Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Providers Chapter 40: Drugs for Heart Failure 2023
353. A patient asks a nurse why he
... [Show More] cannot use digoxin [Lanoxin] for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not the first-line therapy for which reason?
a. It causes tachycardia and increases the cardiac workload.
b. It does not correct the underlying pathology of heart failure.
c. It has a wide therapeutic range that makes dosing difficult.
d. It may actually shorten the patient's life expectancy. correct answers ANS: B
Digoxin improves cardiac output, alters electrical effects, and helps to decrease sympathetic outflow from the central nervous system (CNS) through its neurohormonal effects; however, it does not alter the underlying pathology of heart failure or prevent cardiac remodeling. Digoxin causes bradycardia and increases the cardiac workload by increasing contractility. It has a narrow therapeutic range and many adverse effects. Digoxin does not improve life expectancy; in women it may actually shorten life expectancy.
354. A patient has been taking digoxin [Lanoxin] 0.25 mg, and furosemide [Lasix] 40 mg, daily. Upon routine assessment by the nurse, the patient states, "I see yellow halos around the lights." The nurse should perform which action based on this assessment?
a. Check the patient for other symptoms of digitalis toxicity.
b. Withhold the next dose of furosemide.
c. Continue to monitor the patient for heart failure.
d. Document the findings and reassess in 1 hour. correct answers ANS: A
Yellow halos around lights indicate digoxin toxicity. The use of furosemide increases the risk of hypokalemia, which in turn potentiates digoxin toxicity. The patient should also be assessed for headache, nausea, and vomiting, and blood should be drawn for measurement of the serum digoxin level. The nurse should not withhold the dose of furosemide until further assessment is done, including measurement of a serum digoxin level. No evidence indicates that the patient is in worsening heart failure. Documentation of findings is secondary to further assessment and prevention of digoxin toxicity.
355. A patient has heart failure and is taking an ACE inhibitor. The patient has developed fibrotic changes in the heart and vessels. The nurse expects the provider to order which medication to counter this development?
a. Aldosterone antagonist
b. Angiotensin II receptor blocker (ARB)
c. Beta blocker
d. Direct renin inhibitor (DRI) correct answers ANS: A
Aldosterone antagonists are added to therapy for patients with worsening symptoms of HF. Aldosterone promotes myocardial remodeling and myocardial fibrosis, so aldosterone antagonists can help with this symptom. ARBs are given for patients who do not tolerate ACE inhibitors. Beta blockers do not prevent fibrotic changes. DRIs are not widely used.
356. A patient with heart failure who has been taking an ACE inhibitor, a thiazide diuretic, and a beta blocker for several months comes to the clinic for evaluation. As part of the ongoing assessment of this patient, the nurse will expect the provider to evaluate:
a. complete blood count.
b. ejection fraction.
c. maximal exercise capacity.
d. serum electrolyte levels. correct answers ANS: D
Patients taking thiazide diuretics can develop hypokalemia, which can increase the risk for dysrhythmias; therefore, the serum electrolyte levels should be monitored closely. A complete blood count is not recommended. This patient is taking the drugs recommended for patients with Stage C heart failure; although the patient's quality of life and ability to participate in activities should be monitored, routine measurement of the ejection fraction and maximal exercise capacity is not recommended. [Show Less]