Pharm201 CH38

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?

Potassium levels

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?"

Digoxin has been prescribed for an outclient with symptomatic heart failure. What is the priority teaching point to convey to this client?

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

The home care nurse sees a client for the first time. 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 experiencing?

Congestive heart failure

Which instructions would be appropriate to include in the teaching plan for a client taking digoxin at home? (Select all that apply.)

"Weigh yourself each day at the same time and wearing the same amount of clothing." "Check your pulse every day before taking the medication." "Notify the doctor if your pulse is below 60 beats per minute." "Call your doctor if you notice an irregular heart rhythm or you feel nauseated."

The nurse is caring for a 62-year-old male who has had a digitalizing dose of digoxin (Lanoxin) ordered. The nurse would recognize that the health care provider ordered the correct dose if it was:

0.75 mg PO q8h x 24 hrs

The nurse identifies the therapeutic range for digoxin as:

0.8 to 2 ng/mL.

A client is receiving digoxin. The nurse monitors the client's digoxin level. Which level should the nurse interpret as therapeutic?

1.5 ng/mL

A nurse obtains the serum digoxin level and immediately reports a level greater than which value?

2.0 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

At what digoxin level would the care team first suspect that the client is experiencing the therapeutic effects of the medication?

3.0 ng/mL

A male client states that he is seeing halos around lights. The client takes digoxin (Lanoxin) 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?

4.0 nanograms per milliliter

Which assessment findings may indicate the client is experiencing digitalis toxicity? (Select all that apply.)

Abdominal pain Diarrhea Drowsiness Vomiting

In heart failure, by what mechanism does the body compensate for decreased circulating blood volume?

Activation of the renin-angiotensin-aldosterone system

The nurse is caring for a client with heart failure who has been prescribed ivabradine 5 mg PO b.i.d. 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 per minute with regular rhythm and respiratory rate of 21 breaths per minute. What is the nurse's best action?

Administer the medication as prescribed and monitor the client

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

The nurse admits a client to the constant care unit with a digoxin level of 11 ng/mL and a serum potassium level of 5.2 mEq/L. Digoxin immune Fab is administered. The next day, the client's digoxin level remains elevated. What action does the nurse anticipate?

Continue to monitor the client's digoxin level daily.

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 client is admitted to the emergency department with severe heart failure. Milrinone (Primacor) is administered in an IV bolus. For what adverse effect should the client be assessed?

Atrial dysrhythmias

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?

Avoid most over-the-counter drugs.

The client taking digoxin (Lanoxin) has developed an infection. What medication can the nurse safely administer to this client?

Azithromycin

A 96-year-old client is receiving digoxin (Lanoxin) and furosemide (Lasix). In the morning, the client reports a headache and nausea. What will the nurse do first?

Check the client's laboratory values and vital signs.

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.

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.

What sign is indicative of improved heart failure status?

Decreased pedal edema

What conclusion should the nurse draw when a client's digoxin level is reported to be 2.2 ng/mL?

Digitalis toxicity is a possibility.

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 client with heart failure has been started on a milrinone infusion. Which assessment findings would lead the nurse to believe the milrinone is effective?

Diuresis

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.)

Dyspnea Tachycardia Cough

The nurse assesses the client for which symptoms that may indicate heart failure? (Select all that apply.)

Dyspnea Weight gain Edema

When describing cardiotonic drugs, the nurse would expect to include which condition as an indication for use? Select all that apply.

Heart failure Atrial fibrillation

The nurse recognizes that treatment for digitalis toxicity includes which of the following?

Holding the medication

A client who has been prescribed digoxin (Lanoxin) is also taking furosemide (Lasix) 20 mg daily. Which electrolyte imbalances will precipitate the client to develop digoxin toxicity?

Hypokalemia

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

Hypokalemia

Which electrolyte imbalance can precipitate digoxin toxicity?

Hypokalemia

When administering milrinone (Primacor), the nurse should observe the client for which adverse effect?

Hypotension

Which adverse effect might occur in a client receiving milrinone?

Hypotension

The nurse prepares to administer a phosphodiesterase inhibitor by what route?

IV

What are cardiac glycosides used for?

Increase the force of the contraction of the heart

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

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

Increased cardiac output

Milrinone (Primacor) 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 nurse suspects the client may have toxic levels of digoxin in the bloodstream when what is assessed? Select all that apply.

Irregular heart rhythms Nausea Anorexia

The nurse explains to the client that with heart failure, what may occur?

Increased heart rate

The nurse is working with a client who has heart failure. What compensatory mechanisms will this client's body be implementing? Select all that apply.

Increased heart rate Increased blood pressure Increased force of cardiac contraction

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

Increased myocardial contraction

A nurse is assigned to care for a client who is prescribed digoxin. Review of the client's medication history reveals the use of itraconazole for a fungal infection. The nurse would be alert for which adverse reaction resulting from the interaction of these two drugs?

Increased plasma digitalis levels

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 Slows the conduction velocity through the atrioventricular (AV) node Decreases heart rate

When educating a group of nursing students on the mechanisms of action of digitalis, the nursing instructor identifies which pharmacologic actions of digitalis? Select all that apply.

It increases cardiac output by positive inotropic action. It decreases the heart rate through negative chronotropic effect. It retards the conduction velocity through the AV node in the heart.

The nurse recognizes that which finding is associated with right-sided heart failure?

Nocturia

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 59-year-old female client has been prescribed digoxin. The nurse assigned to the client will instruct her to avoid:

OTC cold remedies.

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.

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

Which symptoms would most likely be present in a client with right-sided heart failure? Select all that apply.

Peripheral edema Neck vein distention Nocturia

A nurse is required to monitor a client for right ventricular dysfunction. Which would the nurse most commonly assess?

Pitting edema

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?

Place client in supine position with feet elevated above level of heart.

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

Positive inotropic

The pharmacology instructor is discussing effects on the heart of different medication. What is the term the instructor would use to describe the effect of a medication that increases the force of the contractions of the heart?

Positive inotropic

Prior to administration of digoxin, the nurse evaluates the client's laboratory values. Which lab findings should the nurse alert the health care provider about before administering digoxin?

Potassium level of 3.0 mEq/L

A client presents to the Emergency Department (ED) with rales, wheezing, and blood-tinged sputum. The nurse suspects that the client is in congestive heart failure (CHF). What would the nurse suspect the client is experiencing?

Pulmonary edema

The nurse is caring for a client receiving digoxin. The nurse would intervene for possible digoxin toxicity when the client exhibits which symptoms?

Refusal to eat

What is a priority nursing assessment for a client who is about to begin digoxin therapy?

Renal function

The nurse is preparing to administer a digitalizing dosage of digoxin to a geriatric client. What factors will the nurse assess for first to avoid digoxin toxicity? Select all that apply.

Renal function Low body mass Hydration

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

The client's heart rate changes from 97 to 79 beats per minute

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 client is prescribed digoxin for the treatment of heart failure. The nurse educates the client regarding safe digoxin administration. The nurse should include that which circumstance would lead to considerable reduction in absorption of the drug?

When digoxin is taken with a meal that is very high in bran fiber

A male client has been admitted with digitalis toxicity. He has been taking the same dose for more than 20 years. His family is asking how common this problem is and how he developed a toxic level while taking the usual dose. The nurse's best explanation would be:

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

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

Using fewer pillows to sleep

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

A nurse assessing a client on digoxin suspects toxicity. Which visual disturbances would the nurse expect to assess?

Yellow or green vision

Which medication reduces aldosterone-induced retention of sodium and water when prescribed for the treatment of heart failure?

spironolactone

What assessment should the nurse perform on a daily basis when a client is prescribed furosemide?

body weights

A client is admitted to the emergency department with severe heart failure. Milrinone is administered IV. For what adverse effect should the client be assessed?

thrombocytopenia

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. What is the rationale for the nurse's response?

to rapidly bring the client's serum digoxin levels up to therapeutic levels

A client is diagnosed with heart failure and is started on digoxin. On the second day of therapy, lab values, the ECG results, and the client's symptoms indicate that the medication is not producing a therapeutic effect. An appropriate nursing action would be to:

continue to administer the drug as ordered.

A client is being treated for heart failure. Which is most indicative of improved health status?

decreased pitting edema

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

Which medication will be administered to a client experiencing severe digitalis poisoning?

digoxin immune fab

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?

heart failure

A client is admitted to the intensive care unit with an electrolyte imbalance. Which imbalance will contraindicate the administration of digoxin?

hypokalemia

Which electrolyte imbalance will contribute to the development of digoxin toxicity? Select all that apply.

hypokalemia hypermagnesemia hypocalcemia

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

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 nursing students are learning about digoxin therapy in their pharmac

low serum potassium levels.

The nursing students are learning about digoxin therapy in their pharmacology class. The students will learn that there is a higher risk of digoxin toxicity in clients with

low serum potassium levels.

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

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?

positive inotropic effect

A client is hospitalized for heart failure and is scheduled to receive oral digoxin at 8 AM. The nurse will withhold the medication and notify the prescriber if the client's:

pulse is 52 beats per minute.

When administering digoxin (Lanoxin), the nurse would monitor the apical pulse for 1 full minute. The nurse should withhold digoxin (Lanoxin) and notify the health care provider if:

pulse is 54 beats per minute.