Pharm Ch 30

A female client's drugs include a furosemide, digoxin, and hydralazine. She is unable to afford all of her medications, so she takes them intermittently to make them last longer. In addition to making a referral to social service, what should the home care nurse tell this client?

"Different types of drugs have different actions and produce different responses."

After teaching a client about a prescribed beta blocker therapy, the nurse determines that additional teaching is needed when the client relays which statement?

"I can stop the drug anytime I feel any problems."

The nurse is caring for a client recovering from an acute myocardial infarction (MI). Which client statement indicates that teaching provided about the beta-adrenergic blocking agent propranolol was effective?

"I need to change positions slowly."

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?

"Make sure to take your pulse for a minute before taking your digoxin."

The nurse identifies the therapeutic range for digoxin as:

0.8 to 2 ng/mL.

A 6-year-old child weighing 60 pounds has been prescribed Lanoxin 30 mcg/kg PO daily. How many mg will the child be given?

0.818 mg

A nurse is administering digoxin intravenously as ordered. The nurse would administer the drug over which time frame?

5 minutes

After administering an intravenous (IV) dose of digoxin to a client, the nurse would expect to see effects within what period of time?

5 to 30 minutes

A client with hypertension is prescribed clonidine. The nurse should question this order if which disorder is noted in the client's history?

Active hepatic disease

The nurse is caring for a client who has been diagnosed with heart failure and has been prescribed ivabradine 5 mg PO twice a day. Before administering the drug, the nurse's assessment reveals: temperature 97.2°F (36.2°), blood pressure 106/63 mmHg, apical heart rate 68 beats/min with regular rhythm, and respiratory rate of 21 breaths/min. What is the nurse's best action?

Administer the medication as prescribed.

In a discussion of heart failure, the nursing instructor is explaining preload and afterload. Which of the following statements regarding preload and afterload is accurate?

Afterload is related to the ejection of blood from the ventricle, and preload is related to the filling of the ventricle.

The nurse recognizes which medications may be the cause of a digoxin level of 2.7 nanograms/mL?

Amiodarone

Based on knowledge of the guidelines, which drug combination therapy has been shown to decrease mortality from CHF?

An ACE inhibitor, a beta-blocker, and a diuretic

A nurse is caring for a client who has been prescribed propranolol for angina. After administering the drug, which action would the nurse do?

Ask about relief of symptoms and record responses on the chart.

What is the most accurate method for preventing adverse effects associated with the use of digoxin?

Assess the client's heart rate and hold administration if it is less than 60.

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?

Atropine

When caring for a patient who has been digitalized for his heart failure, the nurse observes that the patient is experiencing bradycardia. Which drug should be administered to patients who develop bradycardia?

Atropine

A nurse is preparing to administer ivabradine to a client with heart failure. Which preadministration assessment should the nurse prioritize for this client?

Check for jugular vein distention.

The 96-year-old client is receiving digoxin and furosemide. In the morning, the client reports having a headache and feeling nauseated. What should the nurse do first?

Check the client's laboratory values and vital signs.

A nurse is preparing to administer a transdermal adrenergic blocker. Which medication would the nurse be preparing to administer?

Clonidine

A client has been prescribed a beta blocker. The nurse knows that beta blockers can have which effect on the heart?

Decrease the heart rate

A nurse prepares to administer atenolol to a client who has recently suffered an acute MI. The nurse anticipates the client will experience which changes related to this medication? Select all that apply.

Decrease the heart's workload Decrease heart rate

A client with Parkinson disease has been using levodopa. The client is now prescribed labetalol for hypertension. Which finding should the nurse prioritize if noted on assessment?

Decreased effect of levodopa

A client has been prescribed an adrenergic blocking drug for glaucoma. Which nursing interventions should the nurse include when teaching the client?

Demonstrate the technique of eye drop instillation.

Which would the nurse identify as a cardiac glycoside?

Digoxin

A client with a history of severe renal failure has been placed on digoxin therapy. Based upon the client's history, what changes should be made to the prescribed therapy?

Digoxin dose will need to be reduced.

A male client is diagnosed with heart failure. The health care provider orders a loading dose of digoxin. Loading doses are necessary for what reason?

Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading.

A nurse is conducting discharge teaching with a client being discharged on clonidine. The nurse would instruct the client about which reaction as a possible adverse reaction? Select all that apply

Dry mouth Sedation Anorexia

Heart failure is a condition in which the heart cannot pump enough blood to supply adequate oxygen and nutrients to the body. At the cellular level, heart failure stems from dysfunction of what cells?

Endothelial cells

A patient is being digitalized for atrial fibrillation. The first dose has been administered. How frequently should the nurse administer digoxin?

Every six to eight hours

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?

Ginseng

A 65-year-old client presents to the health care provider's office with reports of shortness of breath on exertion, edema in the ankles, and waking up in the middle of the night unable to breathe. The nurse suspects that the symptoms are indicative of which condition?

Heart failure

The nurse assesses the client for which of the following adverse reactions related to the use of digoxin?

Hypokalemia

The nursing instructor is discussing digoxin-induced arrhythmias. What risk factor would the instructor identify as increasing risk of arrhythmia in a client taking digoxin?

Hypokalemia

What are cardiac glycosides used for?

Increase the force of the contraction of the heart

An instructor is describing positive inotropic activity. Which would the instructor include as a result of this activity?

Increased cardiac output

The pharmacology instructor is discussing cardiac glycosides with a class of pre-nursing students. According to the instructor, what physiologic effect do cardiac glycosides trigger?

Increased force of heart contraction

The nursing instructor explains to students that positive inotropic action affects the heart in which way?

Increased myocardial contraction

Milrinone is a miscellaneous inotropic drug used in the short-term management of heart failure. What is the only way this drug is approved to be administered?

Intravenously

The client's digoxin level is 0.125. How does the nurse interpret this level?

Low

The nurse is to administer digoxin to a client with heart failure. The nurse auscultates an apical pulse rate of 52. What action should the nurse take?

Notify the health care provider

A client has been admitted to a health care center with reports of dyspnea. The nurse suspects left-sided heart failure based on which assessment finding?

Orthopnea

Which would a nurse expect to assess if a client is experiencing right-sided heart failure?

Peripheral edema

The pharmacology instructor is describing medications that increase the contractile force of the heart. Which term describes this effect?

Positive inotropic

You are teaching an obese client with compensated heart failure how to manage his condition with both prescribed drug therapy and nonpharmacologic measures. What modifications would you suggest that your client make to his diet?

Restrict sodium, reduce fat and calories

A male client takes natural licorice for his arthritis. The client reports being short of breath. The nurse understands that licorice blocks the effects of spironolactone by which mechanism?

Sodium retention and potassium loss

A patient with congestive heart failure has been digitalized. The patient requires long-term digoxin therapy. Which instructions should the nurse provide the patient on discharge?

Take the drug regularly without skipping a dose.

The nurse monitors which client for an increased risk of digoxin toxicity?

The client with renal dysfunction

The nurse is caring for a client who has been diagnosed with heart failure and has been prescribed ivabradine. What assessment finding would best indicate a therapeutic effect?

The client's heart rate changes from 97 to 79 beats/min during the shift.

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

A 77-year-old man's chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect?

The man's chest sounds are clear and his ankle edema is lessened.

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.

A client admitted with digitalis toxicity has been taking the same dose for more than 20 years. The family asks the nurse how someone can develop a toxic level while taking the usual dose. How would the nurse respond?

Toxicity can occur even on low-dose therapy due to various factors including advanced age

The nurse is caring for a client who is taking a nonselective adrenergic blocking agent. What assessment would be among the nurse's priorities?

assessing heart rate

When reviewing beta1-selective adrenergic blocking agents, which medication is found to be most often prescribed for clients diagnosed with hypertension?

atenolol

A client is receiving digoxin and experiences severe bradycardia. Which medication would the nurse anticipate administering if prescribed?

atropine

What is the first drug of choice for treatment of a client with a history of a myocardial infarction (MI) 2 years ago?

beta-blockers

The nurse is administering milrinone to a client with heart failure. The nurse should prioritize what assessment when monitoring the client for common adverse effects?

blood pressure

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

blood pressure.

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

A 66-year-old woman has a complex medical history that includes poorly-controlled type 1 diabetes, renal failure as a result of diabetic nephropathy and chronic heart failure (CHF). Her care provider has recently added spironolactone (Aldactone) to the woman's medication regimen. The nurse should consequently assess for signs and symptoms of

hyperkalemia.

The nurse prepares to administer a phosphodiesterase inhibitor to a client. Which route will the nurse use to administer the medication?

intravenous

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 rapidly brings your serum digoxin levels up to therapeutic levels

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:

left ventricular failure.

The nurse is caring for a client who is prescribed a nonselective adrenergic blocking agent. For which condition would labetalol be prescribed for this client?

pheochromocytoma

The nurse reviews the laboratory results of a client taking digoxin. What finding creates a risk for digoxin toxicity?

potassium 3.3 mmol/L (3.3 mEq/L)

A client presents to the emergency department with rales, wheezing, and blood-tinged sputum. The nurse should select interventions to address what health problem?

pulmonary edema

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:

renal failure.

The nurse is providing medication education to a client prescribed an adrenergic blocker. Which nervous system is the specific focus of this classification of medications?

sympathetic

The nurse evaluates an improvement in the client's heart failure (HF) status on the basis of what assessment finding?

using fewer pillows to sleep