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Lehne 9th Edition Chapter 48: Drugs for Heart Failure questions with verified answers
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Lehne 9th Edition Chapter 48: Drugs for Heart Failure questions with verified answers
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Lehne 9th Edition Chapter 48: Drugsfor Heart Failure
1. 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:
2. a.
3. hypernatremia.
4. b.
5. hypertension.
6. c.
7. hyperkalemia.
8. d.
9. hypokalemia. - ANS-ANS: C
10. 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.
11. 10. The potassium-sparing diuretic spironolactone [Aldactone] prolongs survival and
improves heart failure symptoms by which mechanism?
12. a.
13. Blocking aldosterone receptors
14. b.
15. Increasing diuresis
16. c.
17. Reducing venous pressure
18. d.
19. Reducing afterload - ANS-ANS: A
20. Spironolactone prolongs survival in patients with HF primarily by blocking receptors
for aldosterone. Spironolactone cause only minimal diuresis. It does not reduce
afterload, and it does not reduce venous pressure enough to prolong survival,
because it causes only minimal diuresis.
21. 11. A nurse prepares to administer a scheduled dose of digoxin. The nurse finds a
new laboratory report showing a plasma digoxin level of 0.7 ng/mL. What action
should the nurse take?
22. a.
23. Withhold the drug for an hour and reassess the level.
24. b.
25. Withhold the drug and notify the prescriber immediately.
26. c.
, 27. Administer Digibind to counteract the toxicity.
28. d.
29. Check the patient's apical pulse, and if it is within a safe range, administer the
digoxin. - ANS-ANS: D
30. The optimum plasma digoxin range is 0.5 to 0.8 ng/mL. The patient's pulse should be
checked before administration, as always, and the digoxin should be administered.
The digoxin does not have to be withheld, nor does the prescriber need to be
notified. If the digoxin level is demonstrating a trend of increasing, the issue should
be discussed in rounds. Digibind is not indicated, because the digoxin level is
therapeutic.
31. 12. A patient asks a nurse why he cannot use digoxin [Lanoxin] for his heart failure,
because both of his parents used it for HF. The nurse will explain that digoxin is not
the first-line therapy for which reason?
32. a.
33. It causes tachycardia and increases the cardiac workload.
34. b.
35. It does not correct the underlying pathology of heart failure.
36. c.
37. It has a wide therapeutic range that makes dosing difficult.
38. d.
39. It may actually shorten the patient's life expectancy. - ANS-ANS: B
40. Digoxin improves cardiac output, alters electrical effects, and helps to decrease
sympathetic outflow from the central nervous system (CNS) through its
neurohormonal effects; however, it does not alter the underlying pathology of heart
failure or prevent cardiac remodeling. Digoxin causes bradycardia and increases the
cardiac workload by increasing contractility. It has a narrow therapeutic range and
many adverse effects. Digoxin does not improve life expectancy; in women it may
actually shorten life expectancy.
41. 13. A nurse is preparing to administer digoxin [Lanoxin] to a patient. The patient's
heart rate is 62 beats per minute, and the blood pressure is 120/60 mm Hg. The last
serum electrolyte value showed a potassium level of 5.2 mEq/L. What will the nurse
do?
42. a.
43. Contact the provider to request an increased dose of digoxin.
44. b.
45. Give the dose of digoxin and notify the provider of the potassium level.
46. c.
47. Request an order for a diuretic.
48. d.
49. Withhold the dose and notify the provider of the heart rate. - ANS-ANS: B
50. The patient's serum potassium level is above normal limits, but only slightly. An
elevated potassium level can reduce the effects of digoxin, so there is no risk of
toxicity. There is no indication that an increased dose of digoxin is needed. There is
no indication for a diuretic. The heart rate is acceptable; doses should be withheld if
the heart rate is less than 60 beats per minute.
51. 14. A patient with heart failure who has been given digoxin [Lanoxin] daily for a week
complains of nausea. Before giving the next dose, the nurse will:
52. a.
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