Southwestern College - NURSING 100

Chapter 17: Drug Therapy for Heart Failure

Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition

MULTIPLE CHOICE

BASIC CONCEPTS

1)What does the term “afterload” mean?

1. 1. The amount of blood entering the left ventricle that must be pumped out of the heart
   2. The peripheral resistance of the arterial system, including mean arterial pressure
   3. The ability of the living muscle fibers of the heart to contract and pump blood
   4. The percentage of blood pumped out of the heart with each heartbeat

2. What is the most common cause of heart failure?
   1. High blood pressure
   2. Low blood pressure
   3. Defective heart valves
   4. Defective coronary arteries

3. What is the main physiological problem in most types of heart failure?
   1. Overstretching of the right ventricle so that too much blood leaves the heart
   2. Overstretching of the right ventricle so that too little blood leaves the heart
   3. Overstretching of the left ventricle so that too much blood leaves the heart
   4. Overstretching of the left ventricle so that too little blood leaves the heart

4. Which symptom occurs with only pure right-sided heart failure and does not occur with pure left-sided heart failure?
   1. Confusion
   2. Shortness of breath
   3. Decreased afterload
   4. Swelling in the ankles and legs

5. Which statement about drug therapy for heart failure is true?
   1. The drugs work only directly on the heart muscle.
   2. Drug therapy improves heart function but does not cure heart failure.
   3. When heart function returns to normal, the drug therapy can be stopped.
   4. Drug therapy for heart failure does not work when the patient continues to smoke.

6. What is a common side effect of hydralazine (Apresoline) therapy for heart failure?
   1. Tachycardia
   2. High blood pressure
   3. Constipation
   4. Difficulty sleeping

7. How should sublingual nitroglycerin tablets for heart failure be taken?
   1. On a full stomach
   2. On an empty stomach
   3. Dissolved under the tongue
   4. Placed under a patch on the chest

8. What is the mechanism of action for cardiac glycosides?
   1. Slowing the heart rate and increasing the force of the heart muscle contraction
   2. Increasing the heart rate and decreasing the force of the heart muscle contraction
   3. Directly relaxing blood vessel muscles and decreasing afterload
   4. Directly constricting blood vessel muscles and increasing afterload

9. What is the most common side effect of cardiac glycoside drugs for heart failure therapy?
   1. Abdominal cramping and constipation
   2. Heart rhythm disturbances
   3. High blood pressure
   4. Skin rashes

10. Which drug for heart failure is a common positive inotrope?
    1. Amiloride (Midamor)
    2. Nesiritide (Natrecor)
    3. Captopril (Capoten)
    4. Dobutamine (Dobutrex)

11. When are vasodilator drugs usually prescribed for heart failure?
    1. When angiotensin-converting enzyme (ACE) inhibitors cannot be taken
    2. When venous dilation is also needed
    3. When beta blockers are also being taken
    4. When heart failure is improving

ADVANCED CONCEPTS

12. Why must the muscles of the left ventricle be the strongest ones in the heart?
    1. The mitral (bicuspid) valve is larger than the aortic valve.
    2. The left ventricle receives blood under high pressure from the pulmonary system.
    3. The pressure in the aorta is higher than the pressures elsewhere in the circulatory system.
    4. Blood in the left ventricle is oxygenated, making it thicker and harder to move than deoxygenated blood.

13. Which two factors are most likely to result in improved cardiac output?
    1. Greater preload; greater afterload
    2. Greater preload; reduced afterload
    3. Reduced preload; greater afterload
    4. Reduced preload; reduced afterload

14. Which symptom is commonly assessed when a patient has left ventricular heart failure?
    1. Weight gain
    2. Swelling in the legs
    3. Jugular vein distention
    4. Crackles in the lungs

15. How does hydralazine (Apresoline) help improve heart failure?

1. 1. By directly stimulating the right heart muscle to increase the strength of heart muscle contraction
   2. By directly stimulating the left heart muscle to increase the strength of heart muscle contraction
   3. By directly relaxing blood vessel muscles and decreasing afterload
   4. By directly constricting blood vessel muscles and increasing afterload

16. How do natriuretic peptides work to help improve heart failure?
    1. Increasing preload
    2. Decreasing preload
    3. Decreasing water loss and raising blood pressure
    4. Increasing water loss and lowering blood pressure

17. Which condition alerts you to assess a patient for worsening heart failure?
    1. Blood pressure of 106/40 mm Hg
    2. Pounding headache
    3. Foul urine odor
    4. Ankle swelling

18. You prepare to administer a drug for heart failure to a patient. Which assessment finding do you report to the prescriber before administering the drug?
    1. Systolic blood pressure increase from 128 to 136
    2. Urine output of 2100 mL in 24 hours
    3. Weight gain of 1 lb in 3 days
    4. Heart rate of 54 beats/min

19. Which statement made by a patient with heart failure indicates that more teaching is needed about the prescribed drug therapy?
    1. “I always try to take my heart failure drugs at the same time each day.”
    2. “Now I am using a weekly pill dispenser to keep my drugs straight.”
    3. “Now that my heart failure is cured I can cut back the drugs I take.”
    4. “If I gain more than 3 lb in a week I will call my doctor.”

20. A patient asks you how a prescribed diuretic can help heart failure. What is your best response?
    1. “Urinating more prevents heart failure from damaging your kidneys.”
    2. “Diuretics reduce blood pressure so your heart won’t have to work as hard.”
    3. “Taking a diuretic reduces salt levels so you don’t have to limit your intake of salty foods.”
    4. “The diuretic counteracts the side effects of the other drugs prescribed for your heart failure.”

21. A patient with heart failure asks you why the antihypertensive drug enalapril (Vasotec) has been prescribed. What is your best response?
    1. “Hypertension is the most common cause of heart failure.”
    2. “Lowering your blood pressure will allow your heart to pump more easily.”
    3. “This drug will decrease the amount of blood your heart has to pump, leading to less work for your heart.”
    4. “Enalapril will cause your heart to reestablish its normal electrical functions so that it works more effectively as a pump.”

22. A patient taking lisinopril (Zestril) for heart failure reports a nagging, nonproductive cough. What is your best first action?
    1. Ask the patient whether he or she has received the annual influenza vaccination.
    2. Ask the patient how much the cough is interfering with sleep or other activities.
    3. Document the report as the only action.
    4. Notify the prescriber immediately.

23. After giving the first dose of any antihypertensive drug for heart failure, what action must be taken for a hospitalized patient’s safety?
    1. Recheck the drug order for accuracy.
    2. Ensure that the call light is within reach.
    3. Place a wheelchair in the patient’s room.
    4. Raise all four side rails on the patient’s bed.

24. Which safety precaution should be taught to a patient going home on any antihypertensive drug for heart failure?
    1. Always change positions slowly.
    2. Never get up without assistance.
    3. Take the drug in the evening before bedtime.
    4. Avoid all over-the-counter drugs while taking this drug.

25. 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 your best response?
    1. “These changes are to be expected because you have heart failure.”
    2. “You will probably need a decreased dose of your diuretic drug.”
    3. “I will ask the dietitian to discuss a weight loss diet with you.”
    4. “Your prescriber must be notified because your heart failure is getting worse.”

26. 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 your best action?
    1. Hold the next dose.
    2. Immediately notify the prescriber.
    3. Document the finding as the only action.
    4. Schedule the captopril and carvedilol to be given at different times.

27. A patient with heart failure is prescribed metoprolol (Toprol XL) 25 mg daily. The pharmacy sends metoprolol (Lopressor) 25 mg. What is your best action?
    1. Give the dose as provided because the drugs are the same.
    2. Ask the pharmacy to send the drug as ordered.
    3. Contact the prescriber for clarification.
    4. Check the patient’s heart rate before giving the dose.

28. Which precaution should you stress when teaching a patient about a prescribed nitroglycerin transdermal patch?
    1. “If a patch comes loose, tape it tightly to the skin with several layers of tape.”
    2. “Do not remove old patches, just let them fall off over time.”
    3. “Take care to apply the patches directly over your heart.”
    4. “Remove the old patch before applying the new patch.”

29. A patient with severe heart failure is discharged with a prescription for nitroglycerin ointment. What technique do you teach the patient’s spouse to use to avoid experiencing side effects when applying this drug?
    1. Squeeze the ointment onto the special paper.
    2. Cleanse the skin before applying the drug.
    3. Rotate the drug application skin sites.
    4. Wear a pair of disposable gloves.

30. Which statement by a patient receiving nitroglycerin ointment indicates the need for additional teaching?
    1. “I will remove the previous dose before I put on the new dose.”
    2. “I will reapply the dose every 4 hours around the clock.”
    3. “I must avoid rubbing my skin when I put on a new dose.”
    4. “I will put tape over the paper so that the dose stays in place.”

31. For which drug order would you contact the prescriber to verify it is correct?
    1. Furosemide (Lasix) 40 mg orally each day
    2. Fosinopril (Monopril) 20 mg orally each day

1. 3. Digoxin (Lanoxin) 2.5 mg orally each day
   4. Amiloride (Midamor) 5 mg orally each day

32. A patient is prescribed isosorbide (Isordil). Which condition will you teach the patient is an expected side effect of this drug?
    1. Frequent headaches
    2. Cold hands and feet
    3. Change in urine color
    4. Distaste for sweet foods or drinks

33. Which vasodilator drug can be safely prescribed for a patient with heart failure during pregnancy?
    1. Hydralazine (Apresoline)
    2. Isosorbide (Isordil)
    3. Minoxidil (Lonitin)
    4. Nitroglycerin (Nitrostat)

34. A patient asks you how prescribed digoxin (Lanoxin) will help improve heart failure. What is your best response?
    1. “It dilates your arteries and decreases your blood pressure.”
    2. “It directly perfuses your kidneys which decreases your fluid volume and blood pressure.”
    3. “It increases your heart rate which will result in improved cardiac output.”
    4. “It increases the force of heart contractions and slows down the heart rate to improve cardiac output.”

35. 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 your best action?
    1. Administer the scheduled dose because it will correct these heart failure symptoms.
    2. Assess the patient’s heart rate and then administer the scheduled dose.
    3. Hold the dose and notify the prescriber immediately.
    4. Place the patient on complete bed rest.

36. A patient taking digoxin (Lanoxin) has all of the following laboratory blood values. Which value do you report to the prescriber before administering the next dose of digoxin?
    1. Sodium 133 mEq/L
    2. Potassium 2.8 mEq/L
    3. Blood urea nitrogen 9 mg/dL
    4. White blood cell count 11,000 cells/mm³

37. What is the most important action for you to teach a patient to perform before taking his or her daily dose of digoxin (Lanoxin)?
    1. Check the pulse for a full 60 seconds.
    2. Look for edema in your ankles.
    3. Notify the prescriber for any heart palpitations.
    4. Take the drug at exactly the same time every day.

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

1. 1. “Your prescriber wants you to lose fluids and that’s why you are taking two diuretics.”
   2. “Each of these diuretics works in a different way to decrease workload on your heart.”
   3. “Using two diuretics will double the amount of fluid you lose to decrease the work your heart must do.”
   4. “Let me contact your prescriber because patients usually do not take two diuretics at the same time.”

39. A patient with heart failure is prescribed a one-time dose of furosemide (Lasix) 400 mg by intravenous (IV) push immediately. What is the best action?
    1. Contact the prescriber and request that the dose be changed from IV push to IV piggyback.
    2. Give the dose by IV push over a 10-minute period of time.
    3. Hold the dose and notify the prescriber immediately.
    4. Start an IV and administer the drug as prescribed.

40. A patient receiving dobutamine (Dobutrex) at 180 mcg/min is having all of the following physiologic responses. Which response indicates that the drip rate may be too high?
    1. Systolic blood pressure increase from 106 to 122 mm Hg
    2. Hourly urine output of 100 mL
    3. Facial flushing
    4. Chest pain

41. A patient with heart failure is receiving dobutamine (Dobutrex) intravenously at home. Which sign or symptom should the patient and family be instructed to report to the prescriber immediately?
    1. Burning or pain at the intravenous (IV) site

1. 2. Heart rate between 60 and 70 beats/min
   3. Urine output of 1600 mL over 24 hours
   4. Brief episode of shortness of breath

42. What should you teach a patient who has been prescribed potassium (K-Dur) tablets?
    1. “If you miss a dose, double your next dose to keep your blood level of potassium normal.”
    2. “Take your potassium with food or a full glass or water to avoid nausea/vomiting.”
    3. “Be sure to use salt substitutes instead of salt so that your body will not retain water.”
    4. “Eat lots of foods that are high in potassium such as bananas, spinach, broccoli, and sweet potatoes.”

43. A patient is receiving magnesium by intravenous infusion. Which finding indicates that the patient’s blood magnesium level may be too high?
    1. Respirations are 10 per minute and shallow.
    2. Heart rate is 66 beats/min and regular.
    3. The patient reports difficulty staying asleep.
    4. Episodes of diarrhea.

44. A patient is prescribed inamrinone (Inocor) by continuous intravenous infusion. When you make rounds and assess the patient, the intravenous bag infusing is labeled (Primacor). What should you do?
    1. Stop the infusion and notify the prescriber.
    2. Assess the infusion site for a blood return.
    3. Document the infusion and site conditions as the only action.

1. 4. Slow the infusion rate because Primacor is more potent than Inocor.

45. What is the most important reason intravenous potassium is considered a high alert drug?
    1. When intravenous potassium is administered at too low a dose its mechanism of action is greatly reduced.
    2. Intravenous potassium is a highly irritating solution and can cause significant pain or burning at the infusion site.
    3. Administering too much intravenous potassium or administering it too quickly may cause life-threatening problems.
    4. Excessive blood potassium levels can lead to nausea, vomiting, severe diarrhea, abdominal cramping, and other intestinal problems.

MULTIPLE RESPONSE ADVANCED CONCEPTS

1. Which are sympathetic nervous system compensatory mechanisms of the body for heart failure? (select all that apply)
   1. Increased heart rate
   2. Decreased respiratory rate
   3. Increased contractility
   4. Decreased body temperature
   5. Increased cardiac output
   6. Decreased cardiac output

2. Which lifestyle changes should you suggest to a patient with heart failure? (select all that apply)

1. 1. Fluid restriction of 1000 mL/day
   2. Weight loss program
   3. Smoking cessation program
   4. Aerobic exercise program
   5. Low-salt, low-fat diet

3. A patient has been prescribed sublingual nitroglycerin. Which key points will you teach the patient about this drug? (select all that apply)
   1. Keep the tablet in place until it is dissolved.
   2. Swallow the tablet with a full glass of water.
   3. A tingling sensation means that the drug is potent.
   4. Do not eat anything until after the tablet is dissolved.
   5. Call your prescriber if chest pain persists after one tablet.

4. A patient is to receive nesiritide (Natrecor). Which patient assessments must be checked before giving this drug? (select all that apply)
   1. Heart rate
   2. Swallowing reflex
   3. IV line for patency
   4. Oral intake
   5. Respiratory rate factors

COMPLETION

ADVANCED CONCEPTS