ACE inhibitors in management of heart failure. Dobutamine, a beta 1 selective adrenergic is also used to treat heart failure. The status of the pt's veins is important to assess when this drug is indicated because?

Answer 32

It is only given IV

Question 33

Aldosterone antagonists, such as spironolactone (potassium sparing) and eplerenone, require close assessment of?

Answer 33

heart and breath sounds as well as for the occurrence of edema, a known adverse effect.

Question 34

Hydralazine/isosorbide dinitrate is used mainly in?

Answer 34

African American patients

Question 35

B-type natriuretic peptides, includes the drug nesiritide. Carefully assess?

Answer 35

All body functions, especially cardiac function, with attention to heart sounds, BP, pulse rate, presence of any cardiac dysrhythmias, hypotension, insomnia, and HA. May be exacerbated with this drug

Question 36

It is always important to assess support systems at home, | because?

Answer 36

safe and effective therapy depends on close observation, monitoring of appropriate parameters (e.g., daily weight), attention to patient complaints, and evaluation of how the patient is feeling and functioning.

Question 37

With milrinone, a phosphodiesterase inhibitor, closely monitor what?

Answer 37

cardiac status, which is critical to patient safety. These patients are usually in the ICU setting and require frequent assessment of heart sounds, vital signs, and any evidence of ventricular dysrhythmias on ECG readings - assess also for any history of angina, hypotension, and hypokalemia which may be exacerbated with this drug - significant drug interactions include parenteral furosemide that precipitates immediately if milrinone is present in the IV lines

Question 38

Before giving digoxin, closely monitor the?

Answer 38

apical pulse rate and serum electrolytes, especially potassium levels because low levels or hypokalemia may precipitate toxicity.

Question 39

Hypokalemia is manifested by?

Answer 39

muscle weakness, confusion, lethargy, anorexia, nausea, changes in ECG

Question 40

Low levels of magnesium or hypmagnesemia may also precipitate?

Answer 40

Digoxin toxicity

Question 41

Hypomagnesia is manifested by?

Answer 41

agitation, twitching, hyperactive reflexes, nauseua, vomiting, ECG changes

Question 42

You need to Digoxin levels once administered because of?

Answer 42

The narrow range between the therapeutic and toxic levels of digoxin (low therapeutic index) -measure and document a baseline weight before therapy begins as well as during therapy

Question 43

For the nursing assessment with heart failure drugs perform a careful assessment of

Answer 43

1) Neurologic system: note any history of HA, fatigue, confusion, and/or seizures; assess level of alertness & orientation to person, place, and time 2) GI system: document any changes in appetite (decreased) and/or complaints of diarrhea, N/V 3) Cardiac system: note history of irregularities or other cardiac manifestations; assess pulse for rate lower than 60 or higher than 100; assess baseline BP, note any hypotensive or hypertensive; ausculate heart sounds for extra or abnormal heart sounds and not any abnormal ECG findings 4) Visual and sensory system: document baseline vision as well as any changes in vision, such as GREEN, YELLOW, or PURPLE halo surrounding the peripheral field of vision

Question 44

Hydralazine/isosorbide dinitrate must be used with extreme caution because of the associated?

Answer 44

Syncope. If this occurs the drug will most likely be discontinued -monitor BP & other vital signs, especially the first few doses

Question 45

Nesiritide is strictly used in an intensive care setting in very ill patients who are experiencing acute decompensated heart failure and receiving continuous cardiac monitoring. While the drug is being administered intravenously, monitor the patient for?

Answer 45

all of its severe adverse effects, such as hypotension, dysrhythmias, headache, and abdominal pain. Avoid co-administration of drugs that decrease the patient’s blood pressure, such as ACE inhibitors and diuretics, if at all possible.

Question 46

Always check for compatibility of solutions when giving the?

Answer 46

PDI milrinone. Recognize that hypotension, dysrhythmias, and thrombocytopenia are major adverse effects of milrinone. -Record intake and output, heart rate, blood pressure, daily weight, respiration rate, and heart and breath sounds. Report any evidence of hypokalemia to the prescriber immediately, and monitor the patient closely.

Question 47

When heart failure drugs, such as digoxin, milrinone, and | digoxin immune Fab, are administered parenterally, use an?

Answer 47

infusion pump unless the order is to administer them as an intravenous push.

Question 48

Monitoring patients after the administration of drugs to improve heart contractility, or positive inotropic drugs, is critical for identifying?

Answer 48

therapeutic effects and adverse effects.

Question 49

The therapeutic effects of these drugs include?

Answer 49

increased urinary output, decreased edema, decreased dyspnea and crackles, decreased fatigue, resolution of paroxysmal nocturnal dyspnea, and improved peripheral pulses, skin color, and temperature.

Question 50

Before administering any dose of the cardiac glycoside digoxin, check the?

Answer 50

- Serum potassium and magnesium levels to be sure that they are w/in normal limits to help limit/prevent toxicity - measure apical pulse rate for 1 full min. If lower than 60 or higher than 100, withhold medication & notify prescriber - contact prescriber if patient experiences s/s of digoxin toxicity: HA, dizziness, confusion, nausea, visual disturbances (yellow-green halo or blurred vision) - ECG changes in pt w/digoxin toxicity shows: heart block, atrial tachycardia w/block, or ventricular dysrhythmias

Question 51

Oral digoxin may be administered with meals but NOT with foods high in?

Answer 51

Fiber (bran), because the fiber will bind to the digitalis and lead to altered absorption/bioavailability of the drug

Question 52

If digoxin medication is to be given IV what are the following interventions that are critical to patient safety?

Answer 52

1) infuse undiluted IV forms at around 0.25 mg/min or over longer than a 5 minute period, or as per health care institution protocol 2) administration of intramuscular forms of cardiac glycosides is extremely painful & NOT indicated or recommended and may lead to tissue necrosis and erratic absorption 3) Digoxin incompatible with many other medications in solution or syringe, so ALWAYS double check compatibility before parenteral administration

Question 53

Although digitalization is not commonly used in contemporary practice, it may be performed in some areas of pracitice for management of heart failure. Rapid digitalization (to achieve faster onset of action) is generally reserved for patients who have?

Answer 53

Heart failure and are in acute distress. Such pt's are hospitalized because digitalis toxicities can appear quickly & directly correlated with the high drug concentrations used. -continuously observe pt w/frequent measurement of VS & serum drug as well as serum potassium levels

Question 54

Slow digitalsis (rarely used) is generally performed on an?

Answer 54

Outpatient basis in pt's w/heart failure not in acute distress - advantages: can be performed in an outpatient basis, oral dosages used, safer than rapid - disadvantages: longer time to see therapeutic effects, toxicity symptoms gradually happen so they are insidious

Question 55

If toxicity occurs and digoxin rises to a life-threatening level, what should the nurse do?

Answer 55

Administer the antidote, digoxin immune Fab, as ordered - it is given parenterally over 30 minutes and in some scenarios it is given as an IV bolus - all vials of drug refrigerated - drug stable for 4 hours AFTER being mixed; use immediately, if not used w/in 4 hours discard - one vial of digoxin immune fab binds 0.5mg of digoxin - check compatible solutions for dilution PRIOR to infusion of the antidote - closely monitor BP, apical pulse rate & rhythm, electrocardiogram, & serum potassium levels - document baseline data & observe for changes in assessment findings: muscle strength, occurrence of tremors & muscle cramping, changes in mental status, irregular cardiac rhythms, confusion, thirst, cold, clammy skin

Question 56

Patient education for digoxin

Answer 56

1) instruct how to take radial pulse BEFORE each dose 2) Daily weights same time every morning w/exact amount of clothing 3) for older adult/mentally challenged, important for home healthcare to supervise medication regimen. Important because they are at risk for AEs, toxicity, drug interactions 4) if pulse rate below 60 or is erratic or if above 100 or if there is anorexia, N/V, contact provider 5) Report: palpitations, or feeling of racing heart, change in HR and/or irregular HR, occurrence of dizziness or fainting, any changes in vision, & weight gain (2lbs/day or 5lbs/week)

Question 57

Digoxin is usually taken once a day. Patient education for how to take Digoxin.

Answer 57

1) Take at same time every day 2) if miss a dose, take omitted dose if NO MORE than 12 hrs have passed from the time the drug was to have been taken 3) instruct that if MORE than 12 hrs have passed, patient should NOT skip the dose, NOT double up the next dose, & contact prescriber

Question 58

NEVER abruptly stop any medications taken for heart failure

Answer 58

.

Question 59

If potassium depleting diuretics are being taken as part of the therapy, encourage the pt to?

Answer 59

Consume food high in potassium & to report any weakness, fatigue, or lethargy. Any worsening of dizziness, dyspnea, or occurrance of unusual problems should be reported

Question 60

With medication regimens for heart failure, what foods should patients avoid?

Answer 60

Antacids, or eating ice cream, milk products, yogurt, cheese (dairy products), or bran for 2 hours BEFORE or 2 hours AFTER taking medication to avoid interference w/absorption of the oral dosage forms of these medications

Question 61

Recognize major AEs of milrinone

Answer 61

Hypotension, dysrhythmias, thrombocytopenia

Question 62

Keep informed of the contraindications to the use of digoxin, which include?

Answer 62

History of allergy to digitalis medications, ventricular tachycardia and fibrillations, and AV block

Question 63

Hydralazine/isosorbide dinitrate

Answer 63

- approved for ethnic group (African Americans) | - combination of two older drugs contains 37.5 mg of hydralazine and 20 mg of isosorbide dinitrate

Question 64

Cardiac glycosides (sometimes referred to as digitalis glycosides) are beneficial for?

Answer 64

Failing heart and help control the ventricular response to atrial fibrillation

Question 65

The beneficial effect of digoxin is thought to be an?

Answer 65

Increase in myocardial contractility (positive inotropic effect). This occurs secondarily to the inhibition of the sodium-potassium adenosine triphosphatase pump. When the action of this enzyme-complex is inhibited , the cellular sodium and calcium concentrations increase. Overall result=enhanced myocardial contractility

Question 66

Digoxin also augments cholinergic (or parasympathetic) stimulation via the vagus nerve of the parasympathetic nervous system. Commonly referred to as vagal tone & results in?

Answer 66

Increased diastolic filling between heartbeats secondary to reduced HR. Vagal tone also believed to sensitize cardiac baroreceptors, reducing sympathetic stimulation from CNS

Question 67

The beneficial effect of digoxin is thought to be an increase in?

Answer 67

myocardial contractility—known as a positive inotropic effect. Digoxin decreases the velocity (rate) of electrical conduction and prolongs the refractory period in the conduction system. - occurs SA node to AV node - cardiac cells remain in state of depolorization longer & are unable to start another electrical impulse, which also reduces HR & improves cardiac efficiency

Question 68

The common undesirable effects associated with digoxin use are?

Answer 68

cardiovascular, central nervous system, ocular, and gastrointestinal effects.

Question 69

Digoxin is primarily used in the treatment of?

Answer 69

systolic heart failure and atrial fibrillation. -The latest heart failure treatment guidelines recommend that digoxin be used as an adjunct to drugs of other classes, including beta blockers, diuretics, ACE inhibitors, and ARBs.

Question 70

Contraindications for Digoxin

Answer 70

Known drug allergy 2 or 3rd heart block ventricular fibrillation heart failure resulting from diastolic dysfunction

Question 71

Toxicity and management of overdose for digoxin (Cardiac Glycoside)

Answer 71

- Low therapeutic index - digoxin levels monitored when pt first starts taking drug, once drug reaches steady state, monitor if suspicion of toxicity, non compliance, or deteriorating renal function - normal therapeutic levels of digoxin: 0.5-2 ng/mL - low potassium or magnesium levels may INCREASE potential for toxicity so frequently monitor serum electrolytes - a decrease in renal function common cause of digoxin toxicity, because digoxin is excreted almost exclusively via the kidneys. - Signs and symptoms of digoxin toxicity include bradycardia, headache, dizziness, confusion, nausea, and visual disturbances (blurred vision or yellow vision) - With toxicity, electrocardiographic findings may include heart block, atrial tachycardia with block, or ventricular dysrhythmias.

Question 72

When significant toxicity develops as a result of digoxin therapy, what is given?

Answer 72

digoxin immune Fab may be indicated. Digoxin immune Fab is an antibody that recognizes digoxin as an antigen and forms an antigen-antibody complex with the drug, thus inactivating the free digoxin. - indicated ONLY for: 1) hyperkalemia (serum potassium level higher than 5 mEq/L) 2) life-threatening cardiac dysrythmias, sustained ventricular tachycardia or fibrillation, sever sinus bradycardia or heart block unresponsive to atropine treatment or cardiac pacing 3) Life-threatening digoxin overdose: more than 10 mg digoxin in adults; more than 4 mg in children

Question 73

Heart Failure: Digoxin (Cardiac Glycoside) interactions

Answer 73

- Amiodarone, quinidine, and verapamil can INCREASE digoxin by 50% - when large amounts of BRAN are ingested, the absorption of oral digoxin may be DECREASED - Certain herbal supplements may interact; ginseng may INCREASE levels, hawthorn my potentiate the effects of digoxin, licorice may INCREASE risk for cardiac toxicity due to potassium loss, and St. John's wort may REDUCE digoxin levels - drugs that lower serum potassium or magnesium levels can predispose pt's to toxicity

Question 74

Because of digoxin's fairly long duration of action and half-life, a loading, or "digitalizing" dose is often given to?

Answer 74

Bring serum levels of the drug up to a desirable therapeutic level more quickly

Question 75

Digoxin immune Fab dosing

Answer 75

Dose based on the patients serum digoxin level in conjunction with his/her weight - recommended dosages vary by the amount of cardiac glycoside injested - one vial binds 0.5 mg of digoxin - after given, serum digoxin level will be elevated for days-weeks, so after administration, the clinical s/s of digoxin toxicity, rather than digoxin serum levels, are the focus in monitoring its effectiveness

Question 76

Digoxin has a _____ chronotropic effect

Answer 76

Digoxin has a negative chronotropic effect (decreased heart rate).

Question 77

The patient’s serum digoxin level is 0.4 ng/mL. How does the nurse interpret this laboratory value result for digoxin?

Answer 77

Below the therapeutic level | Therapeutic serum digoxin levels are 0.5 to 2 ng/mL.

Question 78

A patient prescribed digoxin (Lanoxin) 0.25 mg and furosemide (Lasix) 40 mg for the treatment of systolic heart failure states, “I am starting to see yellow halos around lights.” Which action will the nurse take?

Answer 78

Assess for other symptoms of digoxin toxicity. Yellow-green halos around objects is a symptom of digoxin toxicity. Other signs and symptoms of digoxin toxicity include headache, dizziness, confusion, nausea, and blurred vision. Electrocardiogram findings show heart block, atrial tachycardia with block, or ventricular dysrhythmias.

Question 79

Which are therapeutic effects of digoxin (Lanoxin)?

Answer 79

Positive inotropic, negative chronotropic, and negative dromotropic Digoxin increases cardiac contractility (positive inotropic effect), decreases heart rate (negative chronotropic effect), and decreases conductivity (negative dromotropic effect).

Question 80

PDIs are also called inodilators because they have?

Answer 80

both positive inotropic and vasodilatory effects.

Question 81

The nurse reviews an adult patient’s laboratory values and notes a digoxin level of 11 ng/mL and a serum potassium level of 6.2 mEq/L. The nurse would notify the health care provider and anticipate which medication will be prescribed to administer?

Answer 81

Digoxin immune Fab Digoxin immune Fab is indicated for severe digoxin toxicity in patients with the following clinical findings: hyperkalemia (serum potassium level higher than 5 mEq/L) with digoxin toxicity; life-threatening digoxin overdose (more than 10 mg digoxin in adults; more than 4 mg digoxin in children); and life-threatening cardiac dysrhythmias, sustained ventricular tachycardia or fibrillation, and severe sinus bradycardia or heart block unresponsive to atropine treatment or cardiac pacing.

Question 82

``` The nurse would question the use of milrinone (Primacor) in a patient with which condition? Acute renal failure Aortic regurgitation Systolic heart failure Mitral valve prolapse ```

Answer 82

Aortic regurgitation Milrinone (Primacor), a PDI, is contraindicated in severe aortic or pulmonary valvular disease and in diastolic heart failure.

Question 83

``` When teaching a patient regarding the administration of digoxin (Lanoxin), the nurse instructs the patient not to take this medication with which food? Bananas Wheat bran French toast Scrambled eggs ```

Answer 83

Wheat bran Encourage patients to avoid using antacids or eating ice cream, milk products, yogurt, cheese (dairy products), or bran for 2 hours before or 2 hours after taking medication to avoid interference with the drugs absorption.

Question 84

``` For a patient receiving a positive inotropic drug, which nursing assessments should be performed? (Select all that apply.) Check apical pulse. Obtain daily weights. Auscultate lung sounds. Monitor serum electrolytes. Review red blood cell count. ```

Answer 84

Check apical pulse. Obtain daily weights. Auscultate lung sounds. Monitor serum electrolytes. Lung sounds and daily weights are appropriate assessments related to the treatment of heart failure with inotropic drugs. The apical pulse and serum electrolytes are important assessments related to potential adverse reactions (bradycardia, toxicity with hypokalemia).