heart failure Flashcards
An asymptomatic patient at high risk of developing heart failure and have no identifiable structrual or functional cardiac abnormalities is in what stage/class of heart failure?
Stage A / Class 1
An asymptomatic patient at high risk of developing heart failure and have no identifiable structrual or functional cardiac abnormalities is in what stage/class of heart failure?
Stage A / Class I
An patient with structrual heart disease with the development of heart failure but is asymptomatic is in what stage/class of heart failure?
Stage B / Class II
A patient who has current or prior symptoms of heart failure associated with underlying structural disease is in what stage/class of heart failure?
Stage C / Class III
A patient with advanced structural heart disease and marked symptoms of heart failure at rest despite optimal medical management and who require specialized interventions is in what stage/class of heart failure?
Stage D / Class IV
A patient in stage A HF will recive what interventions?
- Patient and family risk factor education
(lifestyle modifications) - Treat hypertension, diabetes, dyslipidemia
some patients ( Tx with Rx: ACE inhibitors or ARBS )
lifestyle modifications include:
- diet
- exercise
- reduce dietary sodium intake
- moderate drinking of alcohol
- weight loss
A patient in stage B HF will recive what interventions?
- Treat hypertension, diabetes, dyslipidemia
In all patients ( Tx with Rx: ACE inhibitors or ARBS )
A patient in stage C HF will recive what interventions?
- Treat hypertension, diabetes, dyslipidemia
In all patients ( Tx with Rx: ACE inhibitors )
In selected patients ( Tx with Rx: beta-blockers ) - Dietary sodium restriction, diuretics, and digoxin
A patient in stage D HF will recive what interventions?
- Treat hypertension, diabetes, dyslipidemia
In all patients ( Tx with Rx: ACE inhibitors )
In selected patients ( Tx with Rx: beta-blockers ) - Dietary sodium restriction, diuretics, and digoxin
- Cardiac resynchronization if bundle block branch present
- Revascularization, mitral-valve surgery
- Consider multidisciplinary team
- Aldosterone antagonist, nesiritide
**- Inotropes - VAD, transplantaion
- Hospice **
A patient is accumulating fluid within their lungs. What type of heart failure can the nurse anticipate the patient is dx with?
left sided heart failure
A patient is accumulating fluid within the periphery. What type of heart failure can the nurse anticipate the patient is dx with?
right sided heart failure
A patient’s heart muscles are unable to contract, to pump out oxygenated blood. What type of heart failure can the nurse anticipate the patient is dx with?
Systolic heart failure
A patient’s muscles of the heart becomes stiffer than normal. What type of heart failure can the nurse anticipate the patient is dx with?
diastolic heart failure
Treatment of heart failure is usually targeted twoards what HFrEF?
Systolic HF
Systolic HF: HF with reduced LV ejection fraction (HFrEF)
Diastolic HF: HF with preserved LV ejection fraction (HFpEF)
decreased cardiac output leads to…
decreased blood pressure
The nurse knows that chronic hypertension and myocardial infaction are just two of the many underlying causes of HF. True or false.
True.
Beta blockers such as Metoprolol, Carvedilol, Bisoprolol decrease the rate of contraction and are therefore called …
( - chronotropes )
Beta blockers such as Metoprolol, Carvedilol, Bisoprolol decrease the rate of contraction and are therefore called what?
( - chronotropes )
Cardiac Glycoside such as Digoxin, increase the force of contraction and are therefore called what?
( + inotropes )
Also + inotropes:
- Sympathomimetics – Isoproterenol, Norepinephrine, Dobutamine
- Dopamine Receptor Agonist – Dopamine, Fenoldopam
- PDE3 Inhibitors – Milrinone
- Peptide Agents – Nesiritide, Valsartan/Sacubitril
The dose of Sustained release Metoprolol is a first line agent in heart failure and must be adjusted slowly and carefully to prevent decreased inotropy. True or false.
True.
What adverse effects should a nurse who is monitoring a patient on Digoxin be concerned about? Sellect all that apply.
a. hypokalemia
b. hypernatremia
c. hyperkalemia
d. hypercalcemia
e. bradycardia
a. , c. , e
potassium (both low and high) and heart rate monitoring is critical for a patient taking digoxin as it can cause toxic effects.
What are signs/symptoms of Digoxin Toxicity?
a. Nausea, Vomiting, Anorexia, Fatigue, and Visual Disturbances
b. SOB, Edema, HTN, and Weight Gain
c. Nause, Vomiting, Disorentation, Sleepiness, and Jaundice
d. Irritability, Sweating, Shaking, Confusion, and Tachycardia
a. Nausea, Vomiting, Anorexia, Fatigue, and Visual Disturbances
visual disturbances such as blurred or yellow vision
a. s/s of digoxin toxicity
b. s/s of fluid overload
c. s/s of liver failure
d. s/s of hypoglycemia
A patient is in bed at 2030 experiencing nausea, vomiting and yellow vision while reading. The nurse know from her constant monitoring that she is on a medication that is causing toxicity right now. What antidote will the nurse administer?
a. Protamine sulfate
b. Physostigmine
c. Vitamin K
d. Digifab
e. Calcium gluconate
d. Digifab
a. antidote for Heparin
b. antidote for Atropine
c. antidote for Warfarin
d. antidote for Digoxin
e. atidote for Magnesium Sulfate
A patient who is in heart failure is experiencing ventricular fibrillation/tachycardia and hypokalemia. They are taking a thiazide drug and a loop diuretic for the edema but need a + inotrope to increase the force of contraction of their heart. The physician orders digoxin to add to their theriputic regime. What should the nurse do next?
a. recheck the patients HR before administration of the drug
b. administer the drug
c. administer 100mL of NS before administration of the drug
d. wait until morning becuse the patient is already on diuretics and you dont want them to use the bathroom throughout the night
e. hold the drug and question the physician’s order
e. hold the drug and question the physician’s order
Digoxin is contraindicated with ventricular fibrillation, tachy cardia or digoxin toxicity.
If the patient is hypokalemic and taking a thiazide combined with a loop diuretic will only increase the toxicity risk of digoxin.
The nurse understands that one of the biggest dangers of class I and class III drugs is?
prolongation of the QT interval
A patient is having low risk asymptomatic dysrhythmias. The nurse understands that in order to treat the patient they should administer the order for an Anti-dysrhythmic drug. True or false.
False.
Anti-dysrhythmic drugs should only be used when dysrhythmias are symptomatically significant and when the potential benefit outweigh the risks.
A patient is taking a class IA sodium channel blocker, Quinidine, and is experiencing diarrhea. The patient tells the nurse that it is so bad that theyd like to d/c taking the drug. What can the nurse suggest to the patient to help with this adverse effect of Quinidine?
a. take it with a full glass of water
b. take it in the evening when their metabolism is slower
c. take it with food
d. take it with digoxin
c. take it with food
Taking Quinidine with digoxin causes an interaction doubling digoxin levels
A patient can experience cinchonism (tinnitus, vertigo, headache, nause, disturbed vision when taking quinidine and it is normal. True or false.
False.
The patient should notify the HCP f these occur.
A patient is experiencing cardiotoxicity when taking a class IA sodium channel blocker, Quinidine, what is the nurses priority intervention.
a. administer the antidote
b. monitor ECG
c. lay the patient flat
b. monitor ECG
A patient is experiencing acute vetricular dysrhythmias. How will the nurse tx the patient?
a. lay the patient down
b. administer a IM injection of lidocane
c. administer an IM injection of atropine
d. administer IV infusion of lidocane
d. administer an IV infusion of lidocane
Amiodarone is used for ventricular dysrhythmias that aren’t responsive to other drugs, but the drug can cause maany toxic effects. Which of the following does the nurse know isn’t an adverse toxic effect of Amiodarone?
a. renal toxicity
b. liver toxicity
c. pulmonary toxicity
d. cardiotoxicity
e. thyroid toxicity
a. renal toxicity
Pulmonary toxicity (hypersensitivity pneumonitis, pulmonary fibrosis) – baseline pulmonary function, educate patients on signs of injury
Cardiotoxicity (heart failure and dysrhythmias) – educate patients on signs of heart failure
Liver Toxicity – baseline liver function, educate patients on signs of liver injury
Thyroid Toxicity – baseline thyroid levels
Adenosine is given IV bolus as close to the heart as possible. True or false.
True.
When administering nitroglycerin sublingually the patient ask for further education on how to properly take the medication. The nurse will state:
let the tablet or powder completely dissolve under the tongue.
When administering nitroglycerin orally the patient ask for further education on how to properly take the medication. The nurse will state:
swallow the tablet without chewing it.
When administering nitroglycerin trransdermally the patient ask for further education on how to properly take the medication. The nurse will state:
Remove the old patch before applying the new one.
allow for 10-12 patch free hours per day to prevent tolerance
When taking nitroglycerine it is important to avoid disrupt withdral and the patient should be titrated off the medication. True or false.
True
A nurse knows that a patient taking nirtoglycerine should avoid medications like slidenafil, which is what class of drugs?
PDE5 inhibitors
A patient is experiencing headaches from taking nitroglycerine. What patient teaching will the nurse provide?
The headached that accompany nitroglycerin will diminish with continued use.
A patient is experiencing orthostatic hypotension from taking nitroglycerine. What patient teaching will the nurse provide?
The patient will need to change positions slowly.
A patient is experiencing reflex tachycardia from taking nitroglycerine. What will the nurse do to help with the adverse affects?
The nurse can administer a beta blocker or an NDHP CCB as they suppress reflex tachycardia of nitroglycerine.
A patient is experiencing a myocardial infarction. list the following interventions on the priority of administration for the nurse.
a. nitroglycerin
b. morphine
c. oxygen
d. aspirin
c. oxygen
d. aspirin
a. nitroglycerin
b. morphine
think MONA therapy
Oxygen – to promote O2 delivery
Aspirin – to suppress platelet aggregation, chew the first dose to speed up absorption
Nitroglycerin – to reduce cardiac work, sublingual every 5 minutes for three doses
Morphine – to relive pain and reduce cardiac work
Beta Blocker – reduce myocardial work, not always given but evidence suggests it can provide a survival benefit
When giving nitroglycerin to a patient for the acute management of a STEMI and Non-STEMI the nurse knows the following administration is correct.
a. sublingual; every 5 minutes
b. buccal; every 5 minutes
c. IM; every hour
d. IV; countinously
a. sublingual; every five minutes
up to three doses
For long term therapy of an MI the patient can have a stent place, the second option would be to place the patient on a fibrinolytic. The nurse knows that early use of what medication wil be better for the patients outcome?
a. metformin
b. heparin
c. clopidogrel
d. alteplase
d. alteplase
Alteplase if the fibrinolytic that is given with an Adjuvant anticoagulant (heparin) and an antiplatelet (aspirin/clopidogrel).
A patient who experienced a STEMI MI will need to add interventions to their regime indefinitely. Which of the following is not an intervention the patient will need to follow to prevent further damage.
a. Adding medications such as asprin, captopril and lovastatin to reduce the blockage.
b. Adding a beta blocker
c. Making lifestyle changes
d. control their colesterol
e. smoke only a pack a day
e. smoking a pack a day.
Reduce the blockage with the use of:
- Antiplatelet – aspirin, clopidogrel
- ACE Inhibitor – Captopril
- Statins – Lovastatin
This combination + a beta blocker is used for post STEMI MI patients indefinitely
- Lifestyle changes are important
- Control cholesterol, stop smoking, exercise, manage BP and diabetes
LDL
BAD; high cholesterol
HDL
GOOD; low cholesterol
think H for HAPPY
Cholesterol is synthesized by what and packaged with triglycerides and phospholipids into liprprotiens.
a. HMGB-CoA Reductase
b. HMGB-CoB Reductase
c. HMGC-BoA Reductase
a. HMGB-CoA Reductase
When does the HMGC-CoA reductase peak?
a. after a meal
b. early in the morning
c. at night
d. anytime a person is sleeping
c. at night
LDL deliver cholesterol by binding to what? Where as HDL picks up excess cholesterol to remove it from circulation by bringing it back to the liver.
LDL Receptor
Which of the following statements needs further teaching about therapeutic lifestyle changes to magnage hyperlipidemia.
a. I exercise 6o minutes a day four times a week.
b. I managed to reach my goal weight
c. I did quit smoking
d. I have reduced the intake of cake and ice cream in my diet and have been eating more oatmeal
e. I cook all my meals using butter
e. I cook all my meals using butter
Butter is a saturated fat
Diet – decrease consumption of cholesterol (<200 mg/day) and saturated fats, lower trans fat consumption, increase soluble fiber intake
Exercise – cardiovascular exercise 30-60 minutes most days
Weight control – managed through diet & exercise, particularly important for patients with metabolic syndrome
moking cessation – reverse the effects of smoking on LDL and HDL
Pharmacological approach is second-line to lifestyle management
Statins reduce LDL levels by inhibiting cholesterol synthesis which increases HMG-coA. True or false.
True.
A patient whom is taking Lovastatin is states that she is experiencing muscle pain and tenderness. What should the patient do?
Notify the HCP
maybe Mypathy / Rhabdomyolysis
other AE:
- should be taken at night 8-12pm
- Monitor enzyme leves for **Hepatotoxicity **
- **Not safe **in pregnancy
The anti-hyperlipidemic, Colesevelam should be given to a patient with something to reduce the risk of esophageal irritation. What is not an item that will help?
a. mixing it with water
b. taking it with fruit juice
c. taking it with soup
d. taking it with pulpy fruit
e. taking in with coffee
e. taking it with coffee
Constipation (cholestyramine and colestipol) – patients should increase dietary fiber and can take a mild laxative if needed
Deficiency in fat soluble vitamins A, D, K, and E (cholestyramine and colestipol) – supplements may be required
Decreased absorption of other drugs (cholestyramine and colestipol)
what are the two PCSK9 Inhibitors that are available for patient use with TLC if they are maxed out on “statin” therapy.
a. receptolin
b. alirocumab
c. heralin
d. evolocumab
b. alirocumab
d. evolocumab
AE:
- Hypersensitivity (vasculitis, rash, urticaria) – severe instances should be reported
- Development of neutralizing antibodies
- Injection site reactions
The newest anti-hyperlipidemic, Bempedoic, should be given in caution to what category of patients.
a. patients in renal failure
b. patients with gout
c. patients with myesthinia gravis
d. patients with ALS
approved in 2020
b. gout patients
Hyperuricemia therefore it can cause gout flare up
another AE would be tendon rupture
The anti-hyperlipidemic, Gemfibrozil, should not be given to what category of patients.
a. patients with gallbladder disease
b. patients with gout
c. patients with myesthinia gravis
d. patients with open wounds
a. patients with gall bladder disease
Also patients with hepatotoxicity, liver or renal dysfunction.
Can also cause myopathy
Ezetimibe reduces total cholesterol by inhibiting NPC1L1 and has mailt the same effects as statins. True or false.
True.
- Post-marketing surveillance still occurring
- Diarrhea, arthralgia, myalgia, myopathy and possible rhabdomyolysis
A drug group that disrupts the coagulation cascade, therby suppressing the production of fibrin.
a. anticoagulants
b. antiplatelets
c. thrombolytics
a.anticoagulants
A drug group that inhibits platelet aggregation.
a. anticoagulants
b. antiplatelets
c. thrombolytics
b. antiplatelets
most effective against arterial thrombosis
A drug group promotes lysis of fibrin, causing dissolution of thrombi.
a. anticoagulants
b. antiplatelets
c. thrombolytics
c. thrombolytics
most effective against venous thrombosis
Aticoagulation agents such as, heparin, enoxaparin, dabigatran, rivaroxaban, and warfarin have the principle adverse effect of bleeding because they prevent clots/coagulation. True or false.
True.
the nurse should monitor for bleeding as a patient may overdose and hemorrhage.
To reduce the risk for a patient bleeding to much when on the anticoagulant, heparin, is to monitor what? select all that apply.
a. aPTT
b. anti-xa levels
c. hemocrit
d. iron levels
a. aPTT
b. anti-xa levels
monitor platelet count 2-3 times a week, then once a month
contraindicated in pts with thrombocytopenia
To reduce the risk for a patient bleeding to much when on the anticoagulant, Warfarin, is to monitor what?
a. aPTT
b. PT
c. hemocrit
d. iron levels
b. PT
prothrombin time
A patient is experiencing reduced bp, elevated hr, and bruises. The nurse know that these are s/s for signs for overdose on Heparin. What will the nurse administer as the antidote?
a. Digifab
b. Flumazenil
c. Calcium Gluconate
d. Protamine Sulfate
d. protamine sulfate
Antidote for digoxin
Antidote for benzodiazepine
Antidote for magnesium sulfate
Antidote for Heparin, Enoxaparin
it is important to monitor for neurological impairment in patients taking anticoagulants. True or false.
True.
A prophylaxis in A. fib, knee/hip replacement, and DVT/PE treatment to prevent clotting by blocking thrombin is:
a. dabigatran
b. clotlescin
c. geomyicin
d. labatran
a. dabigatran
if patients experience bleeding they should stop taking it before the elective surgery.
Patients should also do the same for clopidogrel.
the antidote for dabigatran is idarucizumab. True or false.
True.
What is the only anticoagulant safe in pregnancy.
a. Dabigatran
b. Heparin
c. Rivaroxaban
d. Warfarin
b. Heparin
Warfarin can cause Fetal hemorrhage and teratogenesis, and neonatal harm in breast feeding
The antidote for Rivaroxaban is Andexanet alfa. True or false.
True.
The antidote for warfarin is Vitamin K1 (phytonadione) infused slowely IV or orally. True or false.
True.
Warfarin is a low interaction drug as it it has a low toxicity. True or false.
False.
Warfarin is a high interaction drug as it has high toxicity. It interacts with almost ALL other drugs. Patients should not take any medications, prescription or over the counter, without consulting their prescriber.
What is the hallmark adverse effect of Antiplatelet Agent, clopidogrel.
Thrombotic Thrombocytopenic Purpura
requires urgent treatment
– urgent condition characterized by thrombocytopenia, hemolytic anemia, neurologic symptoms, renal dysfunction, and fever
- tx = (plasmapheresis) , involves removing blood through a needle or catheter and circulating it through a machine where the blood is separated into red cells, white cells, platelets and plasma. The plasma, which is the fluid content of the blood, is discarded and replaced with a substitution fluid (mainly albumin solution).
In thrombolytic agents, such as Streptokinase and Alteplase that break up clots hemorrhage is the biggest concern where:
a. pulmonary
b. intercranially
c. within the leg
d. withing the toes
b. intercranially
The nurse should:
- **MINIMIZE manipulation of the patient ** and concurrent use of anticoagulants or antiplatelets
- AVOID subQ and IM injections
- apply pressure if oozing occurs
A patient with Hemophilia A, the inability to clot can be put on what drugs to promote clotting factors.
- Factor VIII concentrates
- *Desmopressin**
VIII=8
- Antidiuretic hormone analog, increases VIII release from vascular endothelium when factor eight is a problem.
A patient with Hemophilia B, the inability to clot can be put on what drugs to promote clotting factors.
- Factor IX concentrates
IX=9
When administering ferrous sulfate for iron deficiency orally the nurse must give the patient a test dose before administration of the full dose. True or False.
False.
Parental forms carry a risk of anaphylaxis and must be given a test dose.
Epoein alfa, an erythropoietic growth factor, increases the production of RBCs but can have adverse effects such as:
Cardiovascular events and tumor progression
Filgrastim (granulocyte colonystimulating factor), an Leukopoietic growth factor increases the production of WBCs but can mhave adverse effects such as:
bone pain
