PrepU chapter 44
Milrinone (Primacor) is given orally to patients with congestive heart failure when digoxin and diuretics don't work.
False
Pulmonary edema occurs when the right side of the heart is unable to pump to the lungs.
False
Splenomegaly occurs with left-sided heart failure. True False
False Splenomegaly occurs with right-sided heart failure.
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?" "Do you think your heart beats too rapidly?" "Have you been feeling dizzy lately?" "Has it felt like your heart skips a beat?"
"Do you take regular doses of antacids?" 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.
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." "Try to limit the number of high-potassium foods in your diet." "Plan to take your digoxin on an empty stomach to make sure it's fully absorbed." "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. "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.
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? 1.6 nanograms (ng)/ml 2.2 ng/ml 1.8 ng/ml 2 ng/ml Atrial fibrillation (A-fib) is an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart.
2.2 ng/ml 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.
A client experiences nausea and visual disturbances when taking digoxin (Lanoxin). The nurse would anticipate the client's digitalis level to be: 2.7 nanograms/mL 1.7 nanograms/mL 1.3 nanograms/mL 0.2 nanograms/mL
2.7 nanograms/mL 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.
A client is receiving furosemide. When monitoring daily laboratory values, what should the potassium level be for this client? 3.5 to 5.0 mEq/L 6.0 to 6.5 mEq/L 1.5 to 2.0 mEq/L 5.0 to 7.5 mEq/L
3.5 to 5.0 mEq/L Normal serum potassium level is 3.5 to 5.0 mEq/L. A serum potassium level of 1.5 to 3.0 mEq/L is too low. A serum potassium level of 5.0 to 7.5 mEq/L is indicative of hyperkalemia. A serum potassium level of 6.0 to 6.5 mEq/L is indicative of hyperkalemia.
A patient is being administered digoxin (Lanoxin) for treatment of heart failure. At what level should the serum potassium level be maintained? 8.5-10 mEq/L 3.5-5.0 mEq/L 6.0-8.0 mEq/L 1.5-2.0 mEq/L
3.5-5.0 mEq/L
The signs and symptoms of congestive heart failure are related to the backup of blood in the vascular system and the loss of fluid to the tissues.
True
A nurse is administering digoxin intravenously as ordered. The nurse would administer the drug over which time frame? 3 minutes 5 minutes 4 minutes 2 minutes
5 minutes Intravenous digoxin must be administered slowly over at least 5 minutes to prevent cardiac arrhythmias and adverse effects.
A nurse is administering digoxin intravenously as ordered. The nurse would administer the drug over which time frame? 4 minutes 3 minutes 2 minutes 5 minutes
5 minutes Intravenous digoxin must be administered slowly over at least 5 minutes to prevent cardiac arrhythmias and adverse effects.
A male client has called the clinic because he is taking digoxin and is concerned about his pulse rate. The nurse should tell the client to hold the medication if he reports a pulse rate of: 78 beats/minute. 66 beats/minute. 84 beats/minute. 52 beats/minute.
52 beats/minute. A pulse rate below 60 beats/minute would be an indication to withhold the medication.
The nurse should assess for what as a symptom in a client with left-sided heart failure?
Dyspnea Symptoms of left-sided failure include dyspnea and moist cough. Edema, hepatic engorgement, and distended neck veins are symptoms of right-sided failure.
In heart failure, by what mechanism does the body compensate for decreased circulating blood volume? Increasing preload Decreasing afterload Increasing stroke volume Activation of the renin-angiotensin-aldosterone system
Activation of the renin-angiotensin-aldosterone system 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.
After receiving a loading dose of milrinone , what is a client most likely to experience? (Select all that apply.) Hyperkalemia Headache Hypertension Insomnia Angina
Angina Headache The adverse reactions most likely to occur after the administration of milrinone (Primacor) to a client are ventricular arrhythmias, hypotension, angina, chest pain, and hypokalemia.
What is the most accurate method for preventing adverse effects associated with the use of digoxin? Teach clients to take their digoxin in divided doses with each meal. Monitor therapeutic effects based on echocardiogram results. Teach clients the signs and symptoms of heart failure. Assess the client's heart rate and hold administration if it is less than 60.
Assess the client's heart rate and hold administration if it is less than 60. 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
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 joints for swelling. Inspect skin for rash.
Check for jugular vein distention. 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.
The nurse is caring for a client with a history of heart failure and renal insufficiency. The nurse should perform which assessment(s) for safe administration of the digoxin 0.125 mg po every other day? Select all that apply. Auscultate blood pressure (BP) and hold drug if greater than 160/90 mm Hg because the drug may raise the BP. Monitor the liver profile to ensure that the medication is properly metabolized, and report abnormal labs. Assess the radial pulse before administering the medication, and hold if less than 60 beats per minute. Check the renal profile for the serum creatinine, blood urea nitrogen (BUN), and potassium levels. Determine the day and time the client most recently took the digoxin, and keep to the same schedule.
Check the renal profile for the serum creatinine, blood urea nitrogen (BUN), and potassium levels. Determine the day and time the client most recently took the digoxin, and keep to the same schedule. Monitor the liver profile to ensure that the medication is properly metabolized, and report abnormal labs. Before administering digoxin to a client with a history of renal insufficiency, the nurse should determine what day the client took the medication last and maintain the schedule and communicate the pattern to the pharmacy. The nurse should also assess the client's renal status and compare the current labs to previous labs to determine if there is a worsening of the renal clearance and an increase in both the serum creatinine and the BUN. If there is, report it to the primary care provider (PCP). The nurse needs to assess the potassium level because if it is low, the client may become toxic to digoxin. The nurse should assess the liver status and report any abnormal labs to the PCP because the client will not be able to metabolize the drug efficiently and may develop digoxin toxicity. The nurse must assess the apical pulse for one full minute and hold the drug if the apical pulse is less than 60 or greater than 100 beats per minute, unless provided different parameters and report it to the PCP for further orders. Digoxin does not increase blood pressure. The client's blood pressure will increase because of worsening heart failure and/or worsening renal function.
__________ __________ __________ is a condition in which the heart is unable to effectively pump blood around the body.
Congestive Heart Failure
Digoxin is a safe and effective drug that has a wide therapeutic dosing range and limited risk of toxicity.
False
When describing how vasodilators help alleviate heart failure, which would the nurse include? Decrease blood volume Decrease afterload Increase preload Increase cardiac workload
Decrease afterload 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.
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 will need to be changed to another medication because it is contraindicated in the case. Digoxin dose will need to be increased, and furosemide will need to be added. Digoxin dose will need to be reduced. Digoxin dose will need to be reduced, and potassium supplements will need to be added.
Digoxin dose will need to be reduced. Dosage of digoxin must be reduced in the presence of renal failure because most of the drug is excreted unchanged by the kidneys to prevent drug accumulation and toxicity. This problem will not be managed by the addition of a diuretic. The digoxin does not need to be substituted since the problem is related to kidney function not allergy or contraindications.
What is given to treat a massive digoxin overdose? Milrinone (Primacor) Activated charcoal Syrup of ipecac Digoxin immune Fab (Digibind)
Digoxin immune Fab (Digibind) Digoxin immune Fab (Digibind) is used to treat massive digoxin overdoses.
A client is experiencing nausea and visual disturbances when taking digoxin. Which medication will be administered? Nesiritide Felbamate Acetylsalicylic acid Digoxin immune fab
Digoxin immune fab Digoxin immune fab is a digoxin-binding antidote recommended only for severe digitalis poisoning with life-threatening symptoms. Acetylsalicylic acid is used to reduce fever and relieve mild to moderate pain. Nesiritide acts to compensate for deteriorating cardiac function by reducing cardiac preload and afterload. Felbamate is administered for the treatment of seizures. None of these medications are prescribed for digoxin toxicity.
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? Captopril Furosemide Dopamine Digoxin immune fab Bradycardia: slow heart action
Digoxin immune fab (Digibind) A patient who has nausea and visual changes while taking digoxin will most likely be administered digoxin immune fab (Digibind). Acetylsalicylic acid is not administered for digoxin toxicity. Nesiritide is not administered when the patient is experiencing digoxin toxicity. Felbamate is administered for the treatment of seizures.
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? The client is at risk for dysthymia with titrated doses. Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. Oral digoxin is ineffective for the treatment of heart failure. Digoxin's short half-life increases the risk for toxicity.
Digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. Digoxin dosages must be interpreted with consideration of specific client characteristics, including age, weight, gender, renal function, general health state, and concurrent drug therapy. Loading or digitalizing doses are necessary for initiating therapy, because digoxin's long half-life makes therapeutic serum levels difficult to obtain without loading. Loading doses should be used cautiously in clients who have taken digoxin within the previous 2 or 3 weeks.
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? Hyperkalemia Tachycardia Diuresis Arrhythmias
Diuresis 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.
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 Arrhythmias Hyperkalemia Diuresis
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.
Which assessment findings may indicate the client is experiencing digitalis toxicity? (Select all that apply.) Drowsiness Vomiting Diarrhea Abdominal pain Increased appetite
Drowsiness Vomiting Diarrhea Abdominal pain Signs of digitalis toxicity include anorexia, nausea, vomiting, diarrhea, weakness, lethargy, drowsiness, headache, visual disturbances, and arrhythmias.
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? 0.618 mg 0.418 mg 0.218 mg 0.818 mg
First, using the formula: 2.2 lb: 1 kg as 60 lb: times kg, determine the child's weight in kg (60/2.2 = 27.27 kg). Next, using the formula: amount of drug prescribed times weight in kg, determine the dose in mcg the child should receive (30 times 27.27 = 818). Then to determine the amount of mg the child should receive use the formula: 1 mg: 1000 mcg = x mg: 818 mcg (818/1000 = 0.818).
A client is admitted to the intensive care unit with an electrolyte imbalance. Which imbalance will contraindicate the administration of digoxin? Hypocalcemia Hypokalemia Hypermagnesemia Hyperkalemia
Hypokalemia 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.
Which adverse effect might occur in a client receiving milrinone? Hypotension Confusion Hyperkalemia Hypoglycemia
Hypotension Adverse effects of phosphodiesterase inhibitors such as milrinone include hypotension, ventricular arrhythmias, and headache.
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? Hypotension Bradycardia Cyanosis Edema
Hypotension 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.
What are cardiac glycosides used for? Decrease afterload Increase ventricular rate Decrease cardiac output Increase the force of the contraction of the heart
Increase the force of the contraction of the heart Cardiac glycosides exert a cardiotonic or positive inotropic effect. They do not decrease cardiac output, decrease afterload, or increase the ventricular rate of the heart.
An instructor is describing positive inotropic activity. Which would the instructor include as a result of this activity? Decreased heart rate Increased cardiac output Increased conduction velocity Increased preload
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.
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 Decreased cardiac output Increased ventricular rate Decreased afterload
Increased force of heart contraction Cardiac glycosides increase the force of cardiac contraction, which increases cardiac output.
The nursing instructor explains to students that positive inotropic action affects the heart in which way? Decreased venous return Decreased ventricular pressures Increased myocardial contraction Increased heart rate
Increased myocardial contraction Positive inotropic activity occurs with an increase in the force of the contraction. Conduction is slowed through the heart and there is a decrease, not an increase, in the heart rate.
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? Exerting a direct relaxant effect on the vascular smooth muscle Increasing renal excretion of sodium and water Increasing the contractility of myocardial fibers Stimulating the SA node to fire more frequently
Increasing renal excretion of sodium and water 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 has poured a hospital client's scheduled dose of hydrochlorothiazide (HCTZ). The nurse should know that this drug reduces preload by which means? Increasing the contractility of myocardial fibers Stimulating the SA node to fire more frequently Exerting a direct relaxant effect on the vascular smooth muscle Increasing renal excretion of sodium and water
Increasing renal excretion of sodium and water 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 most likely by which route? Oral Intramuscular Subcutaneous Intravenous
Intravenous Inamrinone is administered only by the intravenous route.
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? Loop Thiazide Calcium wasting Potassium sparing
Loop 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).
The nurse is preparing to administer digoxin to a 9-month-old infant. What must the nurse do prior to administration of this medication? Monitor the infant's blood pressure Monitor the infant's respiratory rate Monitor the infant's apical pulse Monitor the infant's temperature
Monitor the infant's apical pulse The nurse must assess the client's apical pulse before administering digoxin because it has a narrow therapeutic index and can cause the heart rate to go too low, so the nurse takes the apical pulse and holds the medication if it is below a certain level (depending upon age of the client.)
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? Administer medication Notify the health care provider Assess the blood pressure Administer half of the dose
Notify the health care provider Before administering each dose of digoxin, take the apical pulse rate for 60 seconds. If the apical rate is below 60 beats per minute, withhold the drug and notify the provider. Blood pressure is not affected by digoxin. Without prescriptive authority, the nurse cannot change medication dosages.
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 contact the health care provider. Omit the dose and inform the oncoming nurse at the next shift change. Give 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. 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.
When dosing digoxin (Lanoxin), which factors are considered? (Select all that apply.) Patient age Pharmacodynamics Patient lean body weight Pharmacokinetics Renal function
Patient age Pharmacodynamics Patient lean body weight Pharmacokinetics Renal function All of the answers are factors to consider when dosing digoxin (Lanoxin).
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? Peripheral edema Hemoptysis Dyspnea Polyuria
Peripheral edema Peripheral edema would be associated with right-sided heart failure. Hemoptysis, dyspnea, and polyuria would be associated with left-sided heart failure. Hemoptysis /hi móp tờ sis/ ho ra mau
Which would a nurse expect to assess if a client is experiencing right-sided heart failure? Wheezing Hemoptysis Peripheral edema Dyspnea
Peripheral edema Peripheral edema would be noted in clients with right-sided heart failure. Wheezing, hemoptysis, and dyspnea would suggest left-sided heart failure.
A nurse is required to monitor a client for right ventricular dysfunction. Which would the nurse commonly assess? Dyspnea Orthopnea Hacking cough Pitting edema
Pitting edema 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.
A nurse is caring for a client who is taking digoxin and a loop diuretic. Which would be most important for the nurse to monitor? Electrocardiogram results Potassium levels Liver enzymes Sodium levels
Potassium levels 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.
The nurse is caring for a client receiving digoxin. The nurse would intervene for possible digoxin toxicity when the client exhibits which symptoms? Sudden disorientation to time and place Reported blurred vision and there are halos around dark objects. Reported feeling of nausea and vomiting in an emesis basin Refusal to eat
Refusal to eat Catching possible digoxin toxicity at its earliest symptom is important, so the nurse may call the primary care provider (PCP) for an order for a digoxin level. Once the digoxin level is available, the nurse should call the PCP with the result and obtain further orders. Anorexia, which is a reported feeling of a decreased or absent appetite, is the first symptom of possible digoxin toxicity. Later symptoms include nausea, vomiting, headache, confusion, and visual disturbances: Blurred vision and halos over dark objects, and disturbances in yellow and green vision. The client may develop bradycardia, a heart rate below 60 beats per minute, or tachy-arrhythmias, a heart rate that is irregular and greater than 100 beats per minute.
Which condition would least likely contribute to the development of heart failure? Renal failure Hypertension Valvular disease Coronary artery disease
Renal failure Renal failure would be least likely to contribute to the development of heart failure. Coronary artery disease, valvular disease, hypertension, and cardiomyopathy are commonly associated with heart failure.
A nurse is providing medication education to a client with a new prescription for digoxin. What herb should the nurse identify as having the tendency to decrease the effects of the medication? licorice ginseng hawthorn St. John's wort
St. John's wort St. John's wort is known to decrease the effects of digoxin, while the other herbs increase its effects.
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. Report to the center if the pulse is less than 70 bpm. Take antacids promptly to avoid gastric problems. Take the drug with high fiber meals.
Take the drug regularly without skipping a dose. Explanation: The nurse should instruct the patient to take the drug regularly without skipping a dose. The patient should consult the provider before discontinuing the drug. Taking the drug with high-fiber meals will decrease the absorption of the drug. The patient should be advised to report to the center if the pulse is less than 60 bpm. Antacids should not be taken as it alters the plasma digoxin levels.
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 experience a decrease in edema. The client will not require inotropes or beta-blockers. The client will exhibit increased serum potassium levels. The client will resume prediagnosis levels of stamina.
The client will experience a decrease in edema. 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.
The nurse monitors which client for an increased risk of digoxin toxicity? The client with an integumentary dysfunction The client with renal dysfunction The client with a peripheral vascular dysfunction The client with liver dysfunction
The client with renal dysfunction The client with renal dysfunction is at an increased risk for digoxin toxicity.
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 The need to take the medication at the same time each day regardless of her heart rate The correct technique for using a home blood pressure cuff Timing household activities to coincide with the administration times of her digoxin
The importance of having required laboratory work performed on time 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.
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. 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).
Which is true about digoxin? 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. Digoxin improves the quality of life for patients with heart failure in the absence of atrial fibrillation.
The therapeutic range for digoxin is 0.5 to 2 ng/mL. 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.
The nurse identifies the therapeutic range for digoxin as: 2 to 3 ng/mL. 0.1 to 0.9 ng/mL. 3 to 4 ng/mL. 0.8 to 2 ng/mL.
Therapeutic digoxin levels are between 0.8 and 2 nanograms/mL. Plasma digoxin levels greater than 2 nanograms/mL are considered toxic.
Digoxin (Lanoxin) improves cardiac output by increasing intracellular calcium in the heart, which improves the contractility of the ventricles
True
Vasodilators used to treat heart failure include nitrates and ACE inhibitors. True False
True 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
Heart failure was once called dropsy.
True 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.
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? Visual disturbances Restlessness Diarrhea Constipation
Visual disturbances 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.
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? Constipation Diarrhea Visual disturbances Restlessness
Visual disturbances 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.
A nurse assessing a client on digoxin suspects toxicity. Which visual disturbances would the nurse expect to assess? Complete loss of vision Difficulty of near vision Double vision Yellow or green vision
Yellow or green vision 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.
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. cognition. intake and output. exercise tolerance.
blood pressure. 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.
Common complaints of patients with left-sided heart failure include __________, __________, and __________.
dyspnea; tachypnea, orthopnea
Common signs and symptoms of right-sided heart failure include __________, __________, __________, and __________.
edema, liver congestion, increased jugular venous pressure; nocturia; ;
A patient has been prescribed inamrinone. The nurse knows that this drug works by: decreasing cyclic adenosine monophosphate (cAMP). decreasing cardiac output. increasing cardiac preload. increasing cyclic adenosine monophosphate (cAMP).
increasing cyclic adenosine monophosphate (cAMP). By blocking the enzyme phosphodiesterase, phosphodiesterase inhibitors such as inamrinone increase myocardial cell cAMP. The resulting increase in cellular calcium levels leads to a stronger myocardial contraction and prolongs the effects of sympathetic stimulation.
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? Stimulating the SA node to fire more frequently Increasing renal excretion of sodium and water Exerting a direct relaxant effect on the vascular smooth muscle Increasing the contractility of myocardial fibers
increasing renal excretion of sodium and water 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 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 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 it helps mitigate the potential for adverse effects
it rapidly brings your serum digoxin levels up to therapeutic levels 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.
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. Pulmonary edema occurs when left ventricular failure (or dysfunction) results in accumulation of blood and fluid in pulmonary veins and tissues.
Digoxin (Lanoxin) is useful to treat right-sided heart failure in patients with __________ failure because it is excreted in the __________.
liver; urine
A client diagnosed with acute-onset pulmonary edema has not experienced a response to digitalization. The nurse should expect what drug to be prescribed for this client? milrinone nitroglycerin furosemide verapamil
milrinone Milrinone is the most commonly used cardiotonic-inotropic agent for short-term management of acute, severe HF that is not controlled by digoxin, diuretics, and vasodilators. Milrinone also relaxes vascular smooth muscle to produce vasodilatation and decrease preload and afterload. Nitroglycerin is prescribed to treat angina. Furosemide is administered to clients with moderate to severe heart failure to reduce edema. Verapamil is a calcium channel blocker used to treat hypertension (high blood pressure), angina (chest pain), and certain heart rhythm disorders.
To maximize absorption of digoxin, the nurse would instruct the patient to take the drug: on an empty stomach. with an antacid. after a meal. with a small glass of water.
on an empty stomach. Digoxin is absorbed best on an empty stomach.
A client with a history of heart failure is being treated with digoxin. The nurse knows that this medication increases the force of contractions of the heart. What effect improves the contractility of the heart? Negative inotropic effect Positive inotropic effect Negative dromotropic effect Positive chronotropic effect
positive inotropic effect In heart failure, digoxin exerts cardiotonic or positive inotropic effect that improves the contractility and pumping ability of the heart. A positive chronotropic effect accelerates the rate of the heart, which is not recommended in a client with heart failure. A negative inotropic effect accelerates the heart, which is not recommended in a client with heart failure. A negative dromotropic effect changes the conductivity of muscle fiber, increasing heart rate.
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. coronary artery disease. hypertension. valvular disease.
renal failure. 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.
Splenomegaly occurs with left-sided heart failure. False True
splēnome'ɡəli la lach to
