Chapter 17 - Book Qs & Evolve Qs

Question 1

1. Which drug produces more venous vasodilation than arterial vasodilation?

A. Digoxin B. Isosorbide C. Capoten D. Dobutamine

Answer 1

B

Question 2

2. Before administering a dose of digoxin, which action is essential?

A. Perform orthostatic vital signs. B. Place the patient on a cardiac monitor. C. Assess lungs for abnormal sounds such as crackles. D. Listen to the apical heart rate for a full minute.

Answer 2

D

Question 3

3. What must you teach a patient about how to take sublingual nitroglycerine?

A. Place the drug between your cheek and gums. B. Drink a full glass or water with the drug. C. Notify the prescriber every time you use this drug. D. A tingling sensation tells you that the drug is potent.

Answer 3

D

Question 4

4. When you administer a vasodilator drug to an older adult, what is the primary risk?

A. Severe headache B. Increased risk for falls C. Sudden increase in blood pressure D. Acute heart attack

Answer 4

B

Question 5

5. Which foods will you teach patients are good sources of magnesium? (Select all that apply.)

A. Bananas B. Almonds C. Black beans D. Sweet potatoes E. Soybeans F. Yogurt G. Molasses

Answer 5

B C E

Question 6

6. A patient who has just been prescribed enalapril (Vasotec) for heart failure asks you how the drug will work. What is your best response?

A. “It will cause your arteries and veins to dilate.” B. “It will slow your heart rate.” C. “It will decrease the fluid and sodium in your blood and tissues.” D. “It will increase the contraction strength of your heart.”

Answer 6

C

Question 7

7. Which symptoms will you likely see in a patient with left heart failure? (Select all that apply.)

A. Weak peripheral pulses B. Full jugular veins when sitting C. Pulmonary congestion D. Weight gain E. Hacking cough that is worse at night F. Crackles in the lungs

Answer 7

A C E F

Question 8

8. A patient was recently started on nitroglycerin ointment 1 inch every 6 hours. The patient asks you why the patch is removed at night. What is your best response?

A. “I will contact the pharmacy and let you know the answer to this question.” B. “This drug loses its effectiveness when it is used continuously.” C. “A break in the use of this drug helps to protect your skin from irritation.” D. “At night you will not need this drug because you have fewer heart failure symptoms.”

Answer 8

B

Question 9

9. Older adults are more sensitive to the effects of many heart failure drugs. Which drug is more likely to cause toxicity in older adults?

A. digoxin (Lanoxin) B. isosorbide (Isordil) C. hydralazine (Apresoline) D. captopril (Capoten)

Answer 9

A

Question 10

10. An adult patient prescribed magnesium (Max-Oxide) 400mg by mouth daily tells you he has nausea after taking this drug. What should you teach the patient about taking this drug? (Select all that apply.)

A. “Take your magnesium with a full glass of water.” B. “Always take your magnesium on an empty stomach for better absorption.” C. “You can take your magnesium right after a meal to decrease the nausea.” D. “Over time you will develop a tolerance for magnesium, and the nausea will go away.” E. “Always take your magnesium with food or a snack to avoid gastrointestinal symptoms.” F. “Good food sources of magnesium include green leafy vegetables and almonds.”

Answer 10

A C E F

Question 11

11. A patient is receiving dobutamine (Dobutrex) 0.5mcg/kg/min by IV. Which manifestations indicate an infection at the IV site? (Select all that apply.)

A. Pain at the IV site B. Blood in the catheter C. Redness at the site D. Hypotension E. Warmth at the site F. Swelling at the site

Answer 11

A C E F

Question 12

12. What are the most important teaching points for a patient who will go home with sublingual nitroglycerin to be used as needed for chest pains? (Select all that apply.)

A. Keep the tablet in place under your tongue until it dissolves. B. Store the drug in the refrigerator to avoid exposing it to heat. C. You should experience a tingling sensation, which indicates that the drug is potent. D. If you experience a headache, acetaminophen can be taken for relief.

Answer 12

A C D F

Question 13

13. What should you teach the patient who has recently been prescribed nesiritide by IV infusion?

A. Your blood pressure will be checked once a day. B. You may feel some burning at the IV site and that is to be expected. C. Monitoring your intake and output is important while you are receiving this drug. D. This drug rarely causes gastrointestinal side effects such as nausea.

Answer 13

C

Question 14

A patient is being discharged with a prescription for nitroglycerin ointment. Which actions are important for the nurse to teach the patient about this medication? (select all that apply)
Select all that apply.

Wear gloves.
Use a special ruled paper.
Measure the ointment directly on the skin.
Use the same site each time.
Tape the special ruled paper in place.

Answer 14

Wear gloves.
Use a special ruled paper.

Tape the special ruled paper in place.

Question 15

A patient who has been taking a nitroglycerin patch for several days reports a headache. What is the best advice the nurse should give to this patient?

“Remove the patch and eliminate the next nitroglycerin dose.”

“Wear gloves when applying and removing the nitroglycerin patch.”

“Report to the nearest available emergency room.”

“Take a mild headache pain reliever such as acetaminophen (Tylenol).”

Answer 15

“Take a mild headache pain reliever such as acetaminophen (Tylenol).”

A mild headache pain reliever such as acetaminophen (Tylenol) may be required for headaches related to nitroglycerin. Teach patients that, while acetaminophen may be needed at first to relieve headaches, most people develop a tolerance for nitroglycerin and isosorbide, and the headaches decrease or disappear. Common side effects of nitroglycerin and isosorbide include hypotension, headache, dizziness, and tachycardia. Removing the patch and eliminating the next nitroglycerin dose could potentially harm the patient, because when the drugs are stopped suddenly, blood vessels constrict too much (rebound response), causing less blood flow to the heart and a rapid rise in blood pressure. They should be discontinued gradually. Asking the patient to wear gloves when applying and removing the nitroglycerin patch would not be a helpful suggestion, because the drug would still be absorbed into the patient’s skin. This complaint is not a life-threatening event, so advising the patient to report to the nearest available emergency department is not necessary.

Question 16

A patient is concerned about forgetting to take the morning dose of digoxin (Lanoxin) and it is now lunchtime. What should you tell the patient?

“Skip this dose and remember to take the next morning dose.”

“Take the dose now.”

“Take half the dose now.”

“Skip the dose now and take double the dose the next morning.”

Answer 16

“Take the dose now.”

A missed dose may be taken within 12 hours of its scheduled time. After that time it should be skipped because a double dose can lead to toxicity. Teach patients to take digoxin exactly as ordered by the prescriber. Digoxin should be taken every day at the same time, and a dose should not be skipped. Skipping the dose entirely would lead to decreased digoxin levels in the blood. Taking half the dose may lead to decreased digoxin levels in the blood. Skipping the dose would lead to decreased digoxin levels now, while doubling the dose the next morning may lead to possible toxicity. Digoxin has a very narrow therapeutic range (0.8 to 2 ng/mL), and levels above 2 ng/mL are considered toxic.

Question 17

The nurse is giving a patient with heart failure a vasodilator. What is the reason why this medication is being given?

They are among the first drugs given.

They are given with angiotensin-converting enzyme (ACE) inhibitors.

They are given when ACE inhibitors cannot be given.

They are given when severe heart failure symptoms appear.

Answer 17

They are given when ACE inhibitors cannot be given.

Vasodilators are often given to patients who cannot take ACE inhibitors or angiotensin II receptor blockers. Vasodilators act directly on the peripheral arteries to cause them to dilate (widen). This leads to lowering of blood pressure and decreases the workload of the heart. ACE inhibitors and not vasodilators are among the first drugs given to patients with heart failure. Beta blockers are typically given with ACE inhibitors. Neither one of them is a vasodilator. Inotropes and not vasodilators are typically first given in the intensive care unit, after severe heart failure symptoms have occurred.

Question 18

A nurse is administering a beta blocker to a patient admitted with heart failure. What is the primary action of this drug?

It blocks the effects of adrenaline on the heart.

It increases the heart rate, thereby increasing the stroke volume.

It increases the blood pressure, thereby increasing the stroke volume.

It increases the force of the heart’s contractions.

Answer 18

It blocks the effects of adrenaline on the heart.

Beta blockers block the effects of epinephrine (adrenaline) on the heart. They decrease and not increase the heart rate and the force of heart contractions, leading to a decrease in blood pressure. This results in the heart not having to work as hard and requires less oxygen. Beta blockers work by decreasing blood pressure, not increasing it. Beta blockers work by decreasing the force of cardiac contractions.

Question 19

How does the cardiac glycoside digoxin (Lanoxin) work to improve cardiac output? (select all that apply)
Select all that apply.

It slows down a heart rate that is too fast.
It causes the peripheral arteries to widen or dilate.
It increases water elimination and blood vessel dilation.
It increases the force of contraction of each heartbeat.
It interferes with the formation of angiotensin II and prevents constriction of the arteries.

Answer 19

It slows down a heart rate that is too fast.

It increases the force of contraction of each heartbeat.

Question 20

The nurse is giving digoxin to a newly admitted telemetry patient with heart failure. What are possible side effects of digoxin? (select all that apply)
Select all that apply.

Fatigue
Tachycardia
Hypotension
Decreased appetite, or anorexia
Nausea/vomiting

Answer 20

Fatigue

Decreased appetite, or anorexia
Nausea/vomiting

Question 21

Which foods are good sources of the electrolyte potassium? (select all that apply)
Select all that apply.

Baked potato
Mixed nuts
Tomato puree
Winter squash
Black beans
Whole-grain rice
Lima beans

Answer 21

Baked potato
Tomato puree
Winter squash
Lima beans

Question 22

The nurse is assessing a patient’s cardiac output. What factors can increase cardiac output (CO)? (select all that apply)
Select all that apply.

Increased heart rate (HR)
Decreased HR
Increased stroke volume (SV)
Decreased SV
Cardiac hypertrophy

Answer 22

Increased heart rate (HR)

Increased stroke volume (SV)

Cardiac output (CO) is the product of heart rate (HR) and stroke volume (SV). The formula for this is CO = HR × SV. A decreased HR would decrease CO. A decreased SV would decrease CO. Cardiac hypertrophy would decrease CO.

Question 23

Before administering a patient’s dose of digoxin (Lanoxin), you assess an apical heart rate of 56. What should you do next?

Call the pharmacy.

Give the medication.

Hold the medication.

Draw a serum digoxin level.

Answer 23

Hold the medication.

For a heart rate lower than 60 beats/min hold the digoxin dose; notify the prescriber and ask if the patient should receive this drug. You would not need to call the pharmacy in this situation. Administering the medication may cause digoxin toxicity in the patient. One of the first symptoms of digoxin toxicity is an apical heart rate of less than 60. The physician may order a serum digoxin level, but that is a not a nursing order.

Question 24

The nurse is performing an assessment on a patient admitted with left heart failure. What symptoms the nurse most likely to find?

Enlarged liver and spleen

Edema in the legs and sacrum

Dyspnea, breathlessness

Jugular (neck vein) distention

Answer 24

Dyspnea, breathlessness

Dyspnea and breathlessness are the symptoms the nurse would most likely to find. When blood collects in the left side of the heart, it results in congestion in the lungs, decreased lung function, and difficulty breathing. Because the left ventricle pumps blood to the body, symptoms include signs of decreased cardiac output (such as fatigue and weakness) and signs of pulmonary congestion (such as crackles and wheezes detected with a stethoscope). Enlarged liver and spleen are symptoms of right heart failure as a result of peripheral congestion. Edema in the legs and sacrum are symptoms of right heart failure as a result of peripheral congestion. Jugular (neck vein) distention is a symptom of right heart failure as a result of peripheral congestion.

Question 25

The nurse is administering nesiritide (Natrecor) to a patient. What life-threatening adverse effect must the nurse watch for after administering this drug?

Apnea

Hypertension

Hypotension

Ventricular dysrhythmias

Answer 25

Apnea

Apnea (absence of breathing) is a life-threatening adverse effect of nesiritide. Side effects of natriuretic peptides include hypotension, dizziness, light-headedness, frequent urination, nausea, vomiting, nervousness, confusion, and palpitations. Nesiritide is given to lower blood pressure, not raise it. Hypotension and palpitations are common side effects, but are not adverse life-threatening effects. Ventricular dysrhythmias are not adverse effects of nesiritide.

Question 26

The nurse is discharging a patient with a prescription for a potassium supplement. What points are important for the nurse to teach this patient? (select all that apply)
Select all that apply.

Missed doses should be taken within 12 hours.
Take with food.
Take on an empty stomach.
Avoid salt substitutes.
Call the prescriber if muscle twitching or weakness occurs.

Answer 26

Take with food.

Avoid salt substitutes.

Call the prescriber if muscle twitching or weakness occurs.

Question 27

The nurse is caring for a patient with heart failure who has a problem with increased afterload. What medication would the nurse expect the prescriber to order? (select all that apply)
Select all that apply.

Angiotensin-converting enzyme (ACE) inhibitors
Vasodilators
Angiotensin II receptor blockers
Beta blockers
Positive inotropes

Answer 27

Angiotensin-converting enzyme (ACE) inhibitors
Vasodilators
Angiotensin II receptor blockers

Question 28

A nurse is administering digoxin to a patient recently admitted with heart failure. What action best describes how this drug works in the body?

It allows more time for the ventricle to fill.

It speeds up a heartbeat that is too slow.

It decreases the force of each heartbeat.

It blocks the effect of epinephrine on the heart.

Answer 28

It allows more time for the ventricle to fill.

Cardiac glycosides of which digoxin is one of the drugs, are a class of medications that improve heart failure by slowing down a heart rate that is too fast, allowing more time for the left ventricle to fill. They also work on the muscle fibers in the heart and increase the force of each heartbeat (contractility) leading to improved cardiac output. Digoxin is used for maintenance therapy with heart failure and comes in oral (tablet, capsules, elixir) and IV forms. Digoxin slows the heartbeat, it does increase it. Digoxin increases and not decreases the force of each heartbeat. Beta blockers block the effect of epinephrine on the heart.

Question 29

A patient with heart failure asks the nurse what treatment would cure the failure. What comment by the nurse is correct?

“Follow your regular regimen of heart failure medications.”

“Healthy lifestyle modifications.”

“A heart transplant.”

“Complete bed rest”

Answer 29

“A heart transplant.”

Because the damage to the heart muscle is not reversible, the only real cure for heart failure is a heart transplant. Lifestyle changes such as weight loss, smoking cessation, and a low-salt and low-fat diet are an important part of a treatment plan. Drug therapy can improve heart function, but drugs do not cure heart failure. Lifestyle modifications and medications can only help to improve quality of life and prolong life. Bed rest would help decrease the workload on the heart for the short term, but it is not a cure.