Heart Failure NCLEX Practice

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1.

A client is being started

on lisinopril (Zestril).
Nursing interventions
during initial therapy
with this medication
must include

Monitoring blood pressure.

4.

Rationale: Lisinopril is an ACE

inhibitor, which can cause severe
hypotension with initial doses. The
nurse should monitor the client
closely for several hours.

Monitoring blood
pressure.
Monitoring intake and
output.
Monitoring EKG.
Monitoring serum levels.
2.

The client is prescribed

a beta-blocker as
adjunct therapy to
treatment of heart
failure. The nurse
recognizes that beta
blockers act by

3.

The client is prescribed

captopril (Capoten) for
treatment of HF. The
nurse teaches that the
primary action of the
drug is to

Rationale: Beta-blockers improve

symptoms of HF by slowing heart
rate and decreasing blood pressure.
The decreased afterload causes
decreased workload on the heart.

Prevent influx of
calcium.
Lower peripheral
resistance and reduce
blood volume.
Increase strength of
ventricular contractions.
Increase heart rate.

5.

Lower peripheral resistance and

reduce blood volume.
Rationale: ACE inhibitors decrease
peripheral resistance and reduce
blood volume by enhancing the
excretion of sodium and water. This
results in decreased afterload and
increased cardiac output.

"This drug will help my heart muscle pump

less."
Rationale: The ability to increase the
strength of contractions is a characteristic
of cardiac glycosides. It may result in a
decrease in pulse. Initially the client may
experience some fatigue. Symptoms of
CHF, such as dyspnea, should improve.

"I should not get

short of breath
anymore."
"This drug will
help my heart
muscle pump
less."
"I may notice my
heart rate
decrease."
"I may feel tired
during early
treatment."

Slowing the heart and decreasing

afterload.

Increasing contractility
and cardiac output.
Decreasing preload.
Slowing the heart and
decreasing afterload.
Decreasing peripheral
resistance

The client is
prescribed
digoxin (Lanoxin)
for treatment of
HR. Which of the
following
statements by the
client indicates
the need for
further teaching
by the nurse?

The client's
serum digoxin
level is 2.2 ng/dL
and the heart rate
is 120 and
irregular. The
nurse expects to
administer which
of the following
drugs?
Digoxin immune
Fab (Digibind)
Furosemide
(Lasix) 60 mg I.V.
Digoxin 0.5 mg
bolus I.V.
Potassium 40
mEq added to I.V.
fluids

Digoxin immune Fab (Digibind)

Rationale: Digibind binds and removes
digoxin from the body and prevents toxic
effects of digoxin overdose. A serum level
of 2.2 is elevated, and the client is
exhibiting signs of digoxin toxicity. The
question does not indicate that the
potassium level is low. Giving additional
digoxin would exacerbate the toxicity.
Giving Lasix may reduce potassium levels
and contribute to increased toxicity.

6.

A client with
congestive heart
failure, CHF, is
prescribed
digoxin (Lanoxin)
and furosemide
(Lasix). Nursing
interventions
will include:
(Select all that
apply.)
Encourage intake
of water and fruit
juices.
Restrict intake of
green, leafy
vegetables.
Checking apical
pulse before
administering
medication.
Monitor
hemoglobin and
hematocrit
levels.
Monitor serum
electrolytes.

7.

A client with HF
has an order for
lisnopril
(Prinivil, Zestril)
Which of the
following
conditions in the
client's history
would lead a
nurse to confirm
the order with
the provider?
1. A history of
HT previously
treated with
diuretics.
2. A history of
seasonal
allergies
currently treated
with
antihistamines.
3. A history of
angioedema after
taking enalapril
(Vasotec)
4. A history of
alcoholism,
currently
abstaining.

Checking apical pulse before administering

medication.

8.

Lisinopril (Prinivil) is
part of the treatment
regimen for a client
with HF. The nurse
monitors the client
for the development
of which of teh
following adverse
effects of this drug?
SELECT ALL THAT
APPLY
1. Hyperkalemia
2.Hypocalcemia
3. Cough
4. Dizziness
5. Heartburn

1. Hyperkalemia
2.Hypocalcemia
3. Cough
4. Dizziness

9.

Lisinopril (Prinivil) is
part of the treatment
regimen for a client
with HF. The nurse
monitors the client
for which electrolyte
imbalance of this
drug?

Hyperkalemia

Monitor serum electrolytes.

Rationale: Digoxin is a cardiac glycoside.

which can slow heart rate, and an apical
heart rate is checked prior to
administration. Lasix is a loop diuretic used
in treatment of CHF, which promotes not
only water loss, but also loss of
electrolytes. A low potassium level
increases risk of digoxin toxicity. Fluids are
often restricted with CHF. H and H level do
not need to be checked, and green, leafy
vegetables would not need to be restricted.

A history of angioedema after taking

enalapril (Vasotec)

Rationale: ACE inhibitors block

aldosterone secretion, which results in
sodium loss and potassium retention.
Hyperkalemia may occur, especially
when the drug is taken concurrently
with potassium-sparing diuretics.

Hyponatremia
Hyperkalemia
Hypokalemia
Hypernatremia
10.

The nurse developing

a teaching plan for a
client receiving
thiazide diuretics
should include the
following.
Teaching the client to
take apical pulse.
Decreasing
potassium-rich foods
in the diet.
Including citrus
fruits, melons, and
vegetables in the
diet.
Teaching the client to
check blood pressure
t.i.d.

Including citrus fruits, melons, and

vegetables in the diet.
Rationale: Thiazide diuretics are
potassium wasting, and levels should
be closely monitored. Encouraging
foods rich in potassium could help
maintain potassium levels. Taking an
apical pulse is indicated before
administering cardiac glycosides and
beta blockers. It would not be
necessary to check blood pressure
TID unless the client was experiencing
hypotension.

11.

A nurse in a provider's office is

monitoring serum electrolytes for 4
older adult clients who take
digoxin(Lanoxin) & furosemide(Lasix).
Which of the following electrolyte
values puts a client at risk for dig
toxicity?
1. Calcium 9.2 mg/dL
2. Calcium 10.3 mg/dL
3. Potassium 3.4 mEq/L
4. Potassium 4.8 mEq/L

3. Potassium 3.4
mEq/L

12.

The nurse includes the definition of HF

in the teaching plan for the client. An
accurate description of the mechanism
of HF is that [Hint]

the heart is unable

to pump
effectively.

16.

A nurse is providing
teaching to a client who
has a new prescription for
digoxin (Lanoxin) Which of
the following may indicate
dig toxicity & should be
reported to the provider?
1. Fatigue
2. constipation
3. Anorexia
4. Rash
5. Diplopia

1. Fatigue
Not constipation but -- nausea,
vomiting & diarrhea
3. Anorexia b/c GI disturbances
5. Diplopia -- visual changes ,
halo, yellow-tinged vision.

17.

The nurse reviews lab

studies of a client
receiving digoxin
(Lanoxin). Intervention by
the nurse is required if
the results include a

Serum potassium level of 3.0

mEq/L.

there is too much fluid in the heart.

the heart cannot get oxygen.
the heart is unable to pump effectively.
there is too much fluid in the lungs.
13.

14.

15.

A nurse is administering a dopamine

infusion at a moderate dose to a client
who has severe HF. Which of the
following is an expected effect?
1. Lowered heart rate
2. Increased myocardial contractility
3. Decreased conduction through the AV
node
D. Vasoconstriction of the renal blood
vessels

2. Increased
myocardial
contractility -- thus
increasing CO

A nurse is caring for an older adult

client who has a new prescription for
digoxin and takes multiple other
medications. concurrent use of which of
the following medications places the
client at risk for dig toxicity?
1. Phenytoin (Dilantin)
2. Verapamil (Calan)
3. Warfarin (Coumadin)
4. Aluminum hydroxide (Amphojel)

2. Verapamil
(Calan) -- CCB,
can increase
digoxin levels. if
used together dig
dosage may need
to be lowered.

A nurse is monitoring the digoxin level

for a client who has been taking a daily
dose of digoxin for 1 month. the digoxin
level is 0.25 ng/mL. The nurse should
notify the provider and anticipate which
of the following:
1. An increase in the client's digoxin
dose.
2. A decrease in the client's digoxin
dose.
3. No change in the client's digoxin
dose.
4. Dicontinuation of the client's digoxin
dose.

1. An increase in
the client's digoxin
dose.

Serum sodium level of

140 mEq/L.
Serum digoxin level of 1.2
ng/dL.
Serum potassium level of
3.0 mEq/L.
Hemoglobin 14.4 g/dL.
18.

When caring for a client

receiving triamterene
(Dyrenium), the nurse
places priority on which
nursing intervention?
Monitor electrolytes for
hyperkalemia.
Monitor electrolytes for
hypernatremia.
Monitor heart rate
closely.
Monitor blood pressure
closely.

Rationale: Normal serum

potassium level is 3.5-5.0 mEq/L.
Hypokalemia may predispose the
client to digitalis toxicity. The
other lab values are WNL.

Monitor electrolytes for

hyperkalemia.
Rationale: Dyrenium is a
potassium-sparing diuretic. The
client should be monitored for
signs of hyperkalemia.
Hyponatremia, not hypernatremia
may occur. BP and heart rate
should be monitored, but are not
priority with this drug.