Ph. Ch 27 Drugs used to Treat Heart Failure

Question 1

when the heart lacks sufficient force to pump all the blood

Answer 1

heart failure with reduced ejection
fractions

Question 2

Having the ability to stimulate the heart to increase the force of contractions

Answer 2

positive inotropy

Question 3

drugs that stimulate the heart to increase the
force of contractions

Answer 3

inotropic agents

Question 4

signs and symptoms include anorexia, nausea, and bradycardia

Answer 4

Digitalis Toxicity

Question 5

having the ability to slow the heart rate

Answer 5

Negative Chronotrophy

Question 6

when the heart fails to relax enough between contractions to allow adequate filling

Answer 6

heart failure with preserved ejection fraction

Question 7

Scenario #1: An 88-year-old patient was admitted to the
hospital with the diagnosis of exacerbation of heart fail-
ure. The patient has a history of coronary artery disease
(CAD) with a stent placed in the past, hypertension,
hyperlipidemia, diabetes, and asthma.

Objective: Explain heart failure in terms of the body’s
compensatory mechanisms.
NCLEX item type: multiple response
Cognitive skill: application

The patient in scenario #1 has symptoms of heart failure with reduced ejection fraction causing decreased cardiac output and decreased tissue perfusion. What can the nurse expect to find upon assessment? (Select all that apply.) (438)

1. Poor peripheral perfusion
2. Insomnia
3. Bradypnea
4. Tinnitus
5. Exercise intolerance

Answer 7

Poor peripheral perfusion
Excercise Intolerance

Question 8

NCLEX item type: multiple choice
Cognitive skill: knowledge

The nurse remembers that heart failure with preserved ejection fraction occurs because of what? (438)

1. The peripheral vasculature develops stiffness.
2. The symptoms of pulmonary embolism develop.
3. The left ventricle becomes soft and boggy from being distended.
4. The left ventricle becomes stiff and fails to relax,
   thus it does not fill adequately prior to the next
   contraction.

Answer 8

The left ventricle becomes stiff and fails to relax,
thus it does not fill adequately prior to the next
contraction.

Question 9

NCLEX item type: multiple choice
Cognitive skill: explain

The nurse understands that when patients are in
heart failure, the kidneys respond to the decreased
perfusion via the renin-angiotensin-aldosterone
system, which stimulates the renal distal tubules to
increase blood volume by what mechanism? (439)

1. Excreting excess fluid
2. Retaining sodium and water
3. Increasing renin production
4. Releasing epinephrine and norepinephrine

Answer 9

Retaining sodium and water

Question 10

Objective: Identify the goals of treatment of heart failure.
NCLEX item type: multiple choice
Cognitive skill: knowledge

The nurse educates the patient in scenario #1 on their underlying diseases that are treated to correct the heart failure. Which patient conditions will be discussed by the nurse? (Select all that apply.) (440)

1. Asthma
2. Hyperlipidemia
3. Hypertension
4. Diabetes
5. CAD

Answer 10

Hyperlipdemia
Hypertension
CAD

Question 11

NCLEX item type: extended multiple response
Cognitive skill: recognize cues

The nurse discusses the goals of treatment for heart failure with the patient in scenario #1 and includes what outcomes in the discussion? (Select all that apply.) (439)

1. Prolonging life
2. Increasing intravascular volume
3. Increasing exercise tolerance
4. Reversing the ventricular damage
5. Improving kidney function
6. Improving quality of life
7. Reducing signs and symptoms of fluid overload
8. Being able to use only one drug to improve
   symptoms

Answer 11

Prolonging life
Increases excersise tolerance
Impriving quality of life
Redcing signs and symptoms of fluid overload

Question 12

NCLEX item type: multiple response
Cognitive skill: application
12. The patient in scenario #1 will be educated by the
nurse on lifestyle changes that are aimed at improv-
ing heart failure. Which questions should the nurse
ask of the patient to get them thinking about this?
(Select all that apply.) (445)

1 “What kinds of coping mechanisms do you use
when you are stressed.”
2 “What do you do at home when you get short
of breath? We need to discuss the proper way to
position yourself during these times.”
3 “Are you currently keeping track of your blood
pressure, pulse, and respirations at home?”
4 “Do you space your activities of daily living in
such a way that will conserve your energy and
avoid fatigue.”
5 “Are you drinking plenty of water with your
meals?”

Answer 12

1 “What kinds of coping mechanisms do you use
when you are stressed.”
2 “What do you do at home when you get short
of breath? We need to discuss the proper way to
position yourself during these times.”
3 “Are you currently keeping track of your blood
pressure, pulse, and respirations at home?”
4 “Do you space your activities of daily living in
such a way that will conserve your energy and
avoid fatigue.”

Question 13

Scenario #2: A 78 year-old patient who has been treated
for many years for heart failure is now being started on
digoxin. The patient also has a history of atrial fibril-
lation and hypothyroidism along with chronic kidney
insufficiency.

Objective: Identify the primary actions on heart failure of digoxin, ACE inhibitors, ARBs, the combination of a neprilysin inhibitor with an ARB (Entresto), and beta blockers.

NCLEX item type: multiple response
Cognitive skill: application

The nurse explains to the patient in scenario #2 what the desired therapeutic outcomes of digoxin are for the treatment of heart failure. Which outcomes will the nurse mention in the discussion? (Select all that apply.) (448-449)

1. Improvement of dyspnea
2. Improved tolerance of activity
3. Tolerating oxygen therapy during rest
4. Maintaining a serum digoxin level of 2.0 ng/mL
5. Improved cardiac output resulting in improved
   tissue perfusion

Answer 13

Improved tolerance of activity
Improved cardiac output resulting in improved
tissue perfusion

Question 14

NCLEX item type: multiple choice
Cognitive skill: contrast

When angiotensin-converting enzyme (ACE) inhibitors are used primarily in heart failure the nurse understands they will have what effect? (446)

1. They increase the secretion of aldosterone.
2. They increase sodium excretion in the kidneys.
3. They reduce afterload of the heart by blocking vasoconstriction.
4. They stimulate the heart to increase the force of
   contractions.

Answer 14

They reduce afterload of the heart by blocking vasoconstriction.

Question 15

NCLEX item type: multiple choice
Cognitive skill: compare

The nurse planning on administering a beta-adrenergic blocking agents for a heart failure patient understands that these drugs will have what effect? (448)

1. They increase sodium excretion.
2. They increase the secretion of aldosterone.
3. They inhibit renin release to improve symptoms of heart failure.
4. They stimulate the renin-angiotensin-aldosterone system.

Answer 15

They inhibit renin release to improve symptoms of heart failure.

Question 16

NCLEX item type: multiple choice
Cognitive skill: illustrate

The patient in scenario #2 is starting on Entresto and asks the nurse what effect this will have on their heart failure. Which statement by the nurse is correct? (446)

1. “The drug Entresto is a combination drug will increase vascular resistance to help with heart failure.”
2. “The combination drug Entresto is used in the treatment of heart failure and works to reduce preload and afterload.”
3. “The combination drug Entresto works by different mechanisms to slow the contractility of the heart.”
4. “The combination drug Entresto will reduce circulating blood volume by stimulating the secretion of aldosterone.

Answer 16

1 “The drug Entresto is a combination drug will increase vascular resistance to help with heart failure.”
3 “The combination drug Entresto works by different mechanisms to slow the contractility of the heart.”
4 “The combination drug Entresto will reduce circulating blood volume by stimulating the secretion of aldosterone.

Question 17

**NCLEX item type: multiple choice
Cognitive skill: explain

The nurse read the chart from the patient in scenario #2 who had recently been in the ICU for short-term management of heart failure with a phosphodiesterase inhibitor milrinone given IV. The nurse remembered the actions of milrinone include what? (Select all that apply.) (450)

1. Increases the force and velocity of myocardial
   contractions
2. Inhibits cardiac response to nerve stimulation,
   reducing blood pressure
3. Relaxes vascular smooth muscle which causes
   vasodilation
4. Inhibits the cardiac pacemaker electrical current
   in the SA node, slowing heart rate
5. Reduces preload and afterload of the heart

Answer 17

1. Increases the force and velocity of myocardial
   contractions
2. Relaxes vascular smooth muscle which causes
   vasodilation
3. Inhibits the cardiac pacemaker electrical current
   in the SA node, slowing heart rate
4. Reduces preload and afterload of the heart

Question 18

Objective: Describe digoxin toxicity and ways to prevent it.

NCLEX item type: multiple choice
Cognitive skill: interpret

When the patient in scenario #2 with heart failure on multiple medications starts to complain of loss of appetite with nausea as well as extreme fatigue, and nightmares, the nurse should consider that what may be happening? (449)

1. The patient is having dysrhythmias.
2. The patient is experiencing digoxin toxicity.
3. The patient is noncompliant with medications.
4. The patient is experiencing worsening of heart failure.

Answer 18

The patient is experiencing digoxin toxicity.

Question 19

NCLEX item type: multiple response
Cognitive skill: taking action

The nurse knows that hypokalemia may induce
digitalis toxicity. Monitoring the patient’s potassium
level is crucial to preventing digitalis toxicity as well
as what other assessments or interventions will the
nurse perform? (Select all that apply.) (449-450)

1. Monitoring the digoxin level in the blood
2. Monitoring the pulse oximeter level
3. Knowing what the antidote is for digoxin toxicity
4. Monitoring the heart rate for bradycardia
5. Knowing what drugs may enhance the effect of
   digoxin

Answer 19

1. Monitoring the digoxin level in the blood
2. Knowing what the antidote is for digoxin toxicity
3. Monitoring the heart rate for bradycardia
4. Knowing what drugs may enhance the effect of
   digoxin

Question 20

Objective: Identify essential assessment data and
nursing interventions needed for a patient with heart
failure.

NCLEX item type: multiple response
Cognitive skill: generate solutions

The nurse is teaching the patient in scenario #2 important health promotion measures and will emphasize which steps for the patient to take? (Select all that apply.) (445)
1. Expect a short-term treatment
2. Continue with a lifelong treatment
3. Practice an exercise regimen
4. Follow a diet low in sodium
5. Manage your medications by understanding their. purpose

Answer 20

2. Continue with a lifelong treatment
3. Practice an exercise regimen
4. Follow a diet low in sodium
5. Manage your medications by understanding their. purpose

Question 21

NCLEX item type: multiple response
Cognitive skill: classify
21. The nurse reviewed the drug classes used to treat
patients in Stage A heart failure. Which drug classes
are included in the list for Stage A? (Select all that
apply.) (442)
1. Diuretics
2. Statins
3. Beta blockers
4. ACE inhibitors
5. Angiotensin Il receptor blockers

Answer 21

2. Statins
3. ACE inhibitors
4. Angiotensin Il receptor blockers

Question 21

NCLEX item type: multiple response
Cognitive skill: classify
21. The nurse reviewed the drug classes used to treat
patients in Stage A heart failure. Which drug classes
are included in the list for Stage A? (Select all that
apply.) (442)
1. Diuretics
2. Statins
3. Beta blockers
4. ACE inhibitors
5. Angiotensin Il receptor blockers

Answer 21

2. Statins
3. ACE inhibitors
4. Angiotensin Il receptor blockers