Author Question: A patient who has heart failure has been treated with furosemide and an ACE inhibitor. The patient's ... (Read 31 times)

maegan_martin · **on:** Jul 24, 2018

A patient who has heart failure has been treated with furosemide and an ACE inhibitor. The patient's cardiologist has added digoxin to the patient's medication regimen. The primary care NP who cares for this patient should expect to monitor:

a. serum electrolytes.
b. blood glucose levels.
c. serum thyroid levels.
d. complete blood counts (CBCs).

Question 2

A patient comes to the clinic with a recent onset of nocturnal and exertional dyspnea. The primary care nurse practitioner (NP) auscultates S3 heart sounds but does not palpate hepatomegaly. The patient has mild peripheral edema of the ankles.

The NP should consult a cardiologist to discuss prescribing a(n): a. B-blocker.
b. loop diuretic.
c. angiotensin-converting enzyme (ACE) inhibitor.
d. angiotensin receptor blocker (ARB).

Anton · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

A
Hypokalemia makes the myocardium more sensitive to digoxin. These levels should be monitored closely in patients taking furosemide, which can deplete potassium. Serum glucose, thyroid levels, and a CBC should be monitored if indicated by other conditions.

Answer to Question 2

B
This patient shows signs of systolic heart failure. Treatment for heart failure should begin with a loop diuretic, with an ACE inhibitor added after the diuretic has been taken. B-Blockers are used in patients with minimal fluid retention and would be added later. ARBs are used if ACE inhibitors are not tolerated or are ineffective.