An outpatient who has chronic heart failure returns to the clinic ...

[RRMR]

An outpatient who has chronic heart failure returns to the clinic after 2 weeks of therapy with metoprolol (Toprol XL). Which assessment finding is most important for the nurse to report to the health care provider?
 
  a. 2+ pedal edema
  b. Heart rate of 56 beats/minute
  c. Blood pressure (BP) of 88/42 mm Hg
  d. Complaints of fatigue

Question 2

A patient has recently started on digoxin (Lanoxin) in addition to furosemide (Lasix) and captopril (Capoten) for the management of heart failure. Which assessment finding by the home health nurse is a priority to communicate to the health care provider?
 
  a. Presence of 1 to 2+ edema in the feet and ankles
  b. Palpable liver edge 2 cm below the ribs on the right side
  c. Serum potassium level 3.0 mEq/L after 1 week of therapy
  d. Weight increase from 120 pounds to 122 pounds over 3 days

[stillxalice]

Answer to Question 1

ANS: C
The patient's BP indicates that the dose of metoprolol may need to be decreased because of hypotension. Bradycardia is a frequent adverse effect of -adrenergic blockade, but the rate of 56 is not unusual with -adrenergic blocker therapy. -Adrenergic blockade initially will worsen symptoms of heart failure in many patients, and patients should be taught that some increase in symptoms, such as fatigue and edema, is expected during the initiation of therapy with this class of drugs.

Answer to Question 2

ANS: C
Hypokalemia can predispose the patient to life-threatening dysrhythmias (e.g., premature ventricular contractions), and potentiate the actions of digoxin and increase the risk for digoxin toxicity, which can also cause life-threatening dysrhythmias. The other data indicate that the patient's heart failure requires more effective therapies, but they do not require nursing action as rapidly as the low serum potassium level.

[RRMR]

Correct answers!

[stillxalice]

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