A patient who has heart failure receives digoxin (Lanoxin) and an ...

[JGIBBSON]

A patient who has heart failure receives digoxin (Lanoxin) and an angiotension-converting enzyme (ACE) inhibitor. The patient will begin taking spironolactone (Aldactone). The patient asks why the new drug is necessary.
 
  The nurse will tell the patient that spironolactone will be given for which reason?
  a. To enhance potassium excretion
  b. To increase cardiac contractility
  c. To minimize fluid losses
  d. To provide cardioprotective effects

Question 2

The nurse is teaching a patient about the use of a transdermal nitroglycerin patch. Which statement by the patient indicates understanding of the teaching?
 
  a. I will apply the patch as needed when I experience anginal pain.
  b. I will remove the old patch and replace it with a new one at bedtime each day.
  c. I should rotate sites when changing the patch to prevent skin irritation.
  d. When I am symptom-free, I may stop using the patch on a regular basis.

[k2629]

Answer to Question 1

ANS: D
Spironolactone is a potassium-sparing diuretic that blocks production of aldosterone, causing improved heart rate variability and decreased myocardial fibrosis. It is given in congestive heart failure for its cardioprotective effects. Spironolactone does not directly alter cardiac contractility but may slightly decrease contractility if fluid volume is decreased. It is a mild diuretic but is not given in this instance to minimize fluid losses.

Answer to Question 2

ANS: C
Patients should be taught to rotate application sites when using the transdermal nitroglycerin. Transdermal nitroglycerin is not used as needed. Patients should remove the patch at bedtime to provide an 8- to 12-hour nitrate-free interval. Patients should use the patch even when symptom-free unless otherwise instructed by the provider.