Drugs for Heart Failure

Understanding Pharmacology Essentials for Medication Safety

Nursing
37
Questions
0
True/False
31
Choices
6
Essay
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Questions

Q1
Free

What is the most common cause of heart failure?

Multiple Choice
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A) Cardiomyopathy
B) Hypertension
C) Myocardial infarction
D) Substance abuse
Answer:
B) Hypertension

Explanation:
Most heart failure is caused by hypertension, and many drugs used to treat heart failure are also used to treat hypertension. Hypertension causes an increase in the workload on the heart, eventually leading to heart failure.
Q2
Free

Why must the muscles of the left ventricle be the strongest ones in the heart?

Multiple Choice
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A) The mitral (bicuspid) valve is larger than the aortic valve.
B) The left ventricle receives blood under high pressure from the pulmonary system.
C) The pressure in the aorta is higher than the pressures elsewhere in the circulatory system.
D) Blood in the left ventricle is oxygenated, making it thicker and harder to move than deoxygenated blood.
Answer:
C) The pressure in the aorta is higher than the pressures elsewhere in the circulatory system.

Explanation:
Movement of blood through the other chambers of the heart is against low pressure and the distance is short. Blood leaving the left ventricle must move with enough force to first overcome pressure in the aorta, which is the highest in the entire circulatory system, and then move long distances throughout the entire body. Contraction of the muscles in the walls of the left ventricle is what provides the pressure to move blood forward into general circulation.
Q3
Free

Which two factors are most likely to result in improved cardiac output?

Multiple Choice
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A) Greater preload; greater afterload
B) Greater preload; reduced afterload
C) Reduced preload; greater afterload
D) Reduced preload; reduced afterload
Answer:
B) Greater preload; reduced afterload

Explanation:
Cardiac output is the movement of blood out of the heart and into general circulation. Preload is the amount of blood in the left ventricle before contraction. This volume stretches the muscle of the left ventricle to result in a better force of contraction. So, to a point, greater preload helps improve cardiac output. Afterload is the pressure in the aorta that must be overcome for blood to leave the left ventricle. When this pressure is lower, the heart does not have to work as hard to move blood out of the left ventricle into the aorta. So, greater preload and reduced afterload tend to improve cardiac output.
Q4

Which symptom is commonly assessed by the nurse when a patient has left ventricular heart failure?

Multiple Choice
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A) Weight gain
B) Swelling in the legs
C) Jugular vein distention
D) Crackles in the lungs
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Q5

Which condition alerts the nurse to assess a patient for worsening heart failure?

Multiple Choice
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A) Blood pressure of 106/40 mm Hg
B) Pounding headache
C) Foul urine odor
D) Ankle swelling
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Q6

The nurse prepares to administer a drug for heart failure to a patient. Which assessment finding does the nurse report to the prescriber before administering the drug?

Multiple Choice
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A) Systolic blood pressure increase from 128 to 136
B) Urine output of 2100 mL in 24 hours
C) Weight gain of 1 pound in 3 days
D) Heart rate of 54 beats per minute
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Q7

Which statement made by a patient with heart failure indicates that more teaching is needed about the prescribed drug therapy?

Multiple Choice
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A) I always try to take my heart failure drugs at the same time each day.
B) Now I am using a weekly pill dispenser to keep my drugs straight.
C) Now that my heart failure is cured I can cut back the drugs I take.
D) If I gain more than 3 pounds in a week I will call my doctor.
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Q8

A patient asks the nurse how a prescribed diuretic can help heart failure. What is the nurses best response?

Multiple Choice
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A) Urinating more prevents heart failure from damaging your kidneys.
B) Diuretics reduce blood pressure so your heart wont have to work as hard.
C) Taking a diuretic reduces salt levels so you dont have to limit your intake of salty foods.
D) The diuretic counteracts the side effects of the other drugs prescribed for your heart failure.
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Q9

A patient with heart failure asks the nurse why the antihypertensive drug enalopril (Vasotec) has been prescribed. What is the nurses best response?

Multiple Choice
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A) Hypertension is the most common cause of heart failure.
B) Lowering your blood pressure will allow your heart to pump more easily.
C) This drug will decrease the amount of blood your heart has to pump, leading to less work for you heart.
D) Enalopril will cause your heart to reestablish its normal electrical functions so that it works more effectively as a pump.
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Q10

A patient taking lisinopril (Zestril) for heart failure reports a nagging, nonproductive cough. What is the nurses best first action?

Multiple Choice
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A) Ask the patient whether he or she has received the annual influenza vaccination.
B) Ask the patient how much the cough is interfering with sleep or other activities.
C) Document the report as the only action.
D) Notify the prescriber immediately.
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Q11

After giving the first dose of any antihypertensive drug for heart failure, what action must the nurse take for patient safety?

Multiple Choice
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A) Recheck the drug order for accuracy.
B) Ensure that the call light is within reach.
C) Place a wheelchair in the patients room.
D) Raise all four siderails on the patients bed.
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Q12

Which safety precaution does the nurse teach a patient going home on any antihypertensive drug for heart failure?

Multiple Choice
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A) Always change positions slowly
B) Never get up without assistance
C) Take the drug in the evening before bedtime
D) Avoid all over-the-counter drugs while taking this drug
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Q13

A patient with heart failure reports a 5-lb weight gain during the past week and episodes of feeling more short of breath. What is the nurses best response?

Multiple Choice
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A) These changes are to be expected because you have heart failure.
B) You will probably need a decreased dose of your diuretic drug.
C) I will ask the dietitian to discuss a weight loss diet with you.
D) Your prescriber must be notified because your heart failure is getting worse.
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Q14

A patient with heart failure is prescribed oral captopril (Capoten) and carvedilol (Coreg). The heart rate after giving these drugs is decreased from 84 per minute to 68 per minute. What is the nurses best action?

Multiple Choice
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A) Hold the next dose
B) Immediately notify the prescriber
C) Document the finding as the only action
D) Schedule the captopril and carvedilol to be given at different times
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Q15

A patient with heart failure is prescribed metoprolol (Toprol XL) 25 mg daily. The pharmacy sends metoprolol (Lopressor) 25 mg. What is the nurses best action?

Multiple Choice
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A) Give the dose as provided because the drugs are the same.
B) Ask the pharmacy to send the drug as ordered.
C) Contact the prescriber for clarification.
D) Check the patients heart rate before giving the dose.
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Q16

When are vasodilator drugs usually prescribed for heart failure?

Multiple Choice
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A) When angiotensin-converting enzyme (ACE) inhibitors cannot be taken
B) When venous dilation is also needed
C) When beta blockers are also being taken
D) When heart failure is improving
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Q17

Which precaution does the nurse stress when teaching a patient about a prescribed nitroglycerin transdermal patch?

Multiple Choice
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A) If a patch comes loose, tape it tightly to the skin with several layers of tape.
B) Do not remove old patches, just let them fall off over time.
C) Take care to apply the patches directly over your heart.
D) Remove the old patch before applying the new patch.
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Q18

A patient is prescribed nitroglycerin ointment. What technique does the nurse use to avoid experiencing side effects from this drug?

Multiple Choice
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A) Squeezes the ointment onto the special paper
B) Cleanses the skin before applying the drug
C) Rotates the drug application skin sites
D) Wears a pair of disposable gloves
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Q19

Which statement by a patient receiving nitroglycerin ointment indicates the need for additional teaching by the nurse?

Multiple Choice
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A) I will remove the previous dose before I put on the new dose.
B) I will reapply the dose every 4 hours around the clock.
C) I must avoid rubbing my skin when I put on a new dose.
D) I will put tape over the paper so that the dose stays in place.
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Q20

A patient is prescribed isosorbide (Isordil). Which condition does the nurse teach the patient is an expected side effect of this drug?

Multiple Choice
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A) Frequent headaches
B) Cold hands and feet
C) Change in urine color
D) Distaste for sweet foods or drinks
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Q21

Which vasodilator drug can be safely prescribed for a patient with heart failure during pregnancy?

Multiple Choice
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A) hydralazine (Apresoline)
B) isosorbide (Isordil)
C) minoxidil (Lonitin)
D) nitroglycerin (Nitrostat)
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Q22

A patient asks the nurse how prescribed digoxin (Lanoxin) will help improve heart failure. What is the nurses best response?

Multiple Choice
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A) It dilates your arteries and decreases your blood pressure.
B) It directly perfuses your kidneys which decreases your fluid volume and blood pressure.
C) It increases your heart rate which will result in improved cardiac output.
D) It increases the force of heart contractions and slows down the heart rate to improve cardiac output.
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Q23

A patient with heart failure is prescribed digoxin (Lanoxin). The patient reports nausea, blurry vision, and feeling like the heart is skipping beats. What is the nurses best action?

Multiple Choice
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A) Administer the scheduled dose because it will correct these side effects.
B) Assess the patients heart rate and then administer the scheduled dose.
C) Hold the dose and notify the prescriber immediately.
D) Place the patient on complete bed rest.
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Q24

A patient taking digoxin (Lanoxin) has all of the following laboratory blood values. Which value does the nurse report to the prescriber before administering the next dose of digoxin?

Multiple Choice
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A) Sodium 133 mEq/L
B) Potassium 2.8 mEq/L
C) Blood urea nitrogen 9 mg/dL
D) White blood cell count 11,000 cells/mm3
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Q25

What is the most important action for the nurse to perform before administering a patients daily dose of digoxin (Lanoxin)?

Multiple Choice
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A) Check the patients apical pulse for a full 60 seconds.
B) Assess the patients dependent body areas for edema formation.
C) Ask whether the patient has experienced any heart palpitations during the last 24 hours.
D) Verify that the time of administration today is within one-half hour of the time the drug was administered yesterday.
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Q26

A patient with heart failure asks the nurse why two diuretic drugs, furosemide (Lasix) and spironolactone (Aldactone), have been prescribed. What is the nurses best response?

Multiple Choice
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A) Your prescriber wants you to lose fluids and thats why you are taking two diuretics.
B) Each of these diuretics works in a different way to decrease workload on your heart.
C) Using two diuretics will double the amount of fluid you lose to decrease the work your heart must do.
D) Let me contact your prescriber because patients usually do not take two diuretics at the same time.
Answer:

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Q27

A patient with heart failure is prescribed a one-time dose of furosemide (Lasix) 400 mg by intravenous (IV) push immediately. What is the nurses best action?

Multiple Choice
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A) Contact the prescriber and request that the dose be changed from IV push to IV piggyback.
B) Give the dose by IV push over a 10-minute period of time.
C) Hold the dose and notify the prescriber immediately.
D) Start an IV and administer the drug as prescribed.
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Q28

A patient receiving dobutamine (Dobutrex) at 180 mcg/minute is having all of the following physiologic responses. Which response indicates that the drip rate may be too high?

Multiple Choice
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A) Systolic blood pressure increase from 106 to 122 mm Hg
B) Hourly urine output of 100 mL
C) Facial flushing
D) Chest pain
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Q29

A patient with heart failure is receiving dobutamine (Dobutrex) intravenously at home. Which sign or symptom does the home health nurse tell the patient to report?

Multiple Choice
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A) Burning or pain at the intravenous (IV) site
B) Heart rate between 60 and 70 beats per minute
C) Urine output of 1600 mL over 24 hours
D) Brief episode of shortness of breath
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Q30

What does the nurse teach a patient who has been prescribed potassium (K-Dur)?

Multiple Choice
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A) If you miss a dose, double your next dose to keep your blood level of potassium normal.
B) Take your potassium with food or a full glass or water to avoid nausea and vomiting.
C) Be sure to use salt substitutes instead of salt so that your body will not retain water.
D) Eat lots of foods that are high in potassium such as bananas, spinach, broccoli, and sweet potatoes.
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Q31

A patient is receiving magnesium by intravenous infusion. Which assessment finding indicates that the patients blood magnesium level may be too high?

Multiple Choice
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A) Respirations are 10 per minute and shallow.
B) Heart rate is 66 beats per minute and regular.
C) The patient reports difficulty staying asleep.
D) Hourly urine output is 30 mL.
Answer:

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Q32

[Multiple Response] Which are sympathetic nervous system compensatory mechanisms of the body for heart failure? (Select all that apply.)
a. Increased heart rate
b. Decreased respiratory rate
c. Increased contractility
d. Decreased body temperature
e. Increased cardiac output

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Q33

[Multiple Response] The nurse is creating a care plan for a patient with heart failure. Which lifestyle changes does the nurse include in the plan of care? (Select all that apply.)
a. Fluid restriction of 1000 mL per day
b. Weight loss program
c. Smoking cessation program
d. Aerobic exercise program
e. Low-salt, low-fat diet

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Q34

[Multiple Response] A patient is being discharged with prescribed sublingual nitroglycerin. Which teaching points does the nurse include in the patients care plan? (Select all that apply.)
a. Keep the tablet in place until it is dissolved.
b. Swallow the tablet with a full glass of water.
c. A tingling sensation means that the drug is potent.
d. Do not eat anything until after the tablet is dissolved.
e. Call your prescriber if chest pain persists after one tablet.

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Q35

[Multiple Response] A patient is to receive nesiritide (Natrecor). Which patient assessments does the nurse check before giving this drug? (Select all that apply.)
a. Heart rate
b. Swallowing reflex
c. IV line for patency
d. Oral intake
e. Respiratory rate factors

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Q36

[Multiple Response] A patient is to receive nesiritide (Natrecor). Which patient assessments does the nurse check before giving this drug? (Select all that apply.)
a. Heart rate
b. Swallowing reflex
c. IV line for patency
d. Oral intake
e. Respiratory rate factors

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Q37

A patient is prescribed digoxin (Lanoxin) 0.03 mg as a liquid dose. The drug on hand is digoxin 0.05 mg/mL. How many milliliters does the nurse give? _____ mL

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