Chapter 48: Drugs for Heart Failure

Chapter 48: Drugs for Heart Failure

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

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. The drug therapy 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.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 520

TOP:   Nursing Process: Planning

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

 

2. 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.”

 

 

ANS:  C

The heart rate increases to improve cardiac output, but it may prevent adequate ventricular filling. An increase in arteriole tone improves tissue perfusion but also increases both the resistance to the pumping of the heart and the cardiac workload. Increased contractility helps improve cardiac output but is detrimental because it increases the oxygen demand of the heart. An increase in venous tone improves ventricular filling, but as the ventricles fail, blood can back up and cause pulmonary edema.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   p. 518

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation

 

3. A patient with chronic hypertension is admitted to the hospital. During the admission assessment, the nurse notes a heart rate of 96 beats per minute, 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]

 

 

ANS:  C

This patient shows signs of fluid volume overload and needs a diuretic. Furosemide is a loop diuretic, which can produce profound diuresis very quickly even when the glomerular filtration rate (GFR) is low. An ACE inhibitor will not reduce fluid volume overload. Digoxin has a positive inotropic effect on the heart, which may improve renal perfusion, but this is not its primary effect. Spironolactone is a potassium-sparing diuretic with weak diuresis effects; it is used in conjunction with other diuretics to improve electrolyte balance.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 517-518 | pp. 519-522

TOP:   Nursing Process: Implementation

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

 

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

a.	decreased urine output.
b.	increased blood pressure.
c.	jugular vein distension.
d.	shortness of breath.

 

 

ANS:  A

As the heart rate increases, ventricular filling decreases, and cardiac output and renal perfusion decrease. Tachycardia does not elevate blood pressure. Jugular vein distension and shortness of breath occur with fluid volume overload.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   p. 518

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation