A nurse is caring an older patient with congestive heart failure. The nurse can anticipate which medicine will prescribe by the health care provider?

Appeared in: NORCET -4 , 2023

Explanation

Digoxin is a cardiac glycoside specifically used to manage symptoms of congestive heart failure by improving the heart's pumping ability.
It has a positive inotropic effect, meaning it increases the force of the heart's contractions, leading to improved cardiac output.
It also has a negative chronotropic effect, which slows the heart rate, allowing for better ventricular filling and reducing the heart's overall workload.
These combined actions help to alleviate symptoms of heart failure such as edema, fatigue, and shortness of breath.

Option A: Amiodarone is an antiarrhythmic drug used to manage irregular heart rhythms. It does not primarily address the weak contractility characteristic of heart failure.
Option B: Clopidogrel is an antiplatelet medication used to prevent blood clots. It has no effect on the heart's contractility or the symptoms of heart failure.
Option C: Aspirin is an antiplatelet agent and NSAID. It is used to prevent blood clots and reduce inflammation, not to improve the pumping function of the heart in CHF.

Visual 1: Diagram illustrating the mechanism of action of Digoxin on the sodium-potassium pump in a cardiac myocyte, leading to increased intracellular calcium.
Visual 2: Infographic showing the signs and symptoms of Digoxin toxicity, highlighting visual disturbances (yellow-green halos), gastrointestinal issues (nausea, anorexia), and cardiac signs (bradycardia).

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacological management of congestive heart failure (CHF) to guide bedside assessment, documentation, and the next nursing action.
A critical nursing responsibility is to check the apical pulse for a full minute before administering Digoxin. The dose must be held and the provider notified if the rate is below 60 beats/min in an adult, as this is a key sign of potential toxicity.
Nurses must diligently monitor serum potassium levels, as hypokalemia (low potassium) potentiates the effect of Digoxin and dramatically increases the risk of life-threatening toxicity.
Patient education is vital. The nurse must teach the patient and family the signs of toxicity and the importance of not skipping doses or taking extra doses.

How to Approach the Question

First, identify the core clinical condition in the question: congestive heart failure (CHF), a condition where the heart pump is weak.
Next, analyze the primary function of each medication listed in the options based on its drug class.
Amiodarone is an antiarrhythmic. Clopidogrel and Aspirin are antiplatelets. Digoxin is a cardiac glycoside, which is a positive inotrope.
Match the drug's primary function to the pathophysiology of CHF. The goal is to improve the heart's pumping action.
Conclude that the drug designed to strengthen the heart's contraction (the positive inotrope) is the most direct treatment for CHF among the choices.
This process of elimination based on drug class and mechanism of action identifies Digoxin as the correct answer.

Concept Tested & Keywords

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Practise the full NORCET -4 , 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.