heart failure

Question 1

An asymptomatic patient at high risk of developing heart failure and have no identifiable structrual or functional cardiac abnormalities is in what stage/class of heart failure?

Answer 1

Stage A / Class 1

Question 2

An asymptomatic patient at high risk of developing heart failure and have no identifiable structrual or functional cardiac abnormalities is in what stage/class of heart failure?

Answer 2

Stage A / Class I

Question 3

An patient with structrual heart disease with the development of heart failure but is asymptomatic is in what stage/class of heart failure?

Answer 3

Stage B / Class II

Question 4

A patient who has current or prior symptoms of heart failure associated with underlying structural disease is in what stage/class of heart failure?

Answer 4

Stage C / Class III

Question 5

A patient with advanced structural heart disease and marked symptoms of heart failure at rest despite optimal medical management and who require specialized interventions is in what stage/class of heart failure?

Answer 5

Stage D / Class IV

Question 6

A patient in stage A HF will recive what interventions?

Answer 6

• Patient and family risk factor education
  (lifestyle modifications)
• Treat hypertension, diabetes, dyslipidemia
  some patients ( Tx with Rx: ACE inhibitors or ARBS )

lifestyle modifications include:
- diet
- exercise
- reduce dietary sodium intake
- moderate drinking of alcohol
- weight loss

Question 7

A patient in stage B HF will recive what interventions?

Answer 7

• Treat hypertension, diabetes, dyslipidemia
  In all patients ( Tx with Rx: ACE inhibitors or ARBS )

Question 8

A patient in stage C HF will recive what interventions?

Answer 8

• Treat hypertension, diabetes, dyslipidemia
  In all patients ( Tx with Rx: ACE inhibitors )
  In selected patients ( Tx with Rx: beta-blockers )
• Dietary sodium restriction, diuretics, and digoxin

Question 9

A patient in stage D HF will recive what interventions?

Answer 9

• Treat hypertension, diabetes, dyslipidemia
  In all patients ( Tx with Rx: ACE inhibitors )
  In selected patients ( Tx with Rx: beta-blockers )
• Dietary sodium restriction, diuretics, and digoxin
• Cardiac resynchronization if bundle block branch present
• Revascularization, mitral-valve surgery
• Consider multidisciplinary team
• Aldosterone antagonist, nesiritide
  **- Inotropes
• VAD, transplantaion
• Hospice **

Question 10

A patient is accumulating fluid within their lungs. What type of heart failure can the nurse anticipate the patient is dx with?

Answer 10

left sided heart failure

Question 11

A patient is accumulating fluid within the periphery. What type of heart failure can the nurse anticipate the patient is dx with?

Answer 11

right sided heart failure

Question 12

A patient’s heart muscles are unable to contract, to pump out oxygenated blood. What type of heart failure can the nurse anticipate the patient is dx with?

Answer 12

Systolic heart failure

Question 13

A patient’s muscles of the heart becomes stiffer than normal. What type of heart failure can the nurse anticipate the patient is dx with?

Answer 13

diastolic heart failure

Question 14

Treatment of heart failure is usually targeted twoards what HFrEF?

Answer 14

Systolic HF

Systolic HF: HF with reduced LV ejection fraction (HFrEF)
Diastolic HF: HF with preserved LV ejection fraction (HFpEF)

Question 15

decreased cardiac output leads to…

Answer 15

decreased blood pressure

Question 16

The nurse knows that chronic hypertension and myocardial infaction are just two of the many underlying causes of HF. True or false.

Answer 16

True.

Question 17

Beta blockers such as Metoprolol, Carvedilol, Bisoprolol decrease the rate of contraction and are therefore called …

Answer 17

( - chronotropes )

Question 18

Beta blockers such as Metoprolol, Carvedilol, Bisoprolol decrease the rate of contraction and are therefore called what?

Answer 18

( - chronotropes )

Question 19

Cardiac Glycoside such as Digoxin, increase the force of contraction and are therefore called what?

Answer 19

( + inotropes )

Also + inotropes:
- Sympathomimetics – Isoproterenol, Norepinephrine, Dobutamine
- Dopamine Receptor Agonist – Dopamine, Fenoldopam
- PDE3 Inhibitors – Milrinone
- Peptide Agents – Nesiritide, Valsartan/Sacubitril

Question 20

The dose of Sustained release Metoprolol is a first line agent in heart failure and must be adjusted slowly and carefully to prevent decreased inotropy. True or false.

Answer 20

True.

Question 21

What adverse effects should a nurse who is monitoring a patient on Digoxin be concerned about? Sellect all that apply.
a. hypokalemia
b. hypernatremia
c. hyperkalemia
d. hypercalcemia
e. bradycardia

Answer 21

a. , c. , e

potassium (both low and high) and heart rate monitoring is critical for a patient taking digoxin as it can cause toxic effects.

Question 22

What are signs/symptoms of Digoxin Toxicity?

a. Nausea, Vomiting, Anorexia, Fatigue, and Visual Disturbances
b. SOB, Edema, HTN, and Weight Gain
c. Nause, Vomiting, Disorentation, Sleepiness, and Jaundice
d. Irritability, Sweating, Shaking, Confusion, and Tachycardia

Answer 22

a. Nausea, Vomiting, Anorexia, Fatigue, and Visual Disturbances

visual disturbances such as blurred or yellow vision

a. s/s of digoxin toxicity
b. s/s of fluid overload
c. s/s of liver failure
d. s/s of hypoglycemia

Question 23

A patient is in bed at 2030 experiencing nausea, vomiting and yellow vision while reading. The nurse know from her constant monitoring that she is on a medication that is causing toxicity right now. What antidote will the nurse administer?

a. Protamine sulfate
b. Physostigmine
c. Vitamin K
d. Digifab
e. Calcium gluconate

Answer 23

d. Digifab

a. antidote for Heparin
b. antidote for Atropine
c. antidote for Warfarin
d. antidote for Digoxin
e. atidote for Magnesium Sulfate

Question 24

A patient who is in heart failure is experiencing ventricular fibrillation/tachycardia and hypokalemia. They are taking a thiazide drug and a loop diuretic for the edema but need a + inotrope to increase the force of contraction of their heart. The physician orders digoxin to add to their theriputic regime. What should the nurse do next?

a. recheck the patients HR before administration of the drug
b. administer the drug
c. administer 100mL of NS before administration of the drug
d. wait until morning becuse the patient is already on diuretics and you dont want them to use the bathroom throughout the night
e. hold the drug and question the physician’s order

Answer 24

e. hold the drug and question the physician’s order

Digoxin is contraindicated with ventricular fibrillation, tachy cardia or digoxin toxicity.
If the patient is hypokalemic and taking a thiazide combined with a loop diuretic will only increase the toxicity risk of digoxin.

Question 25

The nurse understands that one of the biggest dangers of class I and class III drugs is?

Answer 25

prolongation of the QT interval

Question 26

A patient is having low risk asymptomatic dysrhythmias. The nurse understands that in order to treat the patient they should administer the order for an Anti-dysrhythmic drug. True or false.

Answer 26

False. ## Footnote Anti-dysrhythmic drugs should only be used when dysrhythmias are symptomatically significant and when the potential benefit outweigh the risks.

Question 27

A patient is taking a class IA sodium channel blocker, Quinidine, and is experiencing diarrhea. The patient tells the nurse that it is so bad that theyd like to d/c taking the drug. What can the nurse suggest to the patient to help with this adverse effect of Quinidine? a. take it with a full glass of water b. take it in the evening when their metabolism is slower c. take it with food d. take it with digoxin

Answer 27

c. take it with food ## Footnote Taking Quinidine with digoxin causes an interaction doubling digoxin levels

Question 28

A patient can experience cinchonism (tinnitus, vertigo, headache, nause, disturbed vision when taking quinidine and it is normal. True or false.

Answer 28

False. ## Footnote The patient should notify the HCP f these occur.

Question 29

A patient is experiencing cardiotoxicity when taking a class IA sodium channel blocker, Quinidine, what is the nurses priority intervention. a. administer the antidote b. monitor ECG c. lay the patient flat

Answer 29

b. monitor ECG

Question 30

A patient is experiencing acute vetricular dysrhythmias. How will the nurse tx the patient? a. lay the patient down b. administer a IM injection of lidocane c. administer an IM injection of atropine d. administer IV infusion of lidocane

Answer 30

d. administer an IV infusion of lidocane

Question 31

Amiodarone is used for ventricular dysrhythmias that aren't responsive to other drugs, but the drug can cause maany toxic effects. Which of the following does the nurse know isn't an adverse toxic effect of Amiodarone? a. renal toxicity b. liver toxicity c. pulmonary toxicity d. cardiotoxicity e. thyroid toxicity

Answer 31

a. renal toxicity ## Footnote Pulmonary toxicity (hypersensitivity pneumonitis, pulmonary fibrosis) – baseline pulmonary function, educate patients on signs of injury Cardiotoxicity (heart failure and dysrhythmias) – educate patients on signs of heart failure Liver Toxicity – baseline liver function, educate patients on signs of liver injury Thyroid Toxicity – baseline thyroid levels

Question 32

Adenosine is given IV bolus as close to the heart as possible. True or false.

Answer 32

True.

Question 33

When administering nitroglycerin sublingually the patient ask for further education on how to properly take the medication. The nurse will state:

Answer 33

let the tablet or powder completely dissolve under the tongue.

Question 34

When administering nitroglycerin orally the patient ask for further education on how to properly take the medication. The nurse will state:

Answer 34

swallow the tablet without chewing it.

Question 35

When administering nitroglycerin trransdermally the patient ask for further education on how to properly take the medication. The nurse will state:

Answer 35

Remove the old patch before applying the new one. ## Footnote allow for 10-12 patch free hours per day to prevent tolerance

Question 36

When taking nitroglycerine it is important to avoid disrupt withdral and the patient should be titrated off the medication. True or false.

Answer 36

True

Question 37

A nurse knows that a patient taking nirtoglycerine should avoid medications like slidenafil, which is what class of drugs?

Answer 37

PDE5 inhibitors

Question 38

A patient is experiencing headaches from taking nitroglycerine. What patient teaching will the nurse provide?

Answer 38

The headached that accompany nitroglycerin will diminish with continued use.

Question 39

A patient is experiencing orthostatic hypotension from taking nitroglycerine. What patient teaching will the nurse provide?

Answer 39

The patient will need to change positions slowly.

Question 40

A patient is experiencing reflex tachycardia from taking nitroglycerine. What will the nurse do to help with the adverse affects?

Answer 40

The nurse can administer a beta blocker or an NDHP CCB as they suppress reflex tachycardia of nitroglycerine.

Question 41

A patient is experiencing a myocardial infarction. list the following interventions on the priority of administration for the nurse. a. nitroglycerin b. morphine c. oxygen d. aspirin

Answer 41

c. oxygen d. aspirin a. nitroglycerin b. morphine | think MONA therapy ## Footnote Oxygen – to promote O2 delivery Aspirin – to suppress platelet aggregation, chew the first dose to speed up absorption Nitroglycerin – to reduce cardiac work, sublingual every 5 minutes for three doses Morphine – to relive pain and reduce cardiac work Beta Blocker – reduce myocardial work, not always given but evidence suggests it can provide a survival benefit

Question 42

When giving nitroglycerin to a patient for the acute management of a STEMI and Non-STEMI the nurse knows the following administration is correct. a. sublingual; every 5 minutes b. buccal; every 5 minutes c. IM; every hour d. IV; countinously

Answer 42

a. sublingual; every five minutes ## Footnote up to three doses

Question 43

For long term therapy of an MI the patient can have a stent place, the second option would be to place the patient on a fibrinolytic. The nurse knows that early use of what medication wil be better for the patients outcome? a. metformin b. heparin c. clopidogrel d. alteplase

Answer 43

d. alteplase ## Footnote Alteplase if the fibrinolytic that is given with an Adjuvant anticoagulant (heparin) and an antiplatelet (aspirin/clopidogrel).

Question 44

A patient who experienced a STEMI MI will need to add interventions to their regime indefinitely. Which of the following is not an intervention the patient will need to follow to prevent further damage. a. Adding medications such as asprin, captopril and lovastatin to reduce the blockage. b. Adding a beta blocker c. Making lifestyle changes d. control their colesterol e. smoke only a pack a day

Answer 44

e. smoking a pack a day. ## Footnote Reduce the blockage with the use of: - Antiplatelet – aspirin, clopidogrel - ACE Inhibitor – Captopril - Statins – Lovastatin This combination + a beta blocker is used for post STEMI MI patients indefinitely - Lifestyle changes are important - Control cholesterol, stop smoking, exercise, manage BP and diabetes

Question 45

LDL

Answer 45

BAD; high cholesterol

Question 46

HDL

Answer 46

GOOD; low cholesterol ## Footnote think H for HAPPY

Question 47

Cholesterol is synthesized by what and packaged with triglycerides and phospholipids into liprprotiens. a. HMGB-CoA Reductase b. HMGB-CoB Reductase c. HMGC-BoA Reductase

Answer 47

a. HMGB-CoA Reductase

Question 48

When does the HMGC-CoA reductase peak? a. after a meal b. early in the morning c. at night d. anytime a person is sleeping

Answer 48

c. at night

Question 49

LDL deliver cholesterol by binding to what? Where as HDL picks up excess cholesterol to remove it from circulation by bringing it back to the liver.

Answer 49

LDL Receptor

Question 50

Which of the following statements needs further teaching about therapeutic lifestyle changes to magnage hyperlipidemia. a. I exercise 6o minutes a day four times a week. b. I managed to reach my goal weight c. I did quit smoking d. I have reduced the intake of cake and ice cream in my diet and have been eating more oatmeal e. I cook all my meals using butter

Answer 50

e. I cook all my meals using butter | Butter is a saturated fat ## Footnote Diet – decrease consumption of cholesterol (<200 mg/day) and saturated fats, lower trans fat consumption, increase soluble fiber intake Exercise – cardiovascular exercise 30-60 minutes most days Weight control – managed through diet & exercise, particularly important for patients with metabolic syndrome moking cessation – reverse the effects of smoking on LDL and HDL Pharmacological approach is second-line to lifestyle management

Question 51

Statins reduce LDL levels by inhibiting cholesterol synthesis which increases HMG-coA. True or false.

Answer 51

True.

Question 52

A patient whom is taking Lovastatin is states that she is experiencing muscle pain and tenderness. What should the patient do?

Answer 52

Notify the HCP | maybe Mypathy / Rhabdomyolysis ## Footnote other AE: - should be taken at night 8-12pm - Monitor enzyme leves for **Hepatotoxicity ** - **Not safe **in pregnancy

Question 53

The anti-hyperlipidemic, Colesevelam should be given to a patient with something to reduce the risk of esophageal irritation. What is not an item that will help? a. mixing it with water b. taking it with fruit juice c. taking it with soup d. taking it with pulpy fruit e. taking in with coffee

Answer 53

e. taking it with coffee ## Footnote Constipation (cholestyramine and colestipol) – patients should increase dietary fiber and can take a mild laxative if needed Deficiency in fat soluble vitamins A, D, K, and E (cholestyramine and colestipol) – supplements may be required Decreased absorption of other drugs (cholestyramine and colestipol)

Question 54

what are the two PCSK9 Inhibitors that are available for patient use with TLC if they are maxed out on "statin" therapy. a. receptolin b. alirocumab c. heralin d. evolocumab

Answer 54

b. alirocumab d. evolocumab ## Footnote AE: - Hypersensitivity (vasculitis, rash, urticaria) – severe instances should be reported - Development of neutralizing antibodies - Injection site reactions

Question 55

The newest anti-hyperlipidemic, Bempedoic, should be given in caution to what category of patients. a. patients in renal failure b. patients with gout c. patients with myesthinia gravis d. patients with ALS | approved in 2020

Answer 55

b. gout patients | Hyperuricemia therefore it can cause gout flare up ## Footnote another AE would be tendon rupture

Question 56

The anti-hyperlipidemic, Gemfibrozil, should not be given to what category of patients. a. patients with gallbladder disease b. patients with gout c. patients with myesthinia gravis d. patients with open wounds

Answer 56

a. patients with gall bladder disease ## Footnote Also patients with hepatotoxicity, liver or renal dysfunction. Can also cause myopathy

Question 57

Ezetimibe reduces total cholesterol by inhibiting NPC1L1 and has mailt the same effects as statins. True or false.

Answer 57

True. ## Footnote - Post-marketing surveillance still occurring - Diarrhea, arthralgia, myalgia, myopathy and possible rhabdomyolysis

Question 58

A drug group that disrupts the coagulation cascade, therby suppressing the production of fibrin. a. anticoagulants b. antiplatelets c. thrombolytics

Answer 58

a.anticoagulants

Question 59

A drug group that inhibits platelet aggregation. a. anticoagulants b. antiplatelets c. thrombolytics

Answer 59

b. antiplatelets ## Footnote most effective against arterial thrombosis

Question 60

A drug group promotes lysis of fibrin, causing dissolution of thrombi. a. anticoagulants b. antiplatelets c. thrombolytics

Answer 60

c. thrombolytics ## Footnote most effective against venous thrombosis

Question 61

Aticoagulation agents such as, heparin, enoxaparin, dabigatran, rivaroxaban, and warfarin have the principle adverse effect of bleeding because they prevent clots/coagulation. True or false.

Answer 61

True. ## Footnote the nurse should monitor for bleeding as a patient may overdose and hemorrhage.

Question 62

To reduce the risk for a patient bleeding to much when on the anticoagulant, heparin, is to monitor what? select all that apply. a. aPTT b. anti-xa levels c. hemocrit d. iron levels

Answer 62

a. aPTT b. anti-xa levels ## Footnote monitor platelet count 2-3 times a week, then once a month contraindicated in pts with thrombocytopenia

Question 63

To reduce the risk for a patient bleeding to much when on the anticoagulant, Warfarin, is to monitor what? a. aPTT b. PT c. hemocrit d. iron levels

Answer 63

b. PT | prothrombin time

Question 64

A patient is experiencing reduced bp, elevated hr, and bruises. The nurse know that these are s/s for signs for overdose on Heparin. What will the nurse administer as the antidote? a. Digifab b. Flumazenil c. Calcium Gluconate d. Protamine Sulfate

Answer 64

d. protamine sulfate ## Footnote Antidote for digoxin Antidote for benzodiazepine Antidote for magnesium sulfate Antidote for Heparin, Enoxaparin

Question 65

it is important to monitor for neurological impairment in patients taking anticoagulants. True or false.

Answer 65

True.

Question 66

A prophylaxis in A. fib, knee/hip replacement, and DVT/PE treatment to prevent clotting by blocking thrombin is: a. dabigatran b. clotlescin c. geomyicin d. labatran

Answer 66

a. dabigatran ## Footnote if patients experience bleeding they should stop taking it before the elective surgery. Patients should also do the same for clopidogrel.

Question 67

the antidote for dabigatran is idarucizumab. True or false.

Answer 67

True.

Question 68

What is the only anticoagulant safe in pregnancy. a. Dabigatran b. Heparin c. Rivaroxaban d. Warfarin

Answer 68

b. Heparin ## Footnote Warfarin can cause Fetal hemorrhage and teratogenesis, and neonatal harm in breast feeding

Question 69

The antidote for Rivaroxaban is Andexanet alfa. True or false.

Answer 69

True.

Question 70

The antidote for warfarin is Vitamin K1 (phytonadione) infused slowely IV or orally. True or false.

Answer 70

True.

Question 71

Warfarin is a low interaction drug as it it has a low toxicity. True or false.

Answer 71

False. ## Footnote Warfarin is a high interaction drug as it has high toxicity. It interacts with almost ALL other drugs. Patients should not take any medications, prescription or over the counter, without consulting their prescriber.

Question 72

What is the hallmark adverse effect of Antiplatelet Agent, clopidogrel.

Answer 72

Thrombotic Thrombocytopenic Purpura | requires urgent treatment ## Footnote – urgent condition characterized by thrombocytopenia, hemolytic anemia, neurologic symptoms, renal dysfunction, and fever - tx = (plasmapheresis) , involves removing blood through a needle or catheter and circulating it through a machine where the blood is separated into red cells, white cells, platelets and plasma. The plasma, which is the fluid content of the blood, is discarded and replaced with a substitution fluid (mainly albumin solution).

Question 73

In thrombolytic agents, such as Streptokinase and Alteplase that break up clots hemorrhage is the biggest concern where: a. pulmonary b. intercranially c. within the leg d. withing the toes

Answer 73

b. intercranially ## Footnote The nurse should: - **MINIMIZE manipulation of the patient ** and concurrent use of anticoagulants or antiplatelets - **AVOID subQ and IM injections** - apply **pressure** if oozing occurs

Question 74

A patient with Hemophilia **A**, the inability to clot can be put on what drugs to promote clotting factors.

Answer 74

- Factor VIII concentrates - *Desmopressin** | VIII=8 ## Footnote * Antidiuretic hormone analog, increases VIII release from vascular endothelium when factor eight is a problem.

Question 75

A patient with Hemophilia **B**, the inability to clot can be put on what drugs to promote clotting factors.

Answer 75

- Factor IX concentrates | IX=9

Question 76

When administering ferrous sulfate for iron deficiency orally the nurse must give the patient a test dose before administration of the full dose. True or False.

Answer 76

False. ## Footnote **Parental forms** carry a risk of anaphylaxis and must be given a test dose.

Question 77

Epoein alfa, an erythropoietic growth factor, increases the production of RBCs but can have adverse effects such as:

Answer 77

Cardiovascular events and tumor progression

Question 78

Filgrastim (granulocyte colonystimulating factor), an Leukopoietic growth factor increases the production of WBCs but can mhave adverse effects such as:

Answer 78

bone pain