Lehne's Pharmacology for Nursing
Care
12th Edition
• Author(s)Jacqueline Rosenjack
Burchum; Laura D. Rosenthal
,TEST BANK
QUESTION 1
Type: MCQ
Clinical Scenario:
A 72-year-old male patient with a history of heart failure with
reduced ejection fraction (HFrEF) is admitted to the cardiac unit
with worsening dyspnea, orthopnea, and peripheral edema. His
current medications include lisinopril 10 mg daily, carvedilol
12.5 mg twice daily, and furosemide 40 mg daily. His vital signs
are: BP 148/92 mmHg, HR 88 bpm, RR 24/min, SpO2 91% on
room air. The healthcare provider orders an additional
medication to improve his cardiac output and reduce preload.
Question Stem:
The nurse anticipates that which medication will be prescribed
to improve cardiac contractility and reduce preload in this
patient?
Answer Options:
A. Digoxin
B. Nitroglycerin
C. Dobutamine
D. Nesiritide
,Correct Answer: D. Nesiritide
Detailed Rationale:
Nesiritide is a recombinant human B-type natriuretic peptide
that causes vasodilation, reduces preload and afterload, and
increases cardiac output without increasing myocardial oxygen
demand. It is indicated for acutely decompensated heart failure
when standard therapies are inadequate. Nesiritide promotes
vasodilation through smooth muscle relaxation, reduces
pulmonary capillary wedge pressure, and improves dyspnea.
The hemodynamic effects include decreased systemic vascular
resistance and increased stroke volume.
Incorrect Option Analysis:
A. Digoxin - Incorrect
• Why It Is Incorrect: Digoxin increases cardiac contractility
through inhibition of Na+/K+-ATPase but does not
significantly reduce preload
• Common Misconception: Digoxin is often considered the
primary inotropic agent for all heart failure patients
• Medication Safety Risk: Digoxin has a narrow therapeutic
window and requires careful monitoring of serum levels
• Nursing Consideration: Digoxin is used for chronic
management, not acute decompensated heart failure; it
does not provide immediate preload reduction
, B. Nitroglycerin - Incorrect
• Why It Is Incorrect: Nitroglycerin primarily causes
venodilation (reducing preload) but does not improve
cardiac contractility
• Common Misconception: All vasodilators have similar
effects on cardiac function
• Medication Safety Risk: Nitroglycerin can cause severe
hypotension, especially in volume-depleted patients
• Nursing Consideration: While nitroglycerin reduces
preload, it does not enhance contractility, which is needed
in this patient with worsening symptoms
C. Dobutamine - Incorrect
• Why It Is Incorrect: Dobutamine is a positive inotrope that
increases cardiac contractility but does not reduce preload
• Common Misconception: All inotropes are equally
effective in acute heart failure
• Medication Safety Risk: Dobutamine increases myocardial
oxygen demand and can precipitate arrhythmias
• Nursing Consideration: Dobutamine is used for short-term
management in cardiogenic shock, not primarily for
preload reduction
Nursing Process Linkage: Implementation
Care
12th Edition
• Author(s)Jacqueline Rosenjack
Burchum; Laura D. Rosenthal
,TEST BANK
QUESTION 1
Type: MCQ
Clinical Scenario:
A 72-year-old male patient with a history of heart failure with
reduced ejection fraction (HFrEF) is admitted to the cardiac unit
with worsening dyspnea, orthopnea, and peripheral edema. His
current medications include lisinopril 10 mg daily, carvedilol
12.5 mg twice daily, and furosemide 40 mg daily. His vital signs
are: BP 148/92 mmHg, HR 88 bpm, RR 24/min, SpO2 91% on
room air. The healthcare provider orders an additional
medication to improve his cardiac output and reduce preload.
Question Stem:
The nurse anticipates that which medication will be prescribed
to improve cardiac contractility and reduce preload in this
patient?
Answer Options:
A. Digoxin
B. Nitroglycerin
C. Dobutamine
D. Nesiritide
,Correct Answer: D. Nesiritide
Detailed Rationale:
Nesiritide is a recombinant human B-type natriuretic peptide
that causes vasodilation, reduces preload and afterload, and
increases cardiac output without increasing myocardial oxygen
demand. It is indicated for acutely decompensated heart failure
when standard therapies are inadequate. Nesiritide promotes
vasodilation through smooth muscle relaxation, reduces
pulmonary capillary wedge pressure, and improves dyspnea.
The hemodynamic effects include decreased systemic vascular
resistance and increased stroke volume.
Incorrect Option Analysis:
A. Digoxin - Incorrect
• Why It Is Incorrect: Digoxin increases cardiac contractility
through inhibition of Na+/K+-ATPase but does not
significantly reduce preload
• Common Misconception: Digoxin is often considered the
primary inotropic agent for all heart failure patients
• Medication Safety Risk: Digoxin has a narrow therapeutic
window and requires careful monitoring of serum levels
• Nursing Consideration: Digoxin is used for chronic
management, not acute decompensated heart failure; it
does not provide immediate preload reduction
, B. Nitroglycerin - Incorrect
• Why It Is Incorrect: Nitroglycerin primarily causes
venodilation (reducing preload) but does not improve
cardiac contractility
• Common Misconception: All vasodilators have similar
effects on cardiac function
• Medication Safety Risk: Nitroglycerin can cause severe
hypotension, especially in volume-depleted patients
• Nursing Consideration: While nitroglycerin reduces
preload, it does not enhance contractility, which is needed
in this patient with worsening symptoms
C. Dobutamine - Incorrect
• Why It Is Incorrect: Dobutamine is a positive inotrope that
increases cardiac contractility but does not reduce preload
• Common Misconception: All inotropes are equally
effective in acute heart failure
• Medication Safety Risk: Dobutamine increases myocardial
oxygen demand and can precipitate arrhythmias
• Nursing Consideration: Dobutamine is used for short-term
management in cardiogenic shock, not primarily for
preload reduction
Nursing Process Linkage: Implementation
