PrepU Chapter 44
A nurse obtains the serum digoxin level and immediately reports a level greater than which value?
2.0 ng/mL. 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.
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 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.
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." 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.
Digoxin has been prescribed for an outclient with symptomatic heart failure. What is the priority teaching point to convey to this client? "If the swelling in your feet gets worse, you can take up twice your normal dose for 1 day." "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." "Make sure to take your pulse for a minute before taking your digoxin."
"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 male client who is prescribed digoxin asks the nurse how he should take the drug. Which instruction would be most appropriate? "Eat a small snack just before taking the drug." "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." "Take the drug after eating your breakfast."
"Take the drug on an empty stomach at the same time each day." 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.
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." This helps to evaluate the effectiveness of the drug and for signs and symptoms of heart failure. This is important in evaluating for digoxin toxicity. A pulse rate below 60 beats/minute might suggest digoxin toxicity. Irregular heart rhythm or nausea may indicate digoxin toxicity. Drug absorption is delayed if the drug is taken with food.
A patient is receiving milrinone IV. The nurse would administer the bolus over which time frame? 10 minutes 2 minutes 5 minutes 15 minutes
10 minutes Milrinone is administered by IV bolus over 10 minutes.
The nurse monitors which client for an increased risk of digoxin toxicity? The client with liver dysfunction The client with an integumentary dysfunction The client with renal dysfunction The client with a peripheral vascular dysfunction
The client with renal dysfunction The client with renal dysfunction is at an increased risk for digoxin toxicity.
The nurse monitors which client for an increased risk of digoxin toxicity? The client with renal dysfunction The client with liver dysfunction The client with an integumentary dysfunction The client with a peripheral vascular 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 correct technique for using a home blood pressure cuff The importance of having required laboratory work performed on time Timing household activities to coincide with the administration times of her digoxin 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 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 dysrhythmia. If the nurse is correct, which action is likely to be taken?
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 dysrhythmias, several drugs may be used, including potassium chloride (if serum potassium is low) and digoxin immune fab (if toxicity is serious).
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 Visual disturbances Restlessness 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? 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 nurse assessing a client on digoxin suspects toxicity. Which visual disturbances would the nurse expect to assess? Double vision Yellow or green vision Difficulty of near vision Complete loss of 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 client is receiving digoxin and experiences severe bradycardia. Which medication would the nurse anticipate administering if prescribed?
atropine 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.
A client is receiving digoxin and experiences severe bradycardia. Which medication would the nurse anticipate administering if prescribed? propafenone milrinone (primacor) activated charcoal atropine
atropine 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.
What assessment should the nurse perform on a daily basis when a client is prescribed furosemide?
body weights When a client is being treated with furosemide, the nurse weighs the client daily and reports any increase in weight of greater than 2 lb (0.9 kg) in 24 hours to the health care provider. Electrolyte levels must be assessed, but sodium and potassium levels are the priority. There is no particular need to assess ABGs or pupillary response.
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 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 situation described does not support the conclusion that any of the other options are responsible for the client's described symptomology.
Which medication will be administered to a client experiencing severe digitalis poisoning? felbamate acetylsalicylic acid nesiritide 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 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 dysrhythmias.
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 stimulating the SA node to fire more frequently increasing the contractility of myocardial fibers 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.
To maximize absorption of digoxin, the nurse would instruct the patient to take the drug: after a meal. with an antacid. with a small glass of water. on an empty stomach.
on an empty stomach. Digoxin is absorbed best on an empty stomach.
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: hypertension. valvular disease. renal failure. coronary artery 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.
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 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 nurse is administering digoxin intravenously as ordered. The nurse would administer the drug over which time frame?
5 minutes Intravenous digoxin must be administered slowly over at least 5 minutes to prevent cardiac arrhythmias and adverse effects.
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 Atropine Nitroglycerin Nifedipine
Atropine Atropine or isoproterenol, used in the management of bradycardia or conduction defects, may be administered to clients with digoxin toxicity.
Which dosage forms are used for digoxin (Lanoxin) maintenance therapy? (Select all that apply.) Patch Tablet Capsule Ointment Injection
Capsule Injection Tablet Capsules and tablets are used for maintenance therapy, injections are used for rapid digitalization, and digoxin patches and ointment do not exist.
A patient is prescribed a cardiotonic medication. Which pre-administration assessment should the nurse perform on this patient? Check for jugular vein distention. Inspect joints for swelling. Obtain blood glucose levels. 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 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 Heart failure has been referred to as congestive heart failure because frequently there is congestion in the lungs and peripheral tissues. The client has pitting edema of the feet and ankles, which is not noted with pneumonia. Liver disease can lead to the development of congestive heart failure but is not the cause of the symptoms of congestion. The client is not presenting with myocardial infarction symptoms.
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 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
Decreased Cardiac Output related to altered cardiac function 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.
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? Digoxin ACE inhibitors Hydrochlorothiazide Human B type natriuretic peptide
Digoxin 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.
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? Digoxin Human B type natriuretic peptide Hydrochlorothiazide ACE inhibitors
Digoxin 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.
Which would the nurse identify as a cardiac glycoside?
Digoxin Digoxin is a cardiac glycoside. Inamrinone and milrinone are phosphodiesterase inhibitors. Captopril is an angiotensin-converting enzyme inhibitor.
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?
Digoxin 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.
A patient is experiencing nausea and visual disturbances when taking digoxin (Lanoxin). Which medication will be administered? Acetylsalicylic acid (aspirin) Nesiritide (Natrecor) Digoxin immune fab (Digibind) Felbamate (Felbatol)
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?
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.
Splenomegaly occurs with left-sided heart failure. True or false
False Splenomegaly occurs with right-sided heart failure.
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 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.
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? Pulmonary edema Asthmatic bronchitis Myocardial infarction Heart failure
Heart failure Cardinal manifestations of HF are dyspnea and fatigue, which can lead to exercise intolerance and fluid retention resulting in pulmonary congestion and peripheral edema.
Which adverse effect might occur in a client receiving milrinone? Hypoglycemia Hyperkalemia Confusion Hypotension
Hypotension Adverse effects of phosphodiesterase inhibitors such as milrinone include hypotension, ventricular dysrhythmias, and headache.
What does the use of cardiotonics lead to? (Select all that apply.) Increase in peripheral edema Improved perfusion to all body tissues Increased myocardial efficiency Improved myocardial contractility Increase in blood pressure
Improved myocardial contractility Increased myocardial efficiency Improved perfusion to all body tissues 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.
An instructor is describing positive inotropic activity. Which would the instructor include as a result of this activity? Increased cardiac output Increased preload Increased conduction velocity Decreased heart rate
Increased cardiac output 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. Decreased conduction velocity, not increased is a negative chronotropic effect.
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 Decreased afterload Increased ventricular rate
Increased force of heart contraction Cardiac glycosides increase the force of cardiac contraction, which increases cardiac output.
A nurse is preparing to administer inamrinone. The nurse would administer this drug most likely by which route? Intravenous Oral Intramuscular Subcutaneous
Intravenous Inamrinone is administered only by the intravenous route.
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 Milrinone (Primacor) is only to be given intravenously. The other routes are not used.
The nurse is caring for a patient receiving cardiotonic drugs. The patient has edema. Which intervention should be taken to alleviate edema?
Measurement of intake and output 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.
Which would a nurse expect to assess if a client is experiencing right-sided heart failure?
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 most 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.
The pharmacology instructor is describing medications that increase the contractile force of the heart. Which term describes this effect?
Positive inotropic A positive inotropic effect improves the contractility and pumping ability of the heart.
A client has acute onset pulmonary edema. The client has not experienced a response to digitalization. The nurse would expect which drug to be used for this client?
Primacor Primacor 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. Primacor also relaxes vascular smooth muscle to produce vasodilatation and decrease preload and afterload.