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Medications and Therapies

- The medications and therapies used for CCF are based on the type, etiology, and severity of heart failure. Some common medications and therapies are :

- ACE inhibitors or ARBs reduce afterload, preload, and neurohormonal activation, and prevent ventricular remodeling. Examples are captopril, enalapril, lisinopril, losartan, valsartan, and candesartan.

- ARNIs enhance the effects of ACE inhibitors or ARBs by inhibiting neprilysin, an enzyme that degrades natriuretic peptides. An example is sacubitril/valsartan.

- Beta-blockers to reduce heart rate, blood pressure, and myocardial oxygen demand, and to prevent ventricular remodeling. Examples are metoprolol, carvedilol, and bisoprolol.

- MRAs to reduce fluid retention, blood pressure, and neurohormonal activation, and to prevent ventricular remodeling. Examples are spironolactone and eplerenone.

- Diuretics to reduce fluid overload, edema, and pulmonary congestion. Examples are furosemide, bumetanide, torsemide, hydrochlorothiazide, and metolazone.

- Digoxin increases the contractility and stroke volume of the heart and decreases the heart rate and conduction velocity. It also has a positive inotropic effect and a negative chronotropic effect.

- Nitrates dilate the veins and arteries, reducing preload and afterload. Examples are nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate.

- Hydralazine dilates the arteries, reducing afterload. It is often combined with nitrates for patients who cannot tolerate ACE inhibitors or ARBs.

- Ivabradine lowers the heart rate by inhibiting the sinoatrial node pacemaker. It is used for patients with HFrEF who have a resting heart rate greater than 70 beats per minute despite optimal medical therapy.

- Sacubitril/valsartan lowers blood pressure by inhibiting neprilysin and blocking angiotensin II receptors. It is used for patients with HFrEF who have NYHA class IIIV symptoms despite optimal medical therapy.

- CRT to synchronize the contraction of the right and left ventricles using a biventricular pacemaker. It is used for patients with HFrEF who have a QRS duration greater than 120 milliseconds and NYHA class IIIV symptoms despite optimal medical therapy.

- ICD to monitor the heart rhythm and deliver electrical shocks if needed to correct life-threatening arrhythmias. It is used for patients with HFrEF who have an EF of less than or equal to 35% and are at high risk of sudden cardiac death.

- VAD assists the pumping function of the ventricle using a mechanical device that is implanted in the chest or abdomen. It is used for patients with end-stage or refractory heart failure who are awaiting heart transplantation or as a destination therapy.

- IABP to increase the coronary perfusion pressure and decrease the afterload using a balloon catheter.

Questions on Medications and Therapies

Correct Answer is C

Explanation

This choice is incorrect because administering a diuretic is not within the nurse's scope of practice without a healthcare provider's order. The nurse should first notify the healthcare provider to evaluate the client's condition and determine the appropriate intervention.

Correct Answer is A

Explanation

This choice is incorrect because a family history of heart disease may increase the client's risk of developing CHF, but it does not directly contribute to the current symptoms the client is experiencing.

Correct Answer is C

Explanation

This choice is incorrect because jugular vein distention is associated with right-sided heart failure, not left-sided heart failure.

Correct Answer is B

Explanation

This choice is incorrect because taking prescribed medications only when symptoms worsen is not appropriate for congestive heart failure management. The client should take prescribed medications as directed by the healthcare provider, even when feeling well, to prevent symptom exacerbation and improve heart function.

Correct Answer is C

Explanation

This choice is incorrect because respiratory alkalosis is not a common side effect of digoxin. Digoxin does not directly affect the respiratory system.Questions

Correct Answer is B

Explanation

This choice is incorrect because anemia and low red blood cell count can impact heart function, but they are not the main causes of CHF. Hypertension and coronary artery disease are more commonly associated with the development of CHF.

Correct Answer is A

Explanation

This choice is incorrect because occupational exposure to toxins can have health implications, but it is not directly related to the client's signs and symptoms of congestive heart failure in this case.

Correct Answer is D

Explanation

This choice is correct. A serum cholesterol level of 240 mg/dL indicates high cholesterol, which is a risk factor for coronary artery disease. Coronary artery disease is a leading cause of congestive heart failure and may have contributed to the client's condition.

Correct Answer is C

Explanation

This choice is incorrect because gender is a non-modifiable risk factor for congestive heart failure. While men may have a slightly higher risk of heart failure compared to women, gender is not something that can be changed or modified.

Correct Answer is D

Explanation

This choice is correct. Uncontrolled diabetes mellitus can lead to microvascular damage, particularly in the small blood vessels of the heart. This damage can contribute to heart muscle dysfunction and congestive heart failure. Diabetes is a significant risk factor for developing heart failure.Questions

Correct Answer is B

Explanation

This choice is incorrect because tachypnea is rapid breathing and is not specifically related to the client's nighttime symptom of sudden breathlessness.

Correct Answer is C

Explanation

This choice is incorrect because peripheral cyanosis is bluish discoloration of the skin and mucous membranes due to reduced blood flow, which is not described by the client.

Correct Answer is B

Explanation

This choice is incorrect because ascites is the accumulation of fluid in the abdominal cavity and is not specific to the client's reported symptoms of swollen ankles and legs.

Correct Answer is D

Explanation

This choice is correct. Crackles, also known as rales, are abnormal lung sounds heard on auscultation and may indicate fluid accumulation in the lungs, a common symptom of congestive heart failure. The presence of crackles suggests pulmonary congestion due to fluid leaking into the alveoli.

Correct Answer is D

Explanation

This choice is correct. Cardiac asthma is a form of wheezing or coughing that occurs as a result of fluid accumulation in the lungs due to congestive heart failure. It is not caused by asthma but is a manifestation of heart failure impacting the respiratory system.Questions

Correct Answer is C

Explanation

This choice is incorrect because a brain natriuretic peptide (BNP) level is a blood test that can aid in the diagnosis of CHF. Elevated BNP levels indicate heart strain, but it is not the gold standard for diagnosing CHF.

Correct Answer is C

Explanation

This choice is incorrect because a normal cardiac silhouette on a chest X-ray would not be indicative of congestive heart failure. The presence of cardiomegaly is more suggestive of heart failure.

Correct Answer is C

Explanation

This choice is incorrect because a C-reactive protein (CRP) level is a marker of inflammation and is not specific to diagnosing CHF.

This choice is incorrect because an irregular heart rhythm with varying intensity is characteristic of cardiac arrhythmias or irregular heartbeats and is not specific to the presence of an S3 sound.

This choice is correct. Ejection fraction (EF) is a parameter measured during an echocardiogram to assess the client's heart function. It represents the percentage of blood pumped out of the heart's left ventricle with each heartbeat and is an essential indicator of heart muscle efficiency and poten

This choice is incorrect because while ACE inhibitors can increase potassium levels, avoiding foods high in potassium is not necessary unless specifically directed by the healthcare provider. The client should follow a balanced diet and inform the healthcare provider of any changes in their dietary

This choice is correct. Loop diuretics are potent potassium-wasting diuretics, meaning they increase potassium excretion in the urine, potentially causing hypokalemia. The nurse should closely monitor the client's potassium levels and provide potassium supplementation if necessary.

This choice is incorrect because the timing of beta-blocker administration varies depending on the specific beta-blocker prescribed and the client's individual response. Some beta-blockers may be taken in the morning, while others may be taken in the evening. The client should follow the prescribed

This choice is incorrect because a dry, nonproductive cough is associated with ACE inhibitors, not furosemide.

This choice is incorrect because blood glucose levels are not specifically impacted by digoxin. However, hypokalemia resulting from digoxin therapy can cause alterations in glucose metabolism, so blood glucose levels should be monitored in clients taking digoxin.Questions

This choice is incorrect because limiting fluid intake is not specific to the administration of ACE inhibitors. Fluid intake may need to be adjusted based on the client's overall fluid balance and congestive heart failure status, but it is not a direct instruction related to the medication.

This choice is incorrect because hyperglycemia (high blood glucose levels) is not a common adverse effect of beta-blockers. In fact, beta-blockers can sometimes cause transient hypoglycemia.

This choice is correct. Loop diuretics are potent potassium-wasting diuretics, meaning they increase potassium excretion in the urine, potentially causing hypokalemia. The nurse should closely monitor the client's potassium levels and provide potassium supplementation if necessary.

This choice is incorrect because blood glucose levels are not specifically impacted by digoxin. However, hypokalemia resulting from digoxin therapy can cause alterations in glucose metabolism, so blood glucose levels should be monitored in clients taking digoxin.

This choice is incorrect because monitoring blood pressure daily and adjusting the dose accordingly is not specific to the administration of spironolactone. While blood pressure may need to be monitored regularly, dosage adjustments should only be made under the guidance of the healthcare provider.Q

This choice is correct. Following a low-sodium diet is essential for clients with congestive heart failure to reduce fluid retention and manage symptoms of fluid overload.

This choice is incorrect because while avoiding certain over-the-counter medications is essential while on digoxin due to potential drug interactions, it is not the primary instruction for the client. The client should discuss any new medications, including over-the-counter drugs, with their healthc

This choice is incorrect because hyperglycemia (high blood glucose levels) is not a common adverse effect of furosemide. In fact, furosemide can sometimes cause transient hypoglycemia.

This choice is correct. Monitoring daily weights is an essential strategy for clients with congestive heart failure to manage fluid balance. Sudden weight gain can indicate fluid retention, a common symptom of CHF. Clients should be instructed to report any significant weight changes to their health

This choice is incorrect because increasing the nitrate dose without healthcare provider guidance can be dangerous. Clients should be instructed to take nitrate medications as prescribed and seek immediate medical attention if chest pain is not relieved within a specific timeframe, as directed by th
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