Progressive Care Nursing Certification (PCCN) Practice Exam

In a patient with decompensated heart failure, which medication can help reduce preload?

1. Spironolactone (Aldactone)

2. Verapamil (Calan)

3. Dabigatran etexilate (Pradaza)

4. No other drugs are essential

The correct answer is: Spironolactone (Aldactone)

In the context of decompensated heart failure, the medication that can help reduce preload is spironolactone. This drug is a potassium-sparing diuretic that functions primarily by blocking aldosterone receptors. In heart failure, the body often retains fluid due to the activation of the renin-angiotensin-aldosterone system, which leads to increased sodium and water retention, thus increasing preload. By using spironolactone, you can mitigate these effects, as it promotes diuresis (increased production of urine), leading to reduced blood volume and consequently lowering preload. This decrease in preload can help alleviate some of the symptoms associated with heart failure, such as edema and shortness of breath due to pulmonary congestion. Other medications listed do not primarily target preload reduction in a way that is beneficial in the setting of heart failure. For instance, verapamil is a calcium channel blocker that primarily acts on heart rate and contractility rather than fluid retention. Dabigatran etexilate is an anticoagulant used for preventing stroke and blood clots, which does not impact preload at all. Hence, in this scenario, spironolactone is the appropriate choice for managing fluid overload and reducing preload.