Adjunct Medications Used in Heart Failure

Every question here, with the answer

1. A nurse is about to give digoxin to a client with heart failure. The apical pulse, counted for 1 full minute, is 54 beats per minute. What should the nurse do?

   1. Give the dose and recheck the pulse in one hour.
   2. Hold the dose.
   3. Give half the dose.
   4. Recount the pulse for 15 seconds and give the dose if it is higher.

   Answer: Hold the dose.

   The pulse is assessed for 1 minute before digoxin, and the dose is not given if the heart rate is under 60 beats per minute. Giving all or part of the dose, or recounting over a shorter period to justify giving it, ignores that rule.

2. A client taking digoxin calls the clinic. Which reported symptoms suggest digoxin toxicity? Select all that apply.

   1. Nausea and vomiting
   2. Weight gain of 1 pound over a month
   3. Yellow or green halos around lights
   4. Increased appetite
   5. Loss of appetite

   Answer: Nausea and vomiting, Yellow or green halos around lights, Loss of appetite

   Anorexia, nausea, vomiting and visual changes such as green or yellow halos around lights are signs of digoxin toxicity, and the client should contact the provider immediately. Increased appetite and slight weight gain are not listed.

3. A client with heart failure who takes hydralazine/isosorbide dinitrate asks whether he can use a prescribed erectile dysfunction medication. What is the nurse's best response?

   1. "No. Taking them together can cause profound hypotension."
   2. "Yes, but only at half the usual dose."
   3. "Yes, they do not interact."
   4. "Yes, as long as you take them at different times of day."

   Answer: "No. Taking them together can cause profound hypotension."

   This combination should not be taken with PDE5 inhibitors because it can lead to profound hypotension, and clients are taught not to take erectile dysfunction medications with it. Spacing or halving the dose is not supported by the section.

4. A client is due for the first dose of hydralazine/isosorbide dinitrate. The blood pressure is 86/54 mm Hg. What should the nurse do?

   1. Withhold the dose and notify the provider.
   2. Give the dose and have the client stay in bed.
   3. Give only the hydralazine part of the dose.
   4. Give the dose with extra fluids.

   Answer: Withhold the dose and notify the provider.

   The medication is not given if the systolic blood pressure is less than 90 mm Hg, because the combination can cause significant hypotension. The other options still give a drug that lowers blood pressure further.

5. A nurse reviews the chart of a client prescribed digoxin. Which findings are contraindications the nurse should report? Select all that apply.

   1. Hypokalemia
   2. Acute myocardial infarction
   3. Reduced ejection fraction with symptoms despite optimized therapy
   4. Hypomagnesemia
   5. Heart failure

   Answer: Hypokalemia, Acute myocardial infarction, Hypomagnesemia

   Hypokalemia, hypomagnesemia and acute myocardial infarction are listed contraindications to digoxin. Ongoing symptoms with a reduced ejection fraction despite optimized first-line therapy is the indication for digoxin, not a contraindication.

6. A nurse is teaching a client who is starting ivabradine. Which statement by the client shows understanding?

   1. "This drug will speed up my heart rate."
   2. "I will take it on an empty stomach with grapefruit juice."
   3. "I will take it with food, avoid grapefruit juice, and report feeling dizzy or an erratic heartbeat."
   4. "If I become pregnant, I can keep taking it."

   Answer: "I will take it with food, avoid grapefruit juice, and report feeling dizzy or an erratic heartbeat."

   Ivabradine must be taken with food, grapefruit juice is avoided, and dizziness or an erratic heartbeat is reported because it may relate to bradycardia or atrial fibrillation. It slows the heart rate and should not be taken in pregnancy.