NURS 3720 Heart Failure - ACE Inhibitors final study guide

Heart Failure - ACE Inhibitors Afterload-reducing agents ACE inhibitors  -enalapril, captopril, losartan, diltiazem, nifedipine, milrinone -monitor clients taking ACE inhibitors for hypotension following the initial dose -can cause angioedema (swelling of the tongue and throat), decreased sense of taste, or skin rash -monitor for increased levels of potassium -can cause dry cough -BP needs to be monitored for 2 hr after the initial dose to detect hypotension A nurse is teaching a client who is starting to take an ace inhibitor to treat hypertension . the nurse should instruct the client to notify his provider if he experiences which of the following adverse effects of this medication A- Persistent Cough B- Frequent Urination C- Constipation D- Tendon Pain  A - Persistent Cough The nurse informs the patient about a newly prescribed medication. The nurse states, "This drug will help relax and open your blood vessels, which will lower your blood pressure and make it easier for your heart to pump." Which drug is prescribed to the patient? Diuretic Positive inotropic agent Vasopressor Angiotensin-converting enzyme (ACE) inhibitor Angiotensin-converting enzyme (ACE) inhibitor ACE inhibitors interfere with the production of angiotensin II, resulting in vasodilation and reduced blood volume. In heart failure, these drugs reduce afterload, and improve cardiac output and renal flow. Positive inotropic agents improve myocardial contractility, resulting in increased cardiac output. Loop diuretics cause the kidneys to release water through the loop of Henle, thereby reducing fluid volume. Vasodilators relax blood vessels. A patient with heart failure has weakened ventricular contractions and decreased cardiac output. The nurse should anticipate an order for which medication to improve cardiac contractility? Positive inotropic Nitrate Loop diuretic Alpha blocker  Positive inotropic Positive inotropic agents, such as digitalis glycoside, increase contractility by improving systolic contractions, which improves cardiac output and perfusion. Nitrates are vasodilators, both venous and arterial. They will not improve contractility. Loop diuretics cause the kidneys to release water through the loop of Henle. They reduce volume but will not improve contractility. Alpha blockers are typically not used in the treatment of heart failure. What are the side effects of ACE inhibitors?  cough, angioedema, rash, hypotension, hyperkalaemia How would you avoid hyperkalaemia?  Conduct a blood test to monitor potassium levels before the administration of ACE inhibitors, and review after 1-2 weeks. Also avoid potassium supplements and give potassium sparing diuretics sparingly. What would be the nursing considerations for patients with heart failure taking ACE inhibitors?  Reduce diuretic dosage, or withhold other diuretics for 24 hours before starting the ACE inhibitor Are ACE inhibitors an appropriate form of treatment for pregnant women?  No, ACE inhibitors should be stopped within the first trimester of the pregnancy and avoided during the second and third trimester. It can cause fetal renal damage and subsequent fetal death. How would you manage the side effect of hypotension and dizziness in patients taking ACE inhibitors?  Show the patient how to rise slowly and change positions to avoid orthostatic hypotension. Advise against alcohol, driving and hazardous activities due to the risk of dizziness and fainting. Heart Failure - Digoxin A nurse in a clinic is caring for a client who has heart failure and is taking digoxin. Which of the following statements by the client indicated the client is experiencing digoxin toxicity? "My vision seems yellow." A nurse is planning to administer digoxin to a client who has heart failure. Which of the following laboratory results is the priority for the nurse to review prior to administering the medication? Potassium level A nurse is planning to administer digoxin to a client who has heart failure. For which of the following findings should the nurse withhold the medication and report to the provider? Report of blurred vision. A nurse is caring for a client who has heart failure and has been taking digoxin 0.25 mg daily. The client refuses breakfast and reports nausea. Which of the following actions should the nurse take? Check the clients vital signs. A nurse is collecting data from a client who reports a sudden onset of SOB, fatigue, and dizziness. Electrocardiography indicates the client is experiencing atrial fibrillation. Which of the following medications should the nurse expect to administer? Digoxin A nurse is caring for a client who has a prescription for digoxin 0.25 mg PO daily for heart failure. The clients current vital signs are: BP 144/96, HR 54/min, respirations 18/min, temp 37C. Which of the following actions should the nurse take? Withhold the digoxin dose for decreased heart rate. A nurse is assisting in the plan of care for a client who is receiving digoxin to treat heart failure. Which of the following actions should the nurse plan to take? Monitor the client for nausea, vomiting, and anorexia. A nurse is planning to administer digoxin to a client who has heart failure. Which of the following lab results is the priority for the nurse to review prior to administering this medication? - Potassium - Hemoglobin - Creatinine - Blood urea nitrogen - Potassium Digoxin is a cardiac glycoside medication used to improve myocardial contractility, increasing stroke volume and cardiac output in a client who has HF. During therapy, the nurse should closely monitor the client's potassium level as hypokalemia increases the risk of digitalis toxicity and cardiac arrhythmias. A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication? - "I can walk a mile a day." - "I've had a backache for several days." - "I am urinating more frequently." - "I feel nauseated and have no appetite." - "I feel nauseated and have no appetite." Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digitalis toxicity. A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate? - Withholding the medication if the heart rate is above 100/min - Instructing the client to eat foods that are low in potassium - Measuring apical pulse rate for 30 seconds before administration - Evaluating the client for nausea, vomiting, and anorexia - Evaluating the client for nausea, vomiting, and anorexia Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.