Chapter 24 Drug Therapy for Heart Failure


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Chapter 24  Drug Therapy for Heart Failure



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Sample Questions



1. The home care nurse sees a patient for the first time. The patient has crackles in the lower lobes of the lungs, an audible S3, and pitting edema in the feet and ankles. What condition is the patient most likely experiencing?

  1. A)  Pneumonia
  2. B)  Liver disease
  3. C)  Heart failure
  4. D)  Myocardial infarction

Ans: C
The cardinal manifestations of heart failure are dyspnea and fatigue, which can lead to exercise intolerance and fluid retention. Fluid retention results in the development of pulmonary congestion and peripheral edema. An audible S3 is often present. The patient is not presenting with myocardial infarction symptoms.

2. A patient is diagnosed with heart failure. She asks the nurse for further details about heart failure. Which of the following statements is most accurate?

  1. A)  “Heart failure can be caused by atherosclerotic plaque due to high-fat diets.”
  2. B)  “Hypothyroidism will result in decreased heart rate and development of heart


  3. C)  “The administration of diuretics increases blood volume, causing symptoms to


  4. D)  “The use of digoxin will slow heart rate to make your heart more efficient.”

Ans: D
Endothelial dysfunction allows processes that narrow the blood vessel lumen and lead to blood clot formation and vasoconstriction that further narrow the blood vessel lumen. These are major factors in coronary artery disease and hypertension, the most common conditions leading to heart failure. Hyperthyroidism, not hypothyroidism, is a cause of heart failure. The administration of diuretics decreases fluid volume, which prevents the symptoms of heart failure. The use of digoxin increases the force of myocardial contraction and prevents the development of congestive heart failure in patients whose heart cannot pump blood to meet tissue needs. A high-fat diet does not directly cause heart failure.

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3. A patient states that he is seeing halos around lights. The patient takes digoxin (Lanoxin) by mouth every day. The physician orders the patient to have serum digoxin level drawn. At what digoxin level would the care team first suspect that the patient is experiencing toxicity?

  1. A)  0.5 ng/mL
  2. B)  1.5 ng/mL
  3. C)  3.0 ng/mL
  4. D)  6.0 ng/mL

Ans: C
The therapeutic serum digoxin level is 0.8 to 2.0 ng/mL.

4. A patient has an elevated BUN and creatinine. The patient has been prescribed digoxin (Lanoxin) for heart failure. What aspect of care is the priority regarding this patient?

  1. A)  The patient should be taught to increase sodium in her diet.
  2. B)  The dose should be increased when her heart rate is below 60.
  3. C)  The dose should be decreased in this patient.
  4. D)  The dosage should be 1.0 mg PO daily.

Ans: C Feedback:

The dose must be reduced in the presence of renal failure because most of the digoxin is excreted unchanged by the kidneys, leading to drug accumulation and toxicity. The patient should be taught to limit sodium intake in the diet. The patient’s heart rate should remain above 60. If the heart rate falls below 60, the digoxin should be held. The dose of 1.0 mg is too large for a patient with altered renal function.

5. A patient with a history of heart failure is being treated with digoxin (Lanoxin). The nurse knows that this medication increases the force of contractions of the heart. What effect improves the contractility of the heart?

  1. A)  Positive chronotropic effect
  2. B)  Positive inotropic effect
  3. C)  Negative inotropic effect
  4. D)  Negative dromotropic effect

Ans: B
In heart failure, digoxin exerts cardiotonic or positive inotropic effect that improves the contractility and pumping ability of the heart. A positive chronotropic effect accelerates the rate of the heart, which is not recommended in a patient with heart failure. A negative inotropic effect accelerates the heart, which is not recommended in a patient with heart failure. A negative dromotropic effect changes the conductivity of muscle fiber, increasing heart rate.

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