Ch 48 Drugs for Heart Failure

What is the half-life of digoxin?

1.5 days

A client who is receiving multiple medications for an MI complains of severe nausea, and the client's HB is irregular and slow. The nurse determines that these signs and symptoms are toxic effects of what drug? A. Digoxin B. Captopril C. Furosemide D. Morphine sulfate

A. Signs of digoxin toxicity include cardiac dysrythmias, anorexia, nausea, vomiting, and visual disturbances. Although nausea and heart block may occur with captopril, these symptoms rarely are seen; drowsiness and CNS disturbances are more common. Toxic effects of morphine are slow, deep respirations, stupor, and constricted pupils; nausea is a side effect, not a toxic effect. Toxic effects of furosemide are renal failure, blood dyscrasias, and loss of hearing.

A nurse is providing discharge instructions about digoxin. Which response should a nurse include as a reason for a client to withhold the digoxin? A. Chest pain B. Blurred vision C. Persistent hiccups D. Increased urinary output

B. Visual disturbances, such as blurred or yellow vision, may be evidence of digoxin toxicity. Chest pain is not a toxic effect of digoxin. Persistent hiccups are not related to digoxin toxicity. An increased urinary output is not a sign of digoxin toxicity; it may be a sign of a therapeutic response to the drug and an improved cardiac output.

A client who has been taking digoxin for 20 years is hospitalized. The client exhibits signs of dehydration, and laboratory results identify the presence of hypokalemia. The nurse should monitor the client for which clinical finding indicating digoxin toxicity? A. Constipation B. Decreased urination C. Cardiac dysrhythmias D. Metallic taste in the mouth

C. The development of cardiac dysrhythmias is often a sign of digoxin toxicity. Constipation is not a sign of toxicity; GI signs and symptoms of toxicity include anorexia, nausea, vomiting, and diarrhea. Decreased urination is not a sign of toxicity. The client will have a decrease in urination because of dehydration. Digoxin does not cause a metallic taste in the mouth.

A client with HF is to receive digoxin and asks the nurse why the medication is necessary. What physiologic response will the nurse include when answering the client's question? A. Reduces edema B. Increases cardiac conduction C. Increases rate of ventricular contractions D. Slows and strengthens cardiac contractions

D. Digoxin increases the strength of myocardial contractions (positive inotropic effect) and, by altering the electrophysiological properties of the heart, slows the HR (negative chronotropic effect). Digoxin increases the strength of the contractions but deceases the HR. Although a reduction in edema may result from the increased blood supply to the kidneys, it is not the reason for administering digoxin. Digoxin decreases, not increases, cardiac impulses through the conduction system of the heart.

The client who takes furosemide and digoxin reports that everything looks yellow. How should the nurse respond? A. "This is related to your heart problems, not to the medication." B. "It is a medication that is necessary, and that side effect is only temporary." C. "Take this dose, and when I see your healthcare provider I will ask about it." D. "I will hold the medication until I consult with your healthcare provider."

D. The response "I will hold the medication until I consult with your healthcare provider" is a safe practice because yellow vision indicates digitalis toxicity. The response "This is related to your heart problems, not to the medication that is necessary, and that side effect is only temporary" is incorrect; yellow vision is not a temporary side effect. The response "Take this dose, and when I see you healthcare provider I will ask about it" is unsafe.

What effects does digoxin have on the heart?

Digoxin increases 1) the force of ventricular contraction, 2) myocardial contractility, and 3) cardiac output.

What is an important lab to monitor in a patient on digoxin?

Potassium, specifically low levels. Hypokalemia increases the risk of digoxin toxicity.

Which assessment should the nurse obtain before administering digoxin to a client? A. Apical HR B. Radial pulse on the left side C. Radial pulse in both right and left arms D. Difference between apical and radial pulses

A. Because digoxin slows the HR, the apical pulse should be counted for 1 min before administration. If the apical rate is below a present parameter (usually 60 beats/min), digoxin should be withheld because its administration may further decrease the HR. Some protocols permit waiting for 1 hr and retaking the apical rate; the result determines if it is administered or if the HCP is notified. Obtaining the radial pulse on the left side is not as accurate as an apical pulse; the client also may have an atrial dysrhythmia, which cannot be detected through a radial rate alone. Obtaining the radial pulse in both right and left arms is not as accurate as an apical pulse; the client also may have an atrial dysrhythmia, which cannot be detected through a radial pulse alone. Obtaining the difference between apical and radial pulses is a pulse deficit, not a pulse rate.

A client has been receiving digoxin. The client calls the clinic and complains of "yellow vision." What is the nurse's best response? A. "This is related to your illness rather than to your medication." B. "Take the medication because this is not a serious side effect." C. "This side effect is only temporary. You should continue the medication." D. "The medication may need to be discontinued. Come to the clinic this afternoon."

D. Yellow vision indicates digoxin toxicity; the medication should be withheld until the healthcare provider can assess the client and check the digoxin blood level. Yellow vision is related to digoxin therapy, not the client's underlying medical condition. Yellow vision is a sign of digoxin toxicity; taking more digoxin will escalate the digoxin toxicity.