Critical Thinking Answers

Drugs Used to Treat Heart Failure

1.c Mental status, vital signs (T,P, R), blood pressure, heart and lung sounds, skin color, neck
vein status, presence of clubbing, central venous pressure, abdomen size, fluid volume
status, nutrition, activity and exercise tolerance, anxiety level, and laboratory tests should
be checked regularly to assess cardiac function.
2.c Before administering digoxin, the apical pulse should be taken for one full minute.
Institution guidelines for withholding the drug should be followed; for example, if pulse
is fewer than 60 or greater than 100 beats per minute. Consult the physician before
administering the prescrived dose of the apical rate is below 60 beats per minute in an
adult, or below 90 beats per minute in a child. In the long-term care setting, radial pulse
may be acceptable. Before initiating therapy, baseline data such as vital signs, lung
sounds, weight, and laboratory studies should be obtained. The patient should be
monitored for development of digitalis toxicity, hypokalemia, hypomagnesemia, or
sudden increase in pulse rate that previously had been normal.
3.c ACE inhibitors reduce afterload by blocking angiotensin II-medicated peripheral
vasoconstriction promoting vasodilation; they also reduce circulating blood volume by
inhibiting alsosterone, allowing excretion of excess water.
4.c Restrict sodium intake.
5.c Epinephrine and norepinephrine are released producing tachycardia adn an increase in
cardiac contractility. The increases sympathetic stimulation also increases peripheral
vasoconstriction, resulting in an increased afterload against which the heart must pump,
causing a further decrease in cardiac output.
6.c Due to diastolic dysfunction of the heart, residual volume remains from the previous
contraction and the left ventricle does not fill adequately prior to next contraction. The
left ventricle develops a ³stiffness,´ and back-pressure builds up in the lungs and
peripheral vasculature that results in symptoms of pulmonary congestion and peripheral
edema.
7.c Any time the dose requires calculation, two qualified nurses should check the dose.
8.c The six cardinal signs of heart disease are dyspnea, associated with inadequate tissue
perfusion and diastolic dysfunction; chest pain, resulting from inadequate oxygen to
support mycocardium function; fatigue, due to depleted oxygen to body tissue; edema,
because the left ventricle is not pumping adequate volumes of blood and a cack-pressure
builds up in the lungs (causing dyspnea) and the peripheral blood vessels, causing
interstitial edema; syncope, due to insufficient oxygen to meet the brain¶s needs; and
palpitations, caused by sympathetic nervous system¶s release of epinephrine and
norepinephrine that produces tachycardia and dysrhythmias.
9.c The nurse would teach the patient that common symptoms of digoxin toxicity include
anorexia, nausea, vomiting, bradycardia, visual disturbances, and psychiatric
disturbances.
10.cTwo phosphodiesterase inhibitors used to treat heart failure are inamrinone and milrinone
(Primacor).

c
Clayton, S. C. (2010). •
  
 

 St. Louis: Mosby Elsevier.