Chapter 47: Drugs for Heart Failure

Chapter 47: Drugs for Heart Failure

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. 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.

 

 

ANS:   C

One of the principal effects of angiotensin-converting enzyme (ACE) inhibitors is hyperkalemia, which is due to decreased aldosterone release arising from blockage of angiotensin II.

There is no indication that careful monitoring of sodium for increased levels is indicated.

Vasotec is indicated for heart failure, not hypertension. It should be monitored to ascertain its effectiveness, but hyperkalemia is the main concern.

Hyperkalemia, not hypokalemia, is a concern because of the decreased aldosterone release that occurs with blockage of angiotensin II.

 

DIF:    Cognitive Level: Application             REF:    p. 520

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

2. A nurse is assessing a patient with a history of heart disease. The nurse records a pulse rate of 50. The nurse also observes cardiac dysrhythmias on the monitor, and the patient complains of seeing halos around lights. The nurse should prepare to administer

a.	Digibind.
b.	oxygen.
c.	naloxone (Narcan).
d.	vitamin K (Phytonadione).

 

 

ANS:   A

All signs and symptoms (low heart rate, seeing halos around lights, dysrhythmias) point to digoxin toxicity. The ability of digoxin to cause dysrhythmias in patients with heart disease is greatly increased. The nurse should suspect digoxin toxicity and administer Digibind.

Oxygen may be indicated, but it will not correct the dysrhythmias or reverse the toxicity.

Naloxone is indicated for opiate overdose, not digoxin toxicity.

Vitamin K is indicated for excessive bleeding, specifically for warfarin toxicity.

 

DIF:    Cognitive Level: Analysis                  REF:    pp. 525-526

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

3. A patient with 3+ peripheral edema, V/S = P–112, BP–162/100, R–32, T–98.9 and a low GFR is receiving hydrochlorothiazide (HydroDIURIL). The most effective nursing action would be to

a.	administer hydrochlorothiazide as ordered.
b.	request furosemide (Lasix).
c.	request spironolactone (Aldactone).
d.	hydrate the patient to improve the GFR.

 

 

ANS:   B

Furosemide can promote fluid loss even when the GFR is low, whereas the thiazide diuretics are not effective with renal dysfunction. Loop diuretics, such as hydrochlorothiazide, are also preferred to thiazides when cardiac output is greatly reduced. This patient is displaying serious fluid overload and needs effective diuresis.

The nurse should not continue the hydrochlorothiazide, because it will not be effective with this patient, who has a low GFR.

Spironolactone (Aldactone) will not be as effective as a loop diuretic, and nothing indicates that the patient has a low potassium level.

Hydrating the patient would only worsen the fluid overload.

 

DIF:    Cognitive Level: Application             REF:    pp. 518-519

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies