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Chapter 19: Heart Failure Drugs

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Chapter 19: Heart Failure Drugs

12 problems · 0 figures

Case Study 19.5.1 §19.5 source ↗

Table 19.16 in the book ↗
Vital Signs Physical Examination
Temperature: 98.2°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Neurological: Within normal limits

• Cardiovascular: No jugular venous distension, 1+ pitting edema of feet and ankles. S1 and S2 heard on heart auscultation. No S3 noted. Brisk capillary refill in nailbeds of hands and feet.

• Respiratory: Crackles auscultated in lung bases bilaterally

• Gastrointestinal: Abdominal sounds heard in all four quadrants, no tenderness, no distension

• Integumentary: Skin appropriate for age
Heart rate: 95 beats/min
Respiratory rate: 22 breaths/min
Blood pressure: 158/94 mm Hg
Height: 5'4"
Weight: 152 lb (up 7 lb per client)

Read the following clinical scenario to answer the questions that follow.

Anna Rodriguez is an 85-year-old client who presents to her health care provider with an exacerbation of heart failure. Anna reports increasing shortness of breath with self-care activities. She also shares that she is no longer going to the senior center because getting in and out of the car leaves her short of breath and fatigued. She also reports that her feet feel “heavy” and that she has gained 3 pounds in the last 1–2 weeks. Anna sleeps on two pillows and does not awaken during the night with shortness of breath. She has also had a persistent itchy, dry cough and asks if she has a respiratory infection. The cough is nonproductive, and Anna reports no fever, chills, achy feeling, congestion, or chest pain.

Anna reports following a low-sodium diet and does not engage in exercise. She is a nonsmoker and does not drink alcohol.

History
Heart failure with preserved ejection fraction
Hypothyroidism

Current Medications
Lisinopril 10 mg twice daily
Levothyroxine 50 mcg once daily

The nurse is reviewing enalapril administration with Anna. Which instruction about this drug will the nurse provide?
  1. a.
    Avoid green, leafy vegetables.
  2. b.
    Do not take if your heart rate is less than 60 beats/minute.
  3. c.
    Avoid salt substitutes that contain potassium.
  4. d.
    Report feelings of depression.

Answer

C. Avoid salt substitutes that contain potassium.
Enalapril is an ACE inhibitor that can cause hyperkalemia (a high potassium level).

Case Study 19.5.2 §19.5 source ↗

Table 19.16 in the book ↗
Vital Signs Physical Examination
Temperature: 98.2°F

• Head, eyes, ears, nose, throat (HEENT): Within normal limits

• Neurological: Within normal limits

• Cardiovascular: No jugular venous distension, 1+ pitting edema of feet and ankles. S1 and S2 heard on heart auscultation. No S3 noted. Brisk capillary refill in nailbeds of hands and feet.

• Respiratory: Crackles auscultated in lung bases bilaterally

• Gastrointestinal: Abdominal sounds heard in all four quadrants, no tenderness, no distension

• Integumentary: Skin appropriate for age
Heart rate: 95 beats/min
Respiratory rate: 22 breaths/min
Blood pressure: 158/94 mm Hg
Height: 5'4"
Weight: 152 lb (up 7 lb per client)

Read the following clinical scenario to answer the questions that follow.

Anna Rodriguez is an 85-year-old client who presents to her health care provider with an exacerbation of heart failure. Anna reports increasing shortness of breath with self-care activities. She also shares that she is no longer going to the senior center because getting in and out of the car leaves her short of breath and fatigued. She also reports that her feet feel “heavy” and that she has gained 3 pounds in the last 1–2 weeks. Anna sleeps on two pillows and does not awaken during the night with shortness of breath. She has also had a persistent itchy, dry cough and asks if she has a respiratory infection. The cough is nonproductive, and Anna reports no fever, chills, achy feeling, congestion, or chest pain.

Anna reports following a low-sodium diet and does not engage in exercise. She is a nonsmoker and does not drink alcohol.

History
Heart failure with preserved ejection fraction
Hypothyroidism

Current Medications
Lisinopril 10 mg twice daily
Levothyroxine 50 mcg once daily

The nurse notes that Anna has 1+ pitting edema in the feet and ankles, a recent weight gain, and crackles in her lung bases. The nurse anticipates that the provider will order which drug?
  1. a.
    Digoxin
  2. b.
    Furosemide
  3. c.
    Hydralazine/isosorbide dinitrate
  4. d.
    Valsartan

Answer

B. Furosemide
Furosemide is a loop diuretic and is used to decrease fluid volume.

19-1 §19.RQ source ↗

What are the components of cardiac output?
  1. a.
    Blood pressure and systemic vascular resistance
  2. b.
    Heart rate and systemic vascular resistance
  3. c.
    Circulatory function and respiratory rate
  4. d.
    Heart rate and stroke volume

Answer

D. Heart rate and stroke volume
Cardiac output is composed of heart rate × stroke volume. Normal resting cardiac output is 4–5 liters per minute.

19-2 §19.RQ source ↗

A client is being prescribed lisinopril at discharge from the hospital by the health care provider. The discharge instructions by the nurse should include that lisinopril acts by doing which of the following?
  1. a.
    Inhibits beta 1 and beta 2
  2. b.
    Inhibits angiotensin-converting enzyme
  3. c.
    Prevents the release of angiotensin
  4. d.
    Blocks angiotensin II from activating angiotensin receptors

Answer

D. Blocks angiotensin II from activating angiotensin receptors
Lisinopril inhibits the enzyme that converts angiotensin I to angiotensin II.

19-3 §19.RQ source ↗

A client has been prescribed lisinopril 7.5 mg twice daily. The tablets are 2.5 mg. How many tablets should the client take per dose?
  1. a.
    1 tablet
  2. b.
    2 tablets
  3. c.
    3 tablets
  4. d.
    4 tablets

Answer

C. 3 tablets
7.5 m g ÷ 2.5 m g = 3 t a b l e t s .

19-4 §19.RQ source ↗

A client with heart failure who had been taking valsartan recently had the medication switched to sacubitril/valsartan. The client understands how valsartan works but is confused about sacubitril. The nurse explains that sacubitril:
  1. a.
    Lowers heart rate to allow for more oxygen to get to the heart muscle tissue
  2. b.
    Inhibits angiotensin-converting enzyme, which lowers blood pressure
  3. c.
    Helps BNP stay in the system longer, which lowers blood pressure
  4. d.
    Causes nitric oxide to be released in smooth muscles, which lowers blood pressure

Answer

C. Helps BNP stay in the system longer, which lowers blood pressure
Sacubitril inhibits neprilysin, which is an enzyme that breaks down BNP. BNP stimulates vasodilation and sodium and water excretion, which decrease afterload and preload, respectively.

19-5 §19.RQ source ↗

A client is taking valsartan, carvedilol, and spironolactone daily. What monitoring should the nurse educate the client about to ensure safe medication administration?
  1. a.
    Electrolytes, because two of the medications cause an elevation in potassium
  2. b.
    Electrolytes, because two of the medications cause a decrease in potassium
  3. c.
    Glucose, because the combination of medications can lower blood glucose
  4. d.
    Uric acid, because the combination of medications can increase uric acid

Answer

A. Electrolytes, because two of the medications cause an elevation in potassium
Valsartan and spironolactone can cause potassium to be reabsorbed in the nephron. Clients are at risk for hyperkalemia.

19-6 §19.RQ source ↗

A client with heart failure had a new medication added to their regimen, dapagliflozin. The nurse recognizes that this medication is effective through which mechanism?
  1. a.
    Inhibiting alpha receptors in the arteries
  2. b.
    Enhancing the release of BNP
  3. c.
    Inhibiting sodium and glucose reabsorption
  4. d.
    Enhancing beta-1 receptors in the heart

Answer

C. Inhibiting sodium and glucose reabsorption
Dapagliflozin is a sodium-glucose cotransporter 2 inhibitor and has received FDA approval for use in the treatment of heart failure.

19-7 §19.RQ source ↗

A client with heart failure has been prescribed furosemide 60 mg every morning. The tablets come in 40 mg. How many tablets should the client take each morning?
  1. a.
    ½ tablet
  2. b.
    1 tablet
  3. c.
    1½ tablets
  4. d.
    2 tablets

Answer

C. 1½ tablets
60 m g ÷ 40 m g = 1.5 o r 1 1 2 t a b l e t s .

19-8 §19.RQ source ↗

A Black client with heart failure has recently had their medication regimen changed to the combination medication hydralazine and isosorbide dinitrate. What education does the nurse provide the client?
  1. a.
    This medication regimen will increase afterload.
  2. b.
    These two medications increase systemic vascular resistance.
  3. c.
    Hydralazine/isosorbide dinitrate works better than other heart failure medications for Black clients.
  4. d.
    This medication combination will cause better diuresis.

Answer

C. Hydralazine/isosorbide dinitrate works better than other heart failure medications for Black clients.
Research has shown that beta blockers and medications affecting the RAAS do not work as well in the treatment of heart failure for Black clients as hydralazine and isosorbide dinitrate do.

19-9 §19.RQ source ↗

The nurse is caring for a client with heart failure who takes digoxin. Which assessment finding should the nurse report to the health care provider prior to administering the drug?
  1. a.
    Blood pressure 124/78 mm Hg
  2. b.
    Respiratory rate 16 breaths/minute
  3. c.
    Temperature 98.2°F
  4. d.
    Heart rate 54 beats/minute

Answer

D. Heart rate 54 beats/minute
Digoxin is a cardiac glycoside and slows the heart rate. It can cause bradycardia. The health care provider should be notified before administering this drug.

19-10 §19.RQ source ↗

A nurse is providing education to a client who has a new prescription for ivabradine. The nurse knows the client has understood the instructions when the client makes which statement?
  1. a.
    “I will stop eating green, leafy vegetables.”
  2. b.
    “I will stop drinking grapefruit juice.”
  3. c.
    “I will take my blood pressure right before I take this medication.”
  4. d.
    “I will take this medication right before I go to bed.”

Answer

B. “I will stop drinking grapefruit juice.”
Ivabradine is an I(f) current inhibitor. Grapefruit juice increases blood levels of ivabradine by inhibiting its metabolism. The excess amount of medication can intensify the medication’s hypotensive effect, placing the client at an increased risk for syncopal episodes.

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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.