Unit6: Chapter 44 (Karch 7th Ed) - Agents for Treating Heart Failure Flashcards
(35 cards)
- A patient presents to the emergency department with rales, wheezing, and blood-tinged sputum. What
does the nurse recognize that these symptoms indicate?
A) Cardiomyopathy
B) Cardiomegaly
C) Valvular heart disease
D) Pulmonary edema
Ans: D
Feedback:
In left-sided heart failure, the left ventricle pumps inefficiently resulting in a backup of blood into the
lungs causing pulmonary vessel congestion and fluid leaks into the alveoli and lung tissue. As more
fluid continues to collect in the alveoli, pulmonary edema develops. The patient will present with rales,
wheezes, blood-tinged sputum, low oxygenation, and development of a third heart sound.
Cardiomyopathy can occur as a result of a viral infection, alcoholism, anabolic steroid abuse, or a
collagen disorder. It causes muscle alterations and ineffective contraction and pumping. Cardiomegaly
is an enlargement of the heart due to compensatory mechanisms in congestive heart failure (CHF) and
leads to ineffective pumping and eventually exacerbated CHF. Valvular heart disease leads to an
overload of the ventricles because the valves do not close adequately causing blood to leak backward.
This causes muscle stretching and increased demand for oxygen and energy.
2. What electrolyte inactivates troponin and allows actin and myosin to form a bridge enabling the muscle fibers to contract? A) Magnesium B) Calcium C) Potassium D) Sodium
Ans: B
Feedback:
Calcium must be present to deactivate troponin so that actin and myosin can react to form actinomycin bridges. Potassium, sodium, and magnesium do not affect troponin.
- A 62-year-old African American man diagnosed with congestive heart failure and hypertension has
BiDil included in his drug therapy. What nursing assessment finding would indicate the patient is
developing a complication from this drug?
A) Alopecia
B) Photosensitivity
C) Anorexia
D) Orthostatic hypotension
Ans: D
Feedback:
Orthostatic hypotension is an adverse effect of a combination of isosorbide dinitrate and hydralazine
called BiDil. This could lead to safety concerns and should be addressed in drug teaching for this
patient. Alopecia, photosensitivity, and anorexia are not adverse effects related to this drug.
- The nurse is preparing digoxin for an infant. What is the nurse’s priority intervention?
A) To perform hand hygiene
B) To have another nurse check dosage calculations
C) To check the child’s apical pulse
D) To identify the patient by checking the ID bracelet
Ans: B
Feedback:
The margin of safety for the dosage of this drug is very narrow in children. The dosage needs to be very
carefully calculated and should be double-checked by another nurse before administration. The other
options are important and the nurse should implement all three. However, these actions are of lower
priority.
- A patient asks the nurse what cardiac glycosides do to improve his condition. What is the nurse’s best
response?
A) They decrease the force of myocardial contractions.
B) They help renal blood flow and increase urine output.
C) They increase heart rate.
D) They increase conduction velocity
Ans: B
Feedback:
Cardiac glycosides increase intracellular calcium and allow more calcium to enter myocardial cells.
This action causes an increased force of myocardial contraction, an increased cardiac output, and renal
perfusion that increases urine output. Cardiac glycosides also serve to slow the heart rate and decrease
conduction velocity.
6. What is the priority nursing assessment for a patient who is about to begin digoxin therapy? A) Blood glucose levels B) Neurological function C) Kidney function D) Liver function
Ans: C
Feedback:
Digoxin is primarily excreted unchanged in the urine, so caution should be exercised if renal
impairment is present. Blood glucose levels and neurological and liver function would not be a priority
assessment related to digoxin therapy.
- A triage nurse in the emergency department is assessing a 78-year-old man. It is determined that the
patient is experiencing severe digoxin toxicity. What drug will the nurse administer immediately?
A) Inamrinone (Inocor)
B) Digoxin immune Fab (Digibind)
C) Verapamil hydrochloride (Calan)
D) Quinidine sulfate
Ans: B
Feedback:
Digoxin immune Fab is an antigen-binding fragment derived from specific antidigoxin antibodies. The
drug is used for the treatment of life-threatening digoxin intoxication when serum levels are greater
than 10 ng/mL. Inamrinone is a phosphodiesterase inhibitor that acts as a cardiotonic agent. Verapamil
hydrochloride is a calcium channel blocker. Quinidine is an antiarrhythmic agent that when taken with
digoxin increases both the therapeutic and toxic effects of digoxin.
- The nurse is providing patient teaching to a patient who has been prescribed digoxin. The patient tells
the nurse that she occasionally use herbals and other alternative therapies. What herb would the nurse
warn the patient to avoid taking with digoxin?
A) Black cohosh
B) Ginseng
C) Saw palmetto
D) Valerian
Ans: B
Feedback:
Digoxin toxicity can occur if the drug is taken concurrently with licorice, ginseng, or hawthorn. St.
John’s wort and psyllium have been shown to decrease the effectiveness of digoxin, so that
combination should be avoided. There is no drug-to-drug interaction with black cohosh, saw palmetto,
or valerian
- The nurse administers an IV phosphodiesterase inhibitor. What drug will result in forming a precipitate
if given via the same IV line without adequate flushing?
A) Albuterol (Proventil)
B) Nifedipine (Procardia)
C) Furosemide (Lasix)
D) Lovastatin (Mevacor)
Ans: C
Feedback: Furosemide, when given with a phosphodiesterase inhibitor, forms precipitates; therefore, this
combination should be avoided. Use alternate lines if both of these drugs are being given IV. There are
no known drug-to-drug interactions with albuterol, nifedipine, or lovastatin
- A 6-year-old child weighing 60 pounds has been prescribed oral digoxin (Lanoxin) 30 mcg/kg as a
loading dose. How many milligram will she be given?
A) 0.218 mg
B) 0.418 mg
C) 0.618 mg
D) 0.818 mg
Ans: D
Feedback:
First, using the formula: 2.2 pounds and 60 pounds: multiplied by kg, determine the child’s weight in
kg (60/2.2 = 27.27 kg). Next, using the formula: amount of drug prescribed times weight in kg,
determine the dose in mcg the child should receive (30 multiplied by 27.27 = 0. 818 mcg). Then to
determine the amount of mg the child should receive, use the formula: 1 mg: 1,000 mcg = X mg: 818
mcg (818/1,000 = 0.818 mg).
- The nurse assesses the patient before administering digoxin (Lanoxin) and withholds the drug and
notifies the physician with what finding?
A) Respiratory rate falls below 14
B) History reveals liver failure
C) Pulse is 44 beats/min
D) Blood pressure is 72/40 mm Hg
Ans: C
Feedback:
Monitor apical pulse for 1 full minute before administering the drug to assess for adverse effects. Hold
the dose if the pulse is less than 60 beats/min in an adult or less than 90 beats/min in an infant; retake
pulse in 1 hour. If pulse remains low, document pulse, withhold the drug, and notify the prescriber.
12. When a drug is said to increase the force of contraction of the heart muscle, the nurse appropriately uses what term? A) Positive chronotropic B) Positive inotropic C) Negative inotropic D) Negative dromotropic
Ans: B
Feedback:
Sympathetic stimulation causes an increase in heart rate, blood pressure, and rate and depth of
respirations, as well as a positive inotropic effect (increased force of contraction) on the heart and an
increase in blood volume (through the release of aldosterone). A negative inotropic effect would be one
that decreased the force of a contraction. A negative dromotropic effect is one that slows the
conduction of the impulse through the atrioventricular node. A positive chronotropic effect is one that
increases the heart rate.
- The nurse, caring for a patient who is receiving cardiac glycosides to treat heart failure, will teach the
patient to follow what diet?
A) High sodium, low potassium, high fat
B) Low sodium, low potassium, low fat
C) High iron, high calcium, high potassium
D) Low sodium, high potassium, low fat
Ans: D
Feedback:
Restrict dietary sodium to reduce edema in patients receiving cardiac glycosides. If the patient is
hyponatremic or using a potassium-losing diuretic, increase potassium in diet, as well as limit fat intake
to reduce weight and atherogenic activity.
- What order for a digitalizing dose of digoxin (Lanoxin) for a 62-year-old man would the nurse consider
appropriate and safe to administer?
A) 1.25 mg IV now
B) 0.75 mg orally now
C) 0.25 mg orally every day
D) 1 mg intramuscularly every 4 hours × 24 hours
Ans: B
Feedback:
Digoxin: Adult: loading dose 0.75 to 1.25 mg orally or 0.125 to 0.25 mg IV, then oral maintenance
dose of 0.125 to 0.25 mg/d; decrease dose with renal impairment
15. After administering an IV dose of digoxin, the nurse would expect to see effects within what period of time? A) 30 to 120 minutes B) 5 to 30 minutes C) 1 hour D) 2 hours
Ans: B
Feedback:
The drug has a rapid onset of action and rapid absorption (30 to 120 minutes when taken orally, 5 to 30
minutes when given IV).
16. The patient taking digoxin (Lanoxin) has developed an infection. What antibiotic can the nurse safely administer to this patient? A) Zithromax B) Erythromycin C) Tetracycline D) Cyclosporine
Ans: A
Feedback: Zithromax may be given without impacting the effects of digoxin. There is a risk of increased
therapeutic effects and toxic effects of digoxin if it is taken with verapamil, amiodarone, quinidine,
quinine, erythromycin, tetracycline, or cyclosporine. If digoxin is combined with any of these drugs, it
may be necessary to decrease the digoxin dose to prevent toxicity. If one of these drugs has been part of
a medical regimen with digoxin and is discontinued, the digoxin dose may need to be increased.
- The 96-year-old patient is receiving digoxin (Lanoxin) and furosemide (Lasix). In the morning, the
patient complains of a headache and nausea. What will the nurse do first?
A) Contact the patient’s physician immediately.
B) Check her laboratory values and vital signs.
C) Administer acetaminophen and Maalox.
D) Give her clear liquids and have her lie down.
Ans: B
Feedback:
The nurse will check the patient’s digoxin level and electrolytes. Assessing vital signs is important
because the risk of cardiac arrhythmias could increase due to the patient’s receiving furosemide, which
is a potassium-losing diuretic. The adverse effects most frequently seen with the cardiac glycosides
include headache, weakness, drowsiness, and vision changes (a yellow halo around objects is often
reported). Gastrointestinal (GI) upset and anorexia also commonly occur. Only after checking lab
values and assessing vital signs might the nurse call the physician. Acetaminophen and Maalox would
not be indicated. Having her lie down and restricting her diet to clear liquids would be appropriate but
not the first actions.
- The nurse provides teaching about digoxin to the 62-year-old patient. The nurse evaluates patient
understanding and determines further teaching is needed when the patient says she will do what?
A) Take the medication daily in the morning.
B) Take her pulse before taking her dose.
C) Weigh herself daily at the same time.
D) Take the medication with a meal.
Ans: D
Feedback:
Avoid administering the oral drug with food or antacids to avoid delays in absorption. The other answers are appropriate actions for the patient to take when self-administering digoxin
19. When administering milrinone (Primacor), the nurse will assess the patient for what common adverse effect? A) Hypoglycemia B) Confusion C) Hypotension D) Seizures
Ans: C
Feedback:
The adverse effects most frequently seen with these drugs are ventricular arrhythmias (which can
progress to fatal ventricular fibrillation), hypotension, and chest pain. Hypoglycemia, confusion, and
seizures are not generally adverse effects of milrinone.
- The nurse administers a cardiac glycoside for what therapeutic effect?
A) To decrease cardiac output
B) To decrease afterload
C) To increase ventricular rate
D) To increase the force of the contraction of the heart
Ans: D
Feedback:
Cardiac glycosides exert a negative cardiotonic and positive inotropic effect. They do not decrease
cardiac output, decrease afterload, or increase the ventricular rate of the heart.
21. After administering digoxin, what assessment finding would indicate to the nurse that the drug was having the desired effect? A) Increased heart size B) Increased urinary output C) Decreased respiratory rate D) Increased heart rate
Ans: B
Feedback:
As cardiac output improves, so does urinary output due to increased renal perfusion. Respiratory rate
and heart size would not be impacted by the drug, although ventricular hypertrophy is a common
finding in patients with heart failure. Heart rate would decrease as the force of contraction increases,
ejecting more blood with each contraction.
22. What assessment finding would indicate the patient’s left-sided heart failure is worsening? A) Increased jugular venous pressure B) Liver enlargement C) Increased crackles in lung fields D) Increased pulse rate
Ans: C
Feedback:
Fluid may accumulate in the lungs due to left sided heart failure. Patients may evidence dyspnea,
tachypnea, and orthopnea. Right-sided failure would include increased jugular venous pressure and
liver enlargement. Pulse rate could increase or decrease depending on medications administered.
23. Which drug is in the class of drugs called human B-type natriuretic peptides? A) Bosentan (Tracleer) B) Milrinone (Primacor) C) Digoxin (Lanoxin) D) Nesiritide (Natrecor)
Ans: D Feedback: Nesiritide is the only drug currently available in a class of drugs called human B-type natriuretic peptides. Digoxin is a cardiac glycoside. Milrinone is a phosphodiesterase inhibitor. Bosentan is an endothelin receptor antagonist.
24. The nurse reviews the patient’s lab results and recognizes the patient is at risk for digoxin toxicity due to what electrolyte imbalance? A) Hyperkalemia B) Hypokalemia C) Hypernatremia D) Hyponatremia
Ans: B
Feedback:
Electrolyte abnormalities (e.g., increased calcium, decreased potassium, decreased magnesium) could
alter the action potential and change the effects of the drug. Hypokalemia and hypomagnesemia
increase cardiac excitability and ectopic pacemaker activity leading to dysrhythmias.
