Chapter 14: Drugs for Heart Failure Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 14: Drugs for Heart Failure

Test Bank

MULTIPLE CHOICE

1. What is the most common cause of heart failure?
a. Cardiomyopathy
b. Hypertension
c. Myocardial infarction
d. Substance abuse
ANS: B
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.

PTS: 0 DIF: Cognitive Level: Knowledge (Remembering)
REF: p. 248 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

2. Why must the muscles of the left ventricle be the strongest ones in the heart?
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.
ANS: C
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.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 249 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

3. Which two factors are most likely to result in improved cardiac output?
a. Greater preload; greater afterload
b. Greater preload; reduced afterload
c. Reduced preload; greater afterload
d. Reduced preload; reduced afterload
ANS: B
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.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 253 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

4. Which symptom is commonly assessed by the nurse when a patient has left ventricular heart failure?
a. Weight gain
b. Swelling in the legs
c. Jugular vein distention
d. Crackles in the lungs
ANS: D
When the left ventricle fails, less blood is pumped out to the body and backs up into the pulmonary system causing signs of pulmonary congestion such as crackles and wheezes. Weight gain, peripheral swelling, and jugular vein distention are all signs of right ventricular failure.

PTS: 1 DIF: Cognitive Level: Comprehension (Understanding)
REF: p. 250 TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity

5. Which condition alerts the nurse to assess a patient for worsening heart failure?
a. Blood pressure of 106/40 mm Hg
b. Pounding headache
c. Foul urine odor
d. Ankle swelling
ANS: D
Ankle swelling is associated with heart failure, although other conditions also can cause it. If this is a new symptom or is occurring even when the patient is not spending a lot of time sitting or standing, the nurse should assess the patient for other symptoms of heart failure. Although the blood pressure is not high, the pulse pressure is wide which does not indicate failure. A pounding headache is most associated with elevated blood pressure. Foul-smelling urine is associated with urinary tract infection.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

6. 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?
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
ANS: D
Some drugs for heart failure also slow the heart rate. If the heart rate is slow before taking the drug, the drug can slow the heart rate so much that the patient cannot adequately perfuse and oxygenate his or her vital organs. Usually, if the heart rate is less than 60 beats per minute, the prescriber is notified. The next dose may be held until the pulse rate returns to normal.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

7. Which statement made by a patient with heart failure indicates that more teaching is needed about the prescribed drug therapy?
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.
ANS: C
Heart failure can be improved with drug therapy but the underlying condition remains. When heart failure is a result of damage, it is not cured. Drug dosage needs may change to control heart failure, but usually the dosages only increase as time goes on.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Health Promotion and Maintenance

8. A patient asks the nurse how a prescribed diuretic can help heart failure. What is the nurses best response?
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.
ANS: B
The actions of diuretic drugs help heart failure in several ways. They can relax blood vessels and lower blood pressure so that less effort is needed for the heart contraction to move blood into the general circulation. Removing extra fluid from the circulation also can reduce blood pressure. In addition, some diuretics work on the heart muscle itself.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

9. A patient with heart failure asks the nurse why the antihypertensive drug enalopril (Vasotec) has been prescribed. What is the nurses best response?
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.
ANS: B
Decreasing blood pressure helps improve the hearts action as a pump and decreases the hearts workload. Diuretics are used to decrease blood volume. Enalopril is an angiotensin-converting enzyme (ACE) inhibitor that interferes with the transition of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor that causes increased blood pressure and increased workload for the heart.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

10. A patient taking lisinopril (Zestril) for heart failure reports a nagging, nonproductive cough. What is the nurses best first action?
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.
ANS: B
Many conditions can cause a cough, but a dry, nonproductive cough is the most common side effect of lisinopril and all other ACE inhibitors. Coughs associated with pulmonary infections or worsening of heart failure are usually productive. After assessing the patients issues with the cough, if the patient is uncomfortable or if the cough interferes with sleeping and other activities, report these problems to the prescriber.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Psychosocial Integrity

11. After giving the first dose of any antihypertensive drug for heart failure, what action must the nurse take for patient safety?
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.
ANS: B
Antihypertensive drugs decrease blood pressure and increase a patients risk for dizziness, light-headedness, and hypotension. After giving the first dose of any antihypertensive drug, the nurse should be sure that the call light is within easy reach and instruct the patient to call for assistance when getting out of bed. A wheelchair is not necessary and standards of practice state that the nurse should not raise all four siderails because there is a risk for falls if the patient tries to get out of bed alone.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

12. Which safety precaution does the nurse teach a patient going home on any antihypertensive drug for heart failure?
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
ANS: A
Antihypertensive drugs lower blood pressure, placing the patient at increased risk for dizziness and hypotension. Changing positions slowly gives the body time to adjust, preventing dizziness and falls. The patient can get up at home without assistance if he or she changes positions slowly. Some, but not all, over-the-counter drugs may not be safe with these drugs. The nurse should teach the patient to always consult with the prescriber before taking an over-the-counter drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

13. 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?
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.
ANS: D
Patient weight gain and increased shortness of breath are signs of worsening heart failure. The prescriber should be notified because the plan of care may need to be modified. If the patient is taking a diuretic, it is likely that the dose may be increased.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

14. 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?
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
ANS: C
Beta blockers and ACE inhibitors are often used together to treat heart failure. Beta blockers block the effects of epinephrine on the heart resulting in deceased heart rate and force of contraction, thus decreased blood pressure. The nurse should notify the prescriber if the heart rate is less than 60 per minute.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

15. 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?
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.
ANS: B
When prescribed to treat heart failure, only the sustained-release form of metoprolol is used. Metoprolol (Toprol XL) is the sustained-release form of the drug, whereas metoprolol (Lopressor) is not.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

16. When are vasodilator drugs usually prescribed for heart failure?
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
ANS: A
Vasodilators act directly on the peripheral arteries, causing them to dilate, which leads to decreased blood pressure and workload on the heart. When patients cannot take ACE inhibitors or angiotensin II receptor blockers, vasodilators are often prescribed.

PTS: 1 DIF: Cognitive Level: Knowledge (Remembering)
REF: p. 255 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

17. Which precaution does the nurse stress when teaching a patient about a prescribed nitroglycerin transdermal patch?
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.
ANS: D
The previous patch must be removed (and the area wiped clean of drug) before applying a new patch (to a different site) to prevent leftover drug from contributing to a drug overdose. Applying the patch directly over the heart does not increase the speed of drug action on the heart.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

18. A patient is prescribed nitroglycerin ointment. What technique does the nurse use to avoid experiencing side effects from this drug?
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
ANS: D
Common side effects of nitroglycerin ointment include hypotension and headaches. When a nurse is administering this drug, if his or her skin comes into contact with this drug as it is squeezed onto the special lined paper, these side effects may develop. Wearing gloves prevents skin contact with the drug and the risk for side effects.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

19. Which statement by a patient receiving nitroglycerin ointment indicates the need for additional teaching by the nurse?
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.
ANS: B
Nitroglycerin ointment or patches lose their effectiveness when used continuously. It works much better when there is a drug free time during a 24-hour period. Usually the drug is removed at night when the patient has his or her longest sleeping period because the heart is less stressed during that time.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Health Promotion and Maintenance

20. A patient is prescribed isosorbide (Isordil). Which condition does the nurse teach the patient is an expected side effect of this drug?
a. Frequent headaches
b. Cold hands and feet
c. Change in urine color
d. Distaste for sweet foods or drinks
ANS: A
Isosorbide dilates blood vessels to allow better blood flow to the heart muscle. However, blood vessels are dilated in many body areas. When blood vessels in the brain or head are dilated, headaches can occur.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

21. Which vasodilator drug can be safely prescribed for a patient with heart failure during pregnancy?
a. hydralazine (Apresoline)
b. isosorbide (Isordil)
c. minoxidil (Lonitin)
d. nitroglycerin (Nitrostat)
ANS: A
Hydralazine can be safely used for blood pressure control during pregnancy, but isosorbide and nitroglycerin may affect fetal circulation and should be used with caution during pregnancy. Minoxidil, a pregnancy category C drug, is a vasodilator that is not generally used in the treatment of heart failure.

PTS: 1 DIF: Cognitive Level: Comprehension (Understanding)
REF: p. 258 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

22. A patient asks the nurse how prescribed digoxin (Lanoxin) will help improve heart failure. What is the nurses best response?
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.
ANS: D
Digoxin is a cardiac glycoside drug that works on the muscle fiber of the heart to increase the force of each contraction. It also slows down the heart rate. These actions improve cardiac output.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

23. 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?
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.
ANS: C
Nausea, blurry vision, and heart rate or rhythm changes are signs of digoxin overdose. The dose should be held and the prescriber notified. Most likely the nurse will also obtain a blood sample to measure the digoxin level. Digoxin has a very narrow therapeutic range (0.8 to 2 ng/mL) and this level should be checked whenever a patient shows any signs of toxicity. Symptoms usually resolve when the drug is held and the body eliminates it.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

24. 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?
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
ANS: B
Serum potassium level affects the activity of digoxin. A value of 2.8 is low (hypokalemia). Any abnormal potassium value (high or low) requires the prescriber to change the digoxin dosage. In addition, action is needed to bring this critical electrolyte value back to its normal range. Although the other laboratory values are slightly abnormal, none are critically abnormal or likely to have an effect on digoxin activity.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

25. What is the most important action for the nurse to perform before administering a patients daily dose of digoxin (Lanoxin)?
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.
ANS: A
Although all the actions are important, the most important is to ensure that the pulse rate is between 60 and 100 beats per minute and is regular before administering digoxin or any other cardiac glycoside. For an irregular heart rate or one that is outside of this range, the dose must be held and the prescriber notified immediately.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

26. 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?
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.
ANS: B
Spironolactone, when used in low doses, blocks the action of aldosterone, which causes the body to lose salt and water. Furosemide works in the loop of Henle to decrease reabsorption of salt and water. Spironolactone is usually prescribed with another diuretic to decrease the volume of fluid in the blood vessels, which reduces the workload of the heart. Additionally when used together, these drugs help the body maintain a more normal blood potassium level.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

27. 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?
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.
ANS: C
The usual IV dose of furosemide ranges between 10 mg and 80 mg. A dose of 400 mg is very large. The nurse must verify the correct drug dose before administering it.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

28. 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?
a. Systolic blood pressure increase from 106 to 122 mm Hg
b. Hourly urine output of 100 mL
c. Facial flushing
d. Chest pain
ANS: D
Dobutamine is a positive inotropic drug. Side effects include improved urine output and increased blood pressure. Facial flushing is common but not serious. Chest pain indicates the heart is working too hard, which may be related to the dosage level. The nurse should slow the drip rate and immediately notify the prescriber.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

29. 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?
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
ANS: A
Patients receiving dobutamine at home should be taught the signs and symptoms of IV lines that are no longer patent or have developed infection (e.g., burning, pain, redness, swelling, warmth at the site). Patients should be instructed to report these signs immediately.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

30. What does the nurse teach a patient who has been prescribed potassium (K-Dur)?
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.
ANS: B
Common side effects of potassium include nausea, vomiting, diarrhea, gas, and abdominal discomfort. Taking the drug with food or right after meals with a full glass of water or fruit juice will decrease or prevent these side effects. A patient should never take a double dose of a prescribed drug. Most salt substitutes are made by replacing sodium with potassium. Use of salt substitutes or eating excessive amounts of foods that are high in potassium while taking a potassium supplement increases the risk of hyperkalemia (high blood potassium).

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

31. A patient is receiving magnesium by intravenous infusion. Which assessment finding indicates that the patients blood magnesium level may be too high?
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.
ANS: A
High blood levels of magnesium interfere with muscle contraction, causing muscle weakness. Breathing is dependent on good contraction of respiratory muscles. Shallow and slow respirations are a serious manifestation of excess blood magnesium levels.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

1. 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
ANS: A, C, E
The sympathetic nervous system releases the catecholamine hormones epinephrine and norepinephrine, which act on the heart in two ways. First they increase the heart rate, and second they increase the power of the heart muscle fibers to contract so that the heart pumps more forcefully. These actions increase cardiac output.

PTS: 1 DIF: Cognitive Level: Comprehension (Understanding)
REF: pp. 251, 253 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity

2. 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
ANS: B, C, E
Lifestyle changes that are important in treating heart failure include weight loss, smoking cessation, and a low-salt and low-fat diet. A fluid restriction of 1000 mL can result in decreased perfusion of the kidneys. Patients with heart failure may not be able to tolerate an aerobic exercise program.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Health Promotion and Maintenance

3. 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.
ANS: A, C, D, E
Sublingual or buccal nitroglycerin should not be swallowed because the liver destroys most of the drug and makes it ineffective. The drug should be kept in place until dissolved. Patients should not drink or eat until the tablet is dissolved. A tingling sensation as the tablet dissolves indicates that the drug is potent and any time a patients chest pain persists after using one tablet, the prescriber should be notified.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Planning
MSC: Client Needs Category: Health Promotion and Maintenance

4. 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
ANS: A, C, E
Nesiritide is given by the IV route, so the nurse should always ensure that the IV line is patent. Heart and respiratory rate should always be assessed before giving this drug. The heart rate should be between 60 and 100 beats per minute and the respiratory rate should be between 12 and 20 breaths per minute.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

ESSAY

1. 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

ANS:
0.6 mL

Want 0.03 mg; Have 0.05 mg per 1 mL
cancel mg; 0.05X = 0.03; X = 0.6
0.6 1 mL = 0.6 mL

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

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