NU271 Week 3 PrepU: Agents for Treating Heart Failure
A male client is diagnosed with renal failure secondary to diabetes mellitus. Based on the new diagnosis, how will the physician safely adjust the client's digoxin dose? 0.25 mg every other day 0.125 mg three times a week 0.25 mg five times a week 0.125 mg every day
0.125 mg three times a week Explanation: Digoxin should be used cautiously, in reduced dosages, because renal impairment delays its excretion. Both loading and maintenance doses should be reduced. Clients with advanced renal impairment can achieve therapeutic serum concentrations with a dosage of 0.125 mg three to five times per week. Reference: Chapter 44: Agents for Treating Heart Failure - Page 762
In heart failure, by what mechanism does the body compensate for decreased circulating blood volume? Increasing stroke volume Increasing preload Activation of the renin-angiotensin-aldosterone system Decreasing afterload
Activation of the renin-angiotensin-aldosterone system Explanation: As circulating volume to the kidneys decreases in CHF, the renin-angiotensin-aldosterone system is activated as the body attempts to "correct" for the low levels of circulating volume. Reference: Chapter 44: Agents for Treating Heart Failure - Page 758
The nurse explains to the client that with heart failure, the client may experience which symptom? (Select all that apply.) Fatigue Anxiety Shortness of breath Weakness Tremors
Anxiety Weakness Fatigue Shortness of breath Explanation: Reference: Chapter 44: Agents for Treating Heart Failure - Page 758
hat should the pre-administration physical assessment for cardiotonic drugs include? (Select all that apply.) Apical-radial pulse rate Respiratory rate Urinalysis Blood pressure Weight measurement
Apical-radial pulse rate Respiratory rate Weight measurement Blood pressure Explanation: Pre-administration physical assessment should include all but the urinalysis. This information will establish a database for comparison during therapy. Reference: Chapter 44: Agents for Treating Heart Failure - Page 765
What is the most accurate method for preventing adverse effects associated with the use of digoxin? Monitor therapeutic effects based on echocardiogram results. Teach clients to take their digoxin in divided doses with each meal. Assess the client's heart rate and hold administration if it is less than 60. Teach clients the signs and symptoms of heart failure.
Assess the client's heart rate and hold administration if it is less than 60. Explanation: Clients should be taught to hold their digoxin if their heart rate is less than 60 (or some other defined heart rate). Divided doses are not normally used and an awareness of heart failure does not preclude adverse effects of digoxin. Reference: Chapter 44: Agents for Treating Heart Failure - Page 767
A client is prescribed sacubitril and valsartan for treatment of heart failure. What laboratory blood values should the nurse monitor to assure the treatment is successful? Select all that apply. Potassium Creatinine Glucose Magnesium Blood urea nitrogen
Blood urea nitrogen Creatinine Potassium Explanation: The nurse should assess for signs of improvement or stabilization of chronic heart failure by monitoring laboratory values to assure that blood urea nitrogen, creatinine, and potassium are within acceptable limits. It is not necessary to assess the other values to determine the success of treatment. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
Which dosage forms are used for digoxin (Lanoxin) maintenance therapy? (Select all that apply.) Patch Ointment Tablet Capsule Injection
Capsule Injection Tablet Explanation: Capsules and tablets are used for maintenance therapy, injections are used for rapid digitalization, and digoxin patches and ointment do not exist. Reference: Chapter 44: Agents for Treating Heart Failure - Page 765
When describing how vasodilators help alleviate heart failure, which would the nurse include? Increase cardiac workload Increase preload Decrease afterload Decrease blood volume
Decrease afterload Explanation: Vasodilators decrease cardiac workload, relax vascular smooth muscle to decrease afterload, and allow pooling in the veins thereby decreasing preload. Decreased blood volume results from the use of diuretics. Reference: Chapter 44: Agents for Treating Heart Failure - Page 760
A nurse is caring for a patient admitted to the intensive care unit because of heart failure. The patient is prescribed digoxin. Which nursing diagnosis would be appropriate for this patient? Acute Pain and Headache related to adverse effects of the drug therapy Decreased Cardiac Output related to altered cardiac function Risk of Constipation related to adverse effects of the drug therapy Risk for Hyperthyroidism related to adverse effects of drug therapy
Decreased Cardiac Output related to altered cardiac function Explanation: Use of digoxin increases the risk for Decreased Cardiac Output related to altered cardiac function from the drug therapy. The use of digoxin does not pose a risk for acute pain, headache, hyperthyroidism, or constipation. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
A nurse is caring for a patient admitted to the intensive care unit because of heart failure. The patient is prescribed digoxin. Which nursing diagnosis would be appropriate for this patient? Risk for Hyperthyroidism related to adverse effects of drug therapy Acute Pain and Headache related to adverse effects of the drug therapy Risk of Constipation related to adverse effects of the drug therapy Decreased Cardiac Output related to altered cardiac function
Decreased Cardiac Output related to altered cardiac function Explanation: Use of digoxin increases the risk for Decreased Cardiac Output related to altered cardiac function from the drug therapy. The use of digoxin does not pose a risk for acute pain, headache, hyperthyroidism, or constipation. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
The nurse teaches the client that antacids when taken with digoxin may have which interactions? Anorexia Increased digoxin levels Nausea and vomiting Decreased digoxin levels
Decreased digoxin levels Explanation: When antacids are taken combined with digoxin, the client may experience decreased serum digitalis levels. There is no effect on the gastrointestinal system. Reference: Chapter 44: Agents for Treating Heart Failure - Page 764
Which would the nurse identify as a cardiac glycoside? Captopril Inamrinone Milrinone Digoxin
Digoxin Explanation: Digoxin is a cardiac glycoside. Inamrinone and milrinone are phosphodiesterase inhibitors. Captopril is an angiotensin-converting enzyme inhibitor. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
A client with heart failure has been started on a milrinone infusion. Which assessment findings would lead the nurse to believe the milrinone is effective? Arrhythmias Diuresis Hyperkalemia Tachycardia
Diuresis Explanation: Heart failure occurs when the heart is unable to effectively pump enough blood to meet the needs of the body. Diuresis would indicate that kidney function has improved. Hypokalemia would be an adverse reaction related to diuresis that could lead to arrhythmias. Milrinone should also slow the heart rate. Reference: Chapter 44: Agents for Treating Heart Failure - Page 768
The nurse should assess for what as a symptom in a client with left-sided heart failure? Dyspnea Hepatic engorgement Distended neck veins Edema
Dyspnea Explanation: Symptoms of left-sided failure include dyspnea and moist cough. Edema, hepatic engorgement, and distended neck veins are symptoms of right-sided failure. Reference: Chapter 44: Agents for Treating Heart Failure - Page 759
When describing cardiotonic drugs, the nurse would expect to include which condition as an indication for use? Select all that apply. Hyperlipidemia Heart failure Hypertension Atrial fibrillation Hypothyroidism
Heart failure Atrial fibrillation Explanation: Cardiotonic drugs are used to treat heart failure if other treatments fail to improve client status and to treat atrial fibrillation. Thyroid hormones are used to treat hypothyroidism. Statin therapy is used in the treatment of hyperlipidemia. Thiazides and loop diuretics are used to treat hypertension along with other antihypertensives. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
The nurse is aware that heart failure may result from what problems? (Select all that apply.) A combination of systolic and diastolic dysfunction Impaired relaxation and filling of ventricles during diastole Cardiomyopathy Impaired myocardial contraction during systole Impaired conduction from the SA node
Impaired myocardial contraction during systole Impaired relaxation and filling of ventricles during diastole A combination of systolic and diastolic dysfunction Cardiomyopathy Explanation: Heart failure may result from impaired myocardial contraction during systole (systolic dysfunction), impaired relaxation and filling of ventricles during diastole (diastolic dysfunction), or a combination of systolic and diastolic dysfunction. Cardiomyopathy (weakened and enlarged heart muscle) also increases the risk for the development of heart failure.
The nurse in a physician's office knows that heart failure clients will need which laboratory tests to best monitor their condition? (Select all that apply.) Digoxin levels Creatinine clearance ALT and AST K+ and Na+ levels WBCs
K+ and Na+ levels Creatinine clearance Digoxin levels Explanation: The nurse is aware that the nurse will monitor the client's serum electrolytes, renal function, and serum digoxin level. Reference: Chapter 44: Agents for Treating Heart Failure - Page 757
A client presents to the emergency department with signs and symptoms of acute congestive heart failure. Assessment findings and tests confirm the diagnosis. Which type of diuretic would be the drug of choice to treat the client? Thiazide Loop Calcium wasting Potassium sparing
Loop Explanation: For acute HF, the first drugs of choice may include an IV loop diuretic, a cardiotonic-inotropic agent (e.g., digoxin, dobutamine, milrinone), and vasodilators (e.g., nitroglycerin and hydralazine or nitroprusside). Reference: Chapter 44: Agents for Treating Heart Failure - Page 894
A client presents to the emergency department with signs and symptoms of acute congestive heart failure. Assessment findings and tests confirm the diagnosis. Which type of diuretic would be the drug of choice to treat the client? Thiazide Potassium sparing Loop Calcium wasting
Loop Explanation: For acute HF, the first drugs of choice may include an IV loop diuretic, a cardiotonic-inotropic agent (e.g., digoxin, dobutamine, milrinone), and vasodilators (e.g., nitroglycerin and hydralazine or nitroprusside). Reference: Chapter 44: Agents for Treating Heart Failure - Page 894
Cardiotonic drugs are used as indicated with what to treat heart failure? (Select all that apply.) Beta blockers Thiazide diuretics Angiotensin-converting enzyme inhibitors (ACEIs) Calcium channel blockers Loop diuretics
Loop diuretics Angiotensin-converting enzyme inhibitors (ACEIs) Beta blockers Explanation: Cardiotonic drugs are used in clients with persistent symptoms, recurrent hospitalization, or as indicated in conjunction with ACEIs, loop diuretics, and beta blockers in clients with heart failure. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
The nurse recognizes that which finding is associated with right-sided heart failure? Nocturia Crackles in the lungs Dyspnea Orthopnea
Nocturia Explanation: Nocturia is a symptom of right-sided heart failure. Crackles in the lungs, dyspnea, and orthopnea are symptoms related to left-sided heart failure because they are pulmonary symptoms. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
A client recently admitted to the emergency department (ED) with digitalis toxicity suddenly develops these signs and symptoms: BP 88/50, HR 30, RR 28, presence of pallor, weakness, dizziness, and diaphoresis. Which action would the nurse implement first? Obtain serum electrolytes STAT and notify ED personnel with results. Place client on continuous electrocardiogram (ECG) monitoring. Place client in supine position with feet elevated above level of heart. Administer atropine 0.5 mg intravenous push (IVP) per order.
Place client in supine position with feet elevated above level of heart. Explanation: The nurse's first action when caring for the client exhibiting symptoms of a low cardiac output secondary to the digitalis toxicity because of a brady-arrhythmia with hypotension is to place the client in supine position with feet elevated. The position will help return blood to the heart and raise blood pressure. Next, the nurse will quickly connect the client to the ECG to determine if there is any heart block present, or if the client is experiencing sinus bradycardia. The nurse would provide the atropine IVP to increase the client's heart rate to a normal rate, which will improve the cardiac output. The nurse will ensure the serum electrolytes are obtained STAT and call the results to the emergency department provider. It is important to treat hypokalemia, hypomagnesemia, or hypercalcemia because they increase the potential for digitalis toxicity. Reference: Chapter 44: Agents for Treating Heart Failure - Page 759
A nurse is caring for a client who is taking digoxin and a loop diuretic. Which would be mostimportant for the nurse to monitor? Liver enzymes Electrocardiogram results Potassium levels Sodium levels
Potassium levels Explanation: Although it is important to monitor the client's ECG, it is more important to closely monitor potassium levels when the client is taking a drug that promotes the loss of potassium, such as thiazide or loop diuretics. Hypokalemia increases the effect of digoxin and increases the risk for digoxin toxicity. The client's sodium levels and liver enzyme levels may need to be monitored periodically, but not as closely as potassium levels. Reference: Chapter 44: Agents for Treating Heart Failure - Page 764
Which medication reduces aldosterone-induced retention of sodium and water when prescribed for the treatment of heart failure? Spironolactone Losartan potassium Enalapril maleate Hydrochlorothiazide
Spironolactone Explanation: Spironolactone is an aldosterone antagonist that reduces aldosterone-induced retention of sodium and water and impaired vascular function. Thiazide diuretics, ACE inhibitors, and angiotensin II receptor blockers do not have this mechanism of action. Reference: Chapter 44: Agents for Treating Heart Failure - Page 764
The nurse monitors which client for an increased risk of digoxin toxicity? The client with a peripheral vascular dysfunction The client with liver dysfunction The client with an integumentary dysfunction The client with renal dysfunction
The client with renal dysfunction Explanation: The client with renal dysfunction is at an increased risk for digoxin toxicity. Reference: Chapter 44: Agents for Treating Heart Failure - Page 762
A client is admitted to the emergency department with severe heart failure. Milrinone is administered IV. For what adverse effect should the nurse assess? Thrombocytopenia Hypertension Bradycardia Lethargy
Thrombocytopenia Explanation: The most serious adverse effect associated with the administration of milrinone is the development of potentially fatal ventricular arrhythmias, which reportedly affect 12% of clients. Hypotension, supraventricular arrhythmias, chest pain, angina, headache, thrombocytopenia, and hypokalemia may also occur. Hypertension, bradycardia, and lethargy are not adverse effects of milrinone. Reference: Chapter 44: Agents for Treating Heart Failure - Page 769
A nurse assessing a client on digoxin suspects toxicity. Which visual disturbances would the nurse expect to assess? Yellow or green vision Complete loss of vision Difficulty of near vision Double vision
Yellow or green vision Explanation: The visual disturbance the nurse should assess for is yellow or green vision with a white halo. Visual disturbances occur in digoxin toxicity. Blurring of vision and borders around dark objects are the other visual disturbances. Double vision, difficulty of near vision, and complete loss of vision do not occur in digitalis toxicity. Reference: Chapter 44: Agents for Treating Heart Failure - Page 763
After teaching a group of students about conditions that can lead to heart failure, the instructor determines that additional teaching is needed when the students identify: coronary artery disease. valvular disease. renal failure. hypertension.
renal failure. Explanation: Renal failure would be least likely to contribute to the development of heart failure. Coronary artery disease, cardiomyopathy, valvular disease, and hypertension are commonly associated with heart failure. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
A nurse suspects that a client is experiencing left-sided heart failure. Which would the nurse assess? (Select all that apply.) Orthopnea Tachypnea Peripheral edema Hemoptysis Polyuria Hepatomegaly
achypnea Hemoptysis Orthopnea Polyuria Explanation: Left-sided heart failure would be indicated by tachypnea, hemoptysis, orthopnea, increased urine output (polyuria), nocturia, dyspnea, and cough. Peripheral edema and hepatomegaly suggest right-sided heart failure. Reference: Chapter 44: Agents for Treating Heart Failure - Page 759
What aspect of a client's current health status would potentially contraindicate the administration of nesiritide? blood pressure of 88/50 mm Hg irregular apical heart rate jaundice presence of +2 peripheral edema
blood pressure of 88/50 mm Hg Explanation: Nesiritide should not be administered if the systolic blood pressure is less than 90 mm Hg. The presence of jaundice, edema, or an irregular heart rate does not necessarily contraindicate the use of this drug. Reference: Chapter 44: Agents for Treating Heart Failure - Page 760
After teaching a group of students about possible hypersensitivity reactions associated with milrinone, the students demonstrate a need for additional teaching when they identify: cellulitis. vasculitis. pericarditis. ascites.
cellulitis. Explanation: Cellulitis is not an associated hypersensitivity reaction that occurs with milrinone. Reference: Chapter 44: Agents for Treating Heart Failure - Page 769
A client being treated for hypokalemia has a medication history that includes propranolol, digoxin, and warfarin. When the client reports nausea, abdominal discomfort, and visual changes, the nurse suspects what as the causative factor? digitalis toxicity heart failure myocardial infarction acute renal failure
digitalis toxicity Explanation: People diagnosed with hypokalemia can develop digitalis toxicity even when digoxin levels are not considered elevated. Signs of toxicity include potentially life-threatening heart rhythm disturbances, ranging from very slow to rapid ventricular rhythms. Other side effects include nausea, vomiting, loss of appetite, abdominal discomfort, blurred vision, and mental changes. The client's level is unlikely to be considered therapeutic or untherapeutic or to have resulted from an appropriate loading dose. Reference: Chapter 44: Agents for Treating Heart Failure - Page 762
A client newly diagnosed with heart failure questions why the therapy with digoxin will begin with four doses of digoxin rather than the usual one dose, in a 24-hour period. How would the nurse respond? it helps mitigate the potential for adverse effects it rapidly brings your serum digoxin levels up to therapeutic levels it more accurately gauges the effect of digoxin on your cardiac function it helps confirm that you don't have a hypersensitivity to digoxin
it rapidly brings your serum digoxin levels up to therapeutic levels Explanation: Digitalization is the administration of a loading dose (a dose larger than the regularly prescribed daily dosage) of digoxin to reach the therapeutic index rapidly. None of the options accurately describe the reasoning behind this practice of dose loading. Reference: Chapter 44: Agents for Treating Heart Failure - Page 763
A 58-year-old man is admitted to the emergency department. A diagnosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which drug? Dopamine Captopril Furosemide Digoxin immune fab
Digoxin immune fab Explanation: Digoxin immune fab is used as the antidote to digoxin toxicity. The other drugs would not be used to treat digoxin toxicity. The patient could be taking furosemide as part of the drug regimen for heart failure. Reference: Chapter 44: Agents for Treating Heart Failure - Page 764
A client with heart failure has been started on a milrinone infusion. Which assessment findings would lead the nurse to believe the milrinone is effective? Tachycardia Hyperkalemia Diuresis Arrhythmias
Diuresis Explanation: Heart failure occurs when the heart is unable to effectively pump enough blood to meet the needs of the body. Diuresis would indicate that kidney function has improved. Hypokalemia would be an adverse reaction related to diuresis that could lead to arrhythmias. Milrinone should also slow the heart rate. Reference: Chapter 44: Agents for Treating Heart Failure - Page 768 Add a Note
Which symptoms would most likely be present in a client with left ventricular dysfunction? (Select all that apply.) Dyspnea Moist cough Neck vein distention Restlessness Peripheral edema
Dyspnea Moist cough Restlessness Explanation: The symptoms of left ventricular dysfunction include dyspnea, moist cough, production of frothy, pink sputum, orthopnea, restlessness, and anxiety. Reference: Chapter 44: Agents for Treating Heart Failure - Page 759
A client admitted with digitalis toxicity has taking the same dose for more than 10 years. What question should the nurse ask to assess for the possible cause of the increased serum level of the medication? "Do you take regular doses of antacids?" "Have you been feeling dizzy lately?" "Has it felt like your heart skips a beat?" "Do you think your heart beats too rapidly?"
"Do you take regular doses of antacids?" Explanation: Decreased absorption of digoxin can result in digoxin toxicity or digitalis toxicity. Factors that decrease the absorption of digoxin include the presence of food in the GI tract, malabsorption syndromes, and the concurrent administration of antacids or cholestyramine. The administration of digoxin should take place at least 1 hour before the administration of an antacid. An accumulation of digitalis in the body can lead to nausea, vomiting, visual disturbances, atrial or ventricular tachyarrhythmias, ventricular fibrillation, sinoatrial block, and AV block. Reference: Chapter 44: Agents for Treating Heart Failure - Page 764
A client admitted with digitalis toxicity has taking the same dose for more than 10 years. What question should the nurse ask to assess for the possible cause of the increased serum level of the medication? "Have you been feeling dizzy lately?" "Do you take regular doses of antacids?" "Has it felt like your heart skips a beat?" "Do you think your heart beats too rapidly?"
"Do you take regular doses of antacids?" Explanation: Decreased absorption of digoxin can result in digoxin toxicity or digitalis toxicity. Factors that decrease the absorption of digoxin include the presence of food in the GI tract, malabsorption syndromes, and the concurrent administration of antacids or cholestyramine. The administration of digoxin should take place at least 1 hour before the administration of an antacid. An accumulation of digitalis in the body can lead to nausea, vomiting, visual disturbances, atrial or ventricular tachyarrhythmias, ventricular fibrillation, sinoatrial block, and AV block. Reference: Chapter 44: Agents for Treating Heart Failure - Page 764
The nurse is providing education to a client who has been prescribed digoxin for symptomatic heart failure. What teaching point would the nurse convey to this client? "Plan to take your digoxin on an empty stomach to make sure it's fully absorbed." "Make sure to take your pulse for a minute before taking your digoxin." "Try to limit the number of high-potassium foods in your diet." "If the swelling in your feet gets worse, you can take up twice your normal dose for 1 day."
"Make sure to take your pulse for a minute before taking your digoxin." Explanation: Clients should measure their heart rate for a full minute before taking a dose of digoxin. The drug can be taken with food, and potassium intake should be increased, not decreased. The client's daily dose of digoxin should never be increased in response to short-term changes in symptoms. Reference: Chapter 44: Agents for Treating Heart Failure - Page 765
male client who is prescribed digoxin asks the nurse how he should take the drug. Which instruction would be most appropriate? "Take the drug after eating your breakfast." "Eat a small snack just before taking the drug." "Take the drug on an empty stomach at the same time each day." "Take the medicine with an antacid at any time of the day."
"Take the drug on an empty stomach at the same time each day." Explanation: Food and antacids interfere with the absorption of the drug. Digoxin should be taken on an empty stomach at approximately the same time each day. If the client takes an antacid, the client should separate the dose of antacid and digoxin by 2 to 4 hours. Reference: Chapter 44: Agents for Treating Heart Failure - Page 765
A 70-year-old woman has experienced peripheral edema and decreasing stamina in recent months and has sought care from her primary care provider. The patient's subsequent diagnostic workup has resulted in a diagnosis of chronic heart failure. The woman has been prescribed digoxin and the nurse has begun patient education. What should the nurse teach the patient about her new medication? "This drug won't cure your disease, but it will help you be able to exercise more and be more comfortable." "Most patients see their heart failure resolve in 2 to 4 months after they begin taking digoxin." "By reducing the amount of fluid that your body contains, digoxin will make it easier for your heart to pump." "This will lessen the workload of your heart by reducing your blood pressure."
"This drug won't cure your disease, but it will help you be able to exercise more and be more comfortable." Explanation: Digoxin is used to maintain clinical stability and improve symptoms, quality of life, and exercise tolerance in patients with all phases of CHF; it does not decrease mortality from CHF or cure the disease. Digoxin increases urine production but its therapeutic effect is not primarily gained from diuresis or blood pressure reduction. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
What is the total dose range of digoxin for rapid digitalization? 0.75 to 1.5 mg 2.0 to 2.5 mg 0.125 to 0.05 mg 3.75 to 4 mg
0.75 to 1.5 mg Explanation: Digitalization may be accomplished rapidly by giving a total dose of 0.75 to 1.5 mg of digoxin in divided doses. A digoxin dose range of 2.0 to 4.0 mg is too large. A digoxin dose range of 0.125 to 0.5 mg is too small. Reference: Chapter 44: Agents for Treating Heart Failure - Page 762
A nurse obtains the serum digoxin level and immediately reports a level greater than which value? 1.0 ng/mL. 0.1 ng/mL. 0.5 ng/mL. 2.0 ng/mL.
2.0 ng/mL. Explanation: A nurse must immediately report serum digoxin levels greater than 2.0 ng/mL. Therapeutic drug levels are between 0.8 and 2 ng/mL. Reference: Chapter 44: Agents for Treating Heart Failure - Page 768
A nurse caring for a patient with atrial fibrillation who is started on digitalis is required to monitor plasma digitalis levels in the patient's blood. Which plasma level of digitalis indicates that the nurse should report to the practitioner? 2.2 ng/ml 1.8 ng/ml 2 ng/ml 1.6 nanograms (ng)/ml
2.2 ng/ml Explanation: A plasma digitalis level of more than 2 ng/ml would require the nurse to report to the practitioner; therefore plasma digitalis levels of 2.2 ng/ml indicate digitalis toxicity. In such circumstances, the nurses should immediately report to the practitioner. The therapeutic levels of plasma digitalis are 0.5 to 2 ng/ml. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
client experiences nausea and visual disturbances when taking digoxin (Lanoxin). The nurse would anticipate the client's digitalis level to be: 1.3 nanograms/mL 1.7 nanograms/mL 0.2 nanograms/mL 2.7 nanograms/mL
2.7 nanograms/mL Explanation: Therapeutic drug levels of digoxin are between 0.8 and 2 nanograms/ mL. Plasma digoxin levels greater than 2 nanograms/mL are considered toxic and the client may experience signs and symptoms of toxicity. Reference: Chapter 44: Agents for Treating Heart Failure - Page 766
A patient is being administered digoxin (Lanoxin) for treatment of heart failure. At what level should the serum potassium level be maintained? 1.5-2.0 mEq/L 6.0-8.0 mEq/L 8.5-10 mEq/L 3.5-5.0 mEq/L
3.5-5.0 mEq/L Explanation: Electrolyte imbalance must be monitored during digoxin therapy, and the potassium level should be maintained at 3.5-5.0 mEq/L. A potassium level of 1.5-2.0 mEq/L is too low. Potassium levels of 6.0-80 and 8.5-10 mEq/L are too high. Reference: Chapter 44: Agents for Treating Heart Failure - Page 763
A patient is being administered digoxin (Lanoxin) for treatment of heart failure. At what level should the serum potassium level be maintained? 6.0-8.0 mEq/L 3.5-5.0 mEq/L 1.5-2.0 mEq/L 8.5-10 mEq/L
3.5-5.0 mEq/L Explanation: Electrolyte imbalance must be monitored during digoxin therapy, and the potassium level should be maintained at 3.5-5.0 mEq/L. A potassium level of 1.5-2.0 mEq/L is too low. Potassium levels of 6.0-80 and 8.5-10 mEq/L are too high. Reference: Chapter 44: Agents for Treating Heart Failure - Page 763
A client reports seeing halos around lights. The client takes digoxin by mouth every day. The health care provider orders the client to have serum digoxin level drawn. Which of the digoxin levels indicate the client is experiencing toxicity? 2.0 ng/mL 1.0 ng/mL 4.0 ng/mL 0.5 ng/mL
4.0 ng/mL Explanation: Therapeutic serum levels of digoxin are 0.8 to 2 ng/mL. Levels above that would indicate toxicity, and those below would not yet be therapeutic. Reference: Chapter 44: Agents for Treating Heart Failure - Page 767
A nurse is administering digoxin intravenously as ordered. The nurse would administer the drug over which time frame? 4 minutes 2 minutes 5 minutes 3 minutes
5 minutes Explanation: Intravenous digoxin must be administered slowly over at least 5 minutes to prevent cardiac arrhythmias and adverse effects. Reference: Chapter 44: Agents for Treating Heart Failure - Page 767
The nurse recognizes which medications may be the cause of a digoxin level of 2.7 nanograms/mL? Cholestyramine Antacids Amiodarone Methotrexate
Amiodarone Explanation: When combined with digoxin, amiodarone can cause increased serum digitalis levels leading to toxicity. Methotrexate, cholestyramine, and antacids all may cause decreased serum digitalis levels. Reference: Chapter 44: Agents for Treating Heart Failure - Page 764
A female client presents to the emergency department with nausea, vomiting, and a heart rate of 45 beats per minute. Her husband states that she takes digoxin, Lasix, and nitroglycerin for chest pain. Laboratory results confirm digoxin toxicity. The nurse would expect the health care provider to order what medication to treat the bradycardia? Nesiritide Nitroglycerin Nifedipine Atropine
Atropine Explanation: Atropine or isoproterenol, used in the management of bradycardia or conduction defects, may be administered to clients with digoxin toxicity. Reference: Chapter 44: Agents for Treating Heart Failure - Page 767
A female client is prescribed a cardiac glycoside for the treatment of atrial fibrillation. She tells the nurse that she is concerned about her weight and wants to try this new weight loss program she read about on the Internet. What should a nurse advise her about using cardiac glycosides? Include balanced levels of fats and carbohydrates in her diet. Avoid heavy exercise for 5 hours after taking the drug. Follow a protein-rich diet. Avoid most over-the-counter drugs.
Avoid most over-the-counter drugs. Explanation: It is important for the nurse to advise the patient to avoid over-the-counter antacids and cough, cold, allergy, and diet drugs, except on the advice of the prescriber, because these drugs frequently contain antihistamines that may interact with cardiac glycosides. Ensuring that the diet is rich in proteins, fat, or carbohydrates and heavy exercise do not have an impact on the effects of cardiac glycosides. Reference: Chapter 44: Agents for Treating Heart Failure - Page 766
The nurse is scheduled to administer the following medications at 0900: furosemide, carvedilol, and ivabradine. The morning laboratory values are: sodium 135 mEq/L; potassium 3.2 mEq/L; calcium 9 mg/dl (9 to 11 mg/dl). Which is the nurse's priority in this situation? Call the primary care provider for further orders. Administer the ordered medications per policy. Perform the morning assessment and chart findings. Teach the client about the current medications.
Call the primary care provider for further orders. Explanation: The priority in the situation is to call the primary care provider (PCP) and report the abnormal lab, hypokalemia, 3.2 mEq/L (K+ 3.5 - 5.1 mEq/L) and receive further orders for potassium supplement since the client is taking furosemide, a loop diuretic that depletes potassium. When the potassium is low, it can lead to cardiotonic toxicity, and the client is taking ivabradine. The pharmacy may receive the order and fill it while the nurse assesses the client and charts the findings. The nurse receives the potassium supplement from pharmacy and may administer it with the rest of the medications following the policy for safe administration of meds. The potassium needs to be administered with the medications to keep from further decreasing the potassium level. The nurse could begin teaching about the medications during the administration process, instructing the client about the name of the med, the action, and adverse reactions to report to the PCP. Reference: Chapter 44: Agents for Treating Heart Failure - Page 766
The nurse is scheduled to administer the following medications at 0900: furosemide, carvedilol, and ivabradine. The morning laboratory values are: sodium 135 mEq/L; potassium 3.2 mEq/L; calcium 9 mg/dl (9 to 11 mg/dl). Which is the nurse's priority in this situation? Teach the client about the current medications. Perform the morning assessment and chart findings. Call the primary care provider for further orders. Administer the ordered medications per policy.
Call the primary care provider for further orders. Explanation: The priority in the situation is to call the primary care provider (PCP) and report the abnormal lab, hypokalemia, 3.2 mEq/L (K+ 3.5 - 5.1 mEq/L) and receive further orders for potassium supplement since the client is taking furosemide, a loop diuretic that depletes potassium. When the potassium is low, it can lead to cardiotonic toxicity, and the client is taking ivabradine. The pharmacy may receive the order and fill it while the nurse assesses the client and charts the findings. The nurse receives the potassium supplement from pharmacy and may administer it with the rest of the medications following the policy for safe administration of meds. The potassium needs to be administered with the medications to keep from further decreasing the potassium level. The nurse could begin teaching about the medications during the administration process, instructing the client about the name of the med, the action, and adverse reactions to report to the PCP. Reference: Chapter 44: Agents for Treating Heart Failure - Page 766
A patient is prescribed a cardiotonic medication. Which pre-administration assessment should the nurse perform on this patient? Check for jugular vein distention. Obtain blood glucose levels. Inspect skin for rash. Inspect joints for swelling.
Check for jugular vein distention. Explanation: The nurse should check for jugular vein distention as part of the pre-administration assessment for the patient prescribed a cardiotonic. The nurse need not inspect joints for swelling, inspect skin for rash, or obtain blood glucose levels as these interventions will not provide necessary information with regard to administration of a cardiotonic. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
A patient is prescribed a cardiotonic medication. Which pre-administration assessment should the nurse perform on this patient? Inspect skin for rash. Obtain blood glucose levels. Inspect joints for swelling. Check for jugular vein distention.
Check for jugular vein distention. Explanation: The nurse should check for jugular vein distention as part of the pre-administration assessment for the patient prescribed a cardiotonic. The nurse need not inspect joints for swelling, inspect skin for rash, or obtain blood glucose levels as these interventions will not provide necessary information with regard to administration of a cardiotonic. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
After teaching a class of students about heart failure and drug therapy, the instructor determines that the teaching has been successful when the students identify which drug as most often used as treatment? Furosemide Human B-type natriuretic peptide Digoxin Nitrate
Digoxin Explanation: Digoxin is the drug most often used to treat heart failure. Human B-type natriuretic peptide, nitrate, or furosemide also may be used, but these drugs are not the ones most commonly used. Reference: Chapter 44: Agents for Treating Heart Failure - Page 766
A client is being treated for heart failure. What assessment finding would the nurse interpret as most indicative of improved health status? Increased skin turgor Decreased pitting edema Improved sensorium Heart rate of 52
Decreased pitting edema Explanation: A decrease in pitting edema is an indication of diminished fluid volume, which is indicative of an improved blood supply to the body tissues. Increased skin turgor may represent an increase in fluid volume. A heart rate of 52 is too slow to provide good contractility. Improved sensorium indicates adequate perfusion but is not the most indicative of improved heart failure status. Reference: Chapter 44: Agents for Treating Heart Failure - Page 765
Administration of a cardiotonic drug is contraindicated in which conditions? (Select all that apply.) Hypertension Cardiac tamponade Hypotension Digitalis toxicity Ventricular tachycardia
Digitalis toxicity Cardiac tamponade Ventricular tachycardia Explanation: The cardiotonics are contraindicated in the presence of digitalis toxicity, clients with known drug hypersensitivity, ventricular tachycardia, cardiac tamponade, restrictive cardiomyopathy, or AV block. Reference: Chapter 44: Agents for Treating Heart Failure - Page 762
A nurse is planning an in-service program for a group of staff nurses about heart failure and its treatment. The nurse would identify which agent as the most commonly used drug for treatment? Human B type natriuretic peptide ACE inhibitors Digoxin Hydrochlorothiazide
Digoxin Explanation: Digoxin is the drug most often used to treat heart failure. Human B-type natriuretic peptide, ACE inhibitors, or hydrochlorothiazide also may be used, but these drugs are not the most common ones used. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
The nurse is assessing the client for left-sided heart failure. Which symptom would the nurse identify as left-sided failure? (Select all that apply.) Tachycardia Dyspnea Neck vein distention Hepatic engorgement Cough
Dyspnea Tachycardia Cough Explanation: Left-sided heart failure symptoms include a cough, tachycardia, and dyspnea. Right-sided heart failure symptoms include hepatic engorgement, peripheral edema, and neck vein distention. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
Splenomegaly occurs with left-sided heart failure. True False
False Explanation: Splenomegaly occurs with right-sided heart failure. Reference: Chapter 44: Agents for Treating Heart Failure - Page 759
The nurse is teaching a female patient about newly prescribed digoxin. The patient tells the nurse that she occasionally uses herbal therapies. The nurse should caution the patient against using therapies that involve which herbs? Black cohosh Ginseng Saw palmetto Valerian
Ginseng Explanation: Patients taking digoxin should avoid licorice, ginseng, or hawthorn because concomitant use of those products can increase drug effects or cause toxicity. In general, patients taking any medication should discuss all herbal remedies with a health care provider to assess for potential interactions. Reference: Chapter 44: Agents for Treating Heart Failure - Page 764
The client has crackles in the lower lobes of the lungs, an audible S3, and pitting edema in the feet and ankles. What condition is the client most likely experiencing? Myocardial infarction Heart failure Pneumonia Liver disease
Heart failure Explanation: The cardinal manifestations of heart failure are dyspnea and fatigue, which can lead to exercise intolerance and fluid retention. Fluid retention results in the development of pulmonary congestion and peripheral edema. An audible S3 is often present. The client is not presenting with myocardial infarction symptoms since there is no mention of chest pain. Neither pneumonia nor liver failure would present with the audible S3 sound. Reference: Chapter 44: Agents for Treating Heart Failure - Page 757
A male client takes his pulse rate before taking his regular daily dose of digoxin and finds his pulse to be 52 beats/min. Which would the client do next? Hold the dose and retake the pulse in 1 hour. Go to the nearest emergency care facility for evaluation. Take the drug as ordered and note the pulse rate in a log. Withhold the drug and call the doctor immediately.
Hold the dose and retake the pulse in 1 hour. Explanation: If the pulse rate is below 60 beats/minute, the client should hold the dose and recheck his pulse in 1 hour. Then, if the pulse is still low, he make a note of it, withhold the drug, and notify the prescriber. The prescriber can then determine the next action. Reference: Chapter 44: Agents for Treating Heart Failure - Page 767
A client is admitted to the intensive care unit with an electrolyte imbalance. Which imbalance will contraindicate the administration of digoxin? Hyperkalemia Hypermagnesemia Hypokalemia Hypocalcemia
Hypokalemia Explanation: Digoxin is contraindicated in clients with hypokalemia. Digoxin is not contraindicated in clients with hyperkalemia, hypermagnesemia, or hypocalcemia because its effect would not increase the risk of arrhythmias. Reference: Chapter 44: Agents for Treating Heart Failure - Page 762-763
A nurse is monitoring a patient who is prescribed milrinone for heart failure. Which sign in the patient indicates that the nurse should withhold the drug? Cyanosis Edema Hypotension Bradycardia
Hypotension Explanation: When caring for patients taking milrinone, the development of hypotension would necessitate the nurse withholding the drug and notify the practitioner. Hypotension occurs as an adverse effect of milrinone. Edema and cyanosis need to be assessed by the nurse as part of the pre-administration assessment. Edema, bradycardia, and cyanosis are not adverse effects associated with milrinone. Reference: Chapter 44: Agents for Treating Heart Failure - Page 769
What does the use of cardiotonics lead to? (Select all that apply.) Increase in blood pressure Increased myocardial efficiency Improved perfusion to all body tissues Increase in peripheral edema Improved myocardial contractility
Improved myocardial contractility Increased myocardial efficiency Improved perfusion to all body tissues Explanation: Cardiotonics are drugs used to increase the efficiency and improve the contraction of the heart muscle, which leads to improved blood flow (perfusion) to all tissues of the body. Reference: Chapter 44: Agents for Treating Heart Failure - Page 759
A client takes digoxin and furosemide (Lasix) for peripheral edema resulting from heart failure. Hypokalemia, caused by furosemide, has what effect on digoxin? Increased action of digoxin Increased sodium retention Decreased action of digoxin Decreased sodium retention
Increased action of digoxin Explanation: Hypokalemia makes the heart muscle more sensitive to digitalis, thereby increasing the possibility of developing digitalis toxicity. There is no effect on sodium levels. Reference: Chapter 44: Agents for Treating Heart Failure - Page 769
An instructor is describing positive inotropic activity. Which would the instructor include as a result of this activity? Increased conduction velocity Increased preload Increased cardiac output Decreased heart rate
Increased cardiac output Explanation: Positive inotropes increase cardiac output. Decreased heart rate is a negative chronotropic effect. Increased preload is a result of increased venous tone and circulating volume. Changes in conduction velocity are chronotropic effects, not inotropic. Reference: Chapter 44: Agents for Treating Heart Failure - Page 758
An instructor is describing positive inotropic activity. Which would the instructor include as a result of this activity? Increased preload Increased cardiac output Increased conduction velocity Decreased heart rate
Increased cardiac output Explanation: Positive inotropes increase cardiac output. Decreased heart rate is a negative chronotropic effect. Increased preload is a result of increased venous tone and circulating volume. Changes in conduction velocity are chronotropic effects, not inotropic. Reference: Chapter 44: Agents for Treating Heart Failure - Page 758
Which would be considered a therapeutic effect of digoxin? Decreased renal perfusion Decreased cardiac output Increased heart rate Increased force of contraction
Increased force of contraction Explanation: Digoxin increases the force of myocardial contraction, increases cardiac output and renal perfusion, and slows the heart rate. Reference: Chapter 44: Agents for Treating Heart Failure - Page 766
The nurse explains to the client that with heart failure, what may occur? Diarrhea Visual disturbances Increased heart rate Decreased heart rate
Increased heart rate Explanation: Tachycardia is a symptom related to heart failure. Bradycardia, diarrhea, and visual disturbances are signs of digitalis toxicity. Reference: Chapter 44: Agents for Treating Heart Failure - Page 758
A client asks the nurse about how his prescribed digoxin helps his heart. The nurse would include which response? Select all that apply. Increases force of contraction Decreases heart rate Slows the conduction velocity through the atrioventricular (AV) node Decreases cardiac output Increases heart rate
Increases force of contraction Slows the conduction velocity through the atrioventricular (AV) node Decreases heart rate Explanation: Digoxin exerts the following effects on the heart: increases cardiac output via increased force of contraction, slows the conduction velocity through the AV node, and decreases heart rate. Reference: Chapter 44: Agents for Treating Heart Failure - Page 766
A nurse has poured a hospital client's scheduled dose of hydrochlorothiazide (HCTZ). The nurse should know that this drug reduces preload by which means? Increasing renal excretion of sodium and water Increasing the contractility of myocardial fibers Exerting a direct relaxant effect on the vascular smooth muscle Stimulating the SA node to fire more frequently
Increasing renal excretion of sodium and water Explanation: Hydrochlorothiazide inhibits the reabsorption of sodium and chloride in the distal renal tubule, increasing the excretion of sodium and water by the kidneys. Thiazide diuretics do not relax smooth muscle, increase contractility, or stimulate the SA node.
A nurse is preparing to administer inamrinone. The nurse would administer this drug mostlikely by which route? Intramuscular Oral Subcutaneous Intravenous
Intravenous Explanation: Inamrinone is administered only by the intravenous route. Reference: Karch, A.M. Focus on Nursing Pharmacology, 7th ed., Philadelphia: Wolters Kluwer Health, 2017, Chapter 44: Cardiotonic Agents, p.
A nurse is preparing to administer inamrinone. The nurse would administer this drug mostlikely by which route? Oral Subcutaneous Intramuscular Intravenous
Intravenous Explanation: Inamrinone is administered only by the intravenous route. Reference: Karch, A.M. Focus on Nursing Pharmacology, 7th ed., Philadelphia: Wolters Kluwer Health, 2017, Chapter 44: Cardiotonic Agents, p.
The nurse is caring for a patient receiving cardiotonic drugs. The patient has edema. Which intervention should be taken to alleviate edema? Auscultation of the lungs Measurement of intake and output Observation of respiratory rate Observation of pulse rate
Measurement of intake and output Explanation: Measurement of intake and output is a nursing intervention related to the edema in the patient receiving cardiotonic drugs. Auscultation of the lungs, observation of respiratory rate, and observation of pulse rate are interventions not related to edema in the patient. Reference: Chapter 44: Agents for Treating Heart Failure - Page 764
Ali Kashif, a recent immigrant, is admitted for continued treatment of CHF. During the assessment, he reveals that he has been using drugs containing amrinone because he did not respond positively to treatment with digoxin, diuretics, and vasodilators. Is there a cause for concern in this case? Yes; the drug may interfere with the new therapy planned for the patient. Yes; the drug may cause unknown adverse effects. Yes; the drug is not a preferred drug in the United States. No; amrinone is the International Nonproprietary Name (INN) of inamrinone.
No; amrinone is the International Nonproprietary Name (INN) of inamrinone. Explanation: There is no cause for concern because amrinone is the same as inamrinone (Inocor). The name was officially changed to inamrinone in the United States by the US Pharmacopeia (USP) and the United States Adopted Names Council in July 2000 because of several drug errors that occurred when the drug was confused with a similar-sounding drug, amiodarone, which is an antiarrhythmic. However, this name change has not been adopted internationally, so patients acquiring this drug from other countries may still receive it under the name of amrinone. Reference: Karch, A.M. Focus on Nursing Pharmacology, 7th ed., Philadelphia: Wolters Kluwer Health, 2017, Chapter 44: Cardiotonic Agents, p.
A nurse is caring for a 66-year-old female client who is receiving digoxin. When preparing to administer a dose, the nurse observes that the client's apical pulse rate is 55 bpm. What is the appropriate action to take? Omit the dose and inform the oncoming nurse at the next shift change. Give the dose and contact the health care provider. Omit the dose and contact the health care provider. Reduce the dose and contact the health care provider.
Omit the dose and contact the health care provider. Explanation: Bradycardia is a potential adverse effect of digoxin. Nurses should assess the client's apical pulse before each dose. If the rate is lower than 60 bpm in an adult client, the nurse should omit the dose and notify the provider. Reference: Chapter 44: Agents for Treating Heart Failure - Page 767
When dosing digoxin (Lanoxin), which factors are considered? (Select all that apply.) Patient age Renal function Pharmacodynamics Patient lean body weight Pharmacokinetics
Patient lean body weight Patient age Renal function Pharmacokinetics Pharmacodynamics Explanation: All of the answers are factors to consider when dosing digoxin (Lanoxin). Reference: Chapter 44: Agents for Treating Heart Failure - Page 765
After reviewing the signs and symptoms of heart failure, a student demonstrates understanding when the student identifies which finding as associated with right sided heart failure? Dyspnea Peripheral edema Hemoptysis Polyuria
Peripheral edema Explanation: Peripheral edema would be associated with right-sided heart failure. Hemoptysis, dyspnea, and polyuria would be associated with left-sided heart failure. Reference: Chapter 44: Agents for Treating Heart Failure - Page 757
After reviewing the signs and symptoms of heart failure, a student demonstrates understanding when the student identifies which finding as associated with right sided heart failure? Dyspnea Polyuria Peripheral edema Hemoptysis
Peripheral edema Explanation: Peripheral edema would be associated with right-sided heart failure. Hemoptysis, dyspnea, and polyuria would be associated with left-sided heart failure. Reference: Chapter 44: Agents for Treating Heart Failure - Page 757
Which symptoms would most likely be present in a client with right-sided heart failure? Select all that apply. Neck vein distention Peripheral edema Nocturia Weight loss Orthopnea
Peripheral edema Neck vein distention Nocturia Explanation: The symptoms of right ventricular dysfunction or right-sided heart failure include peripheral edema, neck vein distention, hepatic engorgement, weight gain, nausea, weakness, anorexia, and nocturia. Orthopnea and weight loss are not symptoms of right-sided heart failure. Reference: Chapter 44: Agents for Treating Heart Failure - Page 760
A nurse is required to monitor a client for right ventricular dysfunction. Which would the nurse most commonly assess? Dyspnea Orthopnea Hacking cough Pitting edema
Pitting edema Explanation: One of the most common symptoms associated with right ventricular dysfunction is pitting edema. The other symptoms of right ventricular dysfunction are nocturia, anorexia, weight gain, and weakness. Dyspnea, orthopnea, and hacking cough are the symptoms associated with left ventricular dysfunction, and not right ventricular dysfunction. Reference: Chapter 44: Agents for Treating Heart Failure - Page 760
A nurse is required to monitor a client for right ventricular dysfunction. Which would the nurse most commonly assess? Orthopnea Pitting edema Hacking cough Dyspnea
Pitting edema Explanation: One of the most common symptoms associated with right ventricular dysfunction is pitting edema. The other symptoms of right ventricular dysfunction are nocturia, anorexia, weight gain, and weakness. Dyspnea, orthopnea, and hacking cough are the symptoms associated with left ventricular dysfunction, and not right ventricular dysfunction. Reference: Chapter 44: Agents for Treating Heart Failure - Page 760
A client is receiving inamrinone. Which would be most important for the nurse to monitor? White blood cell count Pulmonary function studies Platelet count Renal function studies
Platelet count Explanation: Although renal function studies may be appropriate to monitor and evaluate the need for possible dosage changes, inamrinone is associated with thrombocytopenia. Therefore, it would be most important for the nurse to monitor the client's platelet count. Inamrinone is not associated with changes in pulmonary function or white blood cell counts. Reference: Chapter 44: Agents for Treating Heart Failure - Page 770
The pharmacology instructor is describing medications that increase the contractile force of the heart. Which term describes this effect? Negative dromotropic Positive chronotropic Positive inotropic Negative inotropic
Positive inotropic Explanation: A positive inotropic effect improves the contractility and pumping ability of the heart. Reference: Chapter 44: Agents for Treating Heart Failure - Page 758
A client has been prescribed spironolactone therapy for the treatment of heart failure. What treatment goal related to the medication will the nurse include in the care plan? The client will not require inotropes or beta-blockers. The client will exhibit increased serum potassium levels. The client will experience a decrease in edema. The client will resume prediagnosis levels of stamina.
The client will experience a decrease in edema. Explanation: Spironolactone is used to decrease edema in clients with heart failure. The goal is not to negate the need for other medications, as spironolactone is part of combination therapy. Prediagnosis levels of stamina are not normally achieved, and increased electrolyte levels are not an identified goal. Reference: Chapter 44: Agents for Treating Heart Failure - Page 760
The nurse monitors which client for an increased risk of digoxin toxicity? The client with liver dysfunction The client with a peripheral vascular dysfunction The client with an integumentary dysfunction The client with renal dysfunction
The client with renal dysfunction Explanation: The client with renal dysfunction is at an increased risk for digoxin toxicity. Reference: Chapter 44: Agents for Treating Heart Failure - Page 762
A client has an elevated BUN. The client has been prescribed digoxin for heart failure. What aspect of care is the priority regarding this client? The dose should be increased when the heart rate is below 60. The dose should be decreased in this client. The dosage should be 1.0 mg per mouth daily. The client should be taught to increase sodium in the diet.
The dose should be decreased in this client. Explanation: The dose must be reduced in the presence of renal failure because most of the digoxin is excreted unchanged by the kidneys, leading to drug accumulation and toxicity. The client should be taught to limit sodium intake in the diet. The client's heart rate should remain above 60. If the heart rate falls below 60, the digoxin should be held. The dose of 1.0 mg is too large for a client with altered renal function. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
Mrs. Houston is a 78-year-old woman who resides in an assisted living facility. Her provider prescribed digoxin at her last visit to the clinic and she has approached the nurse about this new drug. What teaching point should the nurse emphasize to Mrs. Houston? The importance of having required laboratory work performed on time Timing household activities to coincide with the administration times of her digoxin The correct technique for using a home blood pressure cuff The need to take the medication at the same time each day regardless of her heart rate
The importance of having required laboratory work performed on time Explanation: Clients taking digoxin need to know the importance of having all laboratory work (serum drug levels; electrolytes) performed on time. Digoxin is not taken if the client is bradycardic, and it does not provide an immediate or short-term increase in exercise tolerance. Blood pressure monitoring is not normally required for clients who are taking digoxin. Reference: Chapter 44: Agents for Treating Heart Failure - Page 767
A triage nurse in the emergency department suspects that a 78-year-old patient is experiencing severe digoxin toxicity with significant cardiac arrhythmia. If the nurse is correct, which action is likely to be taken? The patient will be given digoxin immune fab. The patient's digoxin dosage will be reduced. The patient will be given sodium chloride. The patient will be monitored to see if symptoms resolve without action.
The patient will be given digoxin immune fab. Explanation: Digoxin is stopped, not merely reduced, in patients experiencing toxicity. If digoxin toxicity is accompanied by serious arrhythmias, several drugs may be used, including potassium chloride (if serum potassium is low) and digoxin immune fab (if toxicity is serious). Reference: Chapter 44: Agents for Treating Heart Failure - Page 764
A group of nursing students are reviewing cardiotonic drugs. The students demonstrate understanding of the information when they identify which adverse reaction associated with cardiotonic medications? Diarrhea Constipation Visual disturbances Restlessness
Visual disturbances Explanation: Adverse reactions associated with cardiotonic medications include headache, weakness, drowsiness, visual disturbances, nausea, anorexia, and arrhythmias. Diarrhea, constipation, and restlessness are not adverse reactions of cardiotonic medications. Reference: Chapter 44: Agents for Treating Heart Failure - Page 766
Which is true about digoxin? The therapeutic range for digoxin is 0.5 to 2 ng/mL. Digoxin improves the quality of life for patients with heart failure in the absence of atrial fibrillation. Digoxin is used to treat paroxysmal atrial fibrillation. Digoxin decreases the mortality associated with heart failure.
The therapeutic range for digoxin is 0.5 to 2 ng/mL. Explanation: The therapeutic range for digoxin is generally considered to be 0.5 to 2 ng/mL. (A lower range of 0.5 to 0.8 ng/mL has been suggested to minimize adverse effects without sacrificing efficacy.) Digoxin has been shown to improve symptoms, increase the quality of life, and increase the exercise tolerance of patients with CHF. These benefits occur regardless of the underlying heart rhythm (normal sinus or atrial fibrillation), the etiology of the heart failure, or other drugs used in therapy (e.g., ACE inhibitors, beta-blockers). Digoxin does not decrease mortality from heart failure. Digoxin is also used in treating chronic atrial fibrillation to maintain a satisfactory resting ventricular rate; it is no longer recommended to prevent paroxysmal (recurrent episodes of) atrial fibrillation. Reference: Chapter 44: Agents for Treating Heart Failure - Page 767
A client is admitted to the emergency department with severe heart failure. Milrinone is administered IV. For what adverse effect should the nurse assess? Hypertension Lethargy Thrombocytopenia Bradycardia
Thrombocytopenia Explanation: The most serious adverse effect associated with the administration of milrinone is the development of potentially fatal ventricular arrhythmias, which reportedly affect 12% of clients. Hypotension, supraventricular arrhythmias, chest pain, angina, headache, thrombocytopenia, and hypokalemia may also occur. Hypertension, bradycardia, and lethargy are not adverse effects of milrinone. Reference: Chapter 44: Agents for Treating Heart Failure - Page 769
Vasodilators used to treat heart failure include nitrates and ACE inhibitors. False True
True Explanation: Drug therapies used to treat heart failure include vasodilators, such as angiotensin-converting enzyme (ACE) inhibitors and nitrates, which decrease cardiac workload, relax vascular smooth muscle to decrease afterload, and allow pooling in the veins, thereby decreasing preload of the heart and helping to improve function. Reference: Chapter 44: Agents for Treating Heart Failure - Page 760
Heart failure was once called dropsy. True False
True Explanation: HF, a condition that was once called "dropsy" or decompensation, is a syndrome that usually involves dysfunction of the cardiac muscle, of which the sarcomere is the basic unit. Reference: Chapter 44: Agents for Treating Heart Failure - Page 757
Which classes of medications are currently used as first-line treatments for heart failure? Select all that apply. angiotensin II receptor blockers (ARBS) angiotensin-converting enzyme inhibitors (ACEIS) beta blockers cardiotonics loop diuretics
angiotensin-converting enzyme inhibitors (ACEIS) beta blockers loop diuretics Explanation: ACEIs, beta blockers, and loop diuretics are currently first-line treatments for heart failure. Cardiotonic drugs are used to treat heart failure if other treatments fail to improve client status and to treat atrial fibrillation. Angiotensin II receptor blockers (ARBs) decrease blood pressure, thus decreasing the workload of the heart. Reference: Chapter 44: Agents for Treating Heart Failure - Page 761
A client is receiving digoxin and experiences severe bradycardia. Which medication would the nurse anticipate administering if prescribed? activated charcoal milrinone (Primacor) atropine propafenone
atropine Explanation: If severe bradycardia occurs, atropine may be ordered. Milrinone is a miscellaneous inotropic drug used to treat heart failure. Activated charcoal is an antidote for poisoning with certain toxic substances, but not digoxin. It also decreases serum digitalis levels. Propafenone increases serum digitalis levels and would not be used. Reference: Chapter 44: Agents for Treating Heart Failure - Page 767
A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient's heart rate, the nurse should prioritize assessment of the patient's exercise tolerance. intake and output. cognition. blood pressure.
blood pressure. Explanation: Fluid balance, cognition, and exercise tolerance are all affected by CHF and should be regularly assessed as part of thorough nursing care. However, the combination of an ACE inhibitor, a beta blocker, and a diuretic constitutes a significant risk for hypotension and indicates a need for frequent blood pressure monitoring. Reference: Chapter 44: Agents for Treating Heart Failure - Page 767
A client presents to the ED with wheezing and blood-tinged sputum. The nurse suspects the client is experiencing pulmonary edema. The nurse should suspect the cause of the pulmonary edema is most likely: valvular heart disease. cardiomyopathy. right ventricular failure. left ventricular failure.
left ventricular failure. Explanation: Pulmonary edema occurs when left ventricular failure (or dysfunction) results in accumulation of blood and fluid in pulmonary veins and tissues. Reference: Chapter 44: Agents for Treating Heart Failure - Page 759
To maximize absorption of digoxin, the nurse would instruct the patient to take the drug: on an empty stomach. with an antacid. with a small glass of water. after a meal.
on an empty stomach. Explanation: Digoxin is absorbed best on an empty stomach. Reference: Chapter 44: Agents for Treating Heart Failure - Page 765
