ch 44 HF drugs

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 (Hemoptysis, dyspnea, and polyuria would be associated with left-sided heart failure.)

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

Pitting edema

A client is being treated for heart failure. Which is most indicative of improved health status? decreased pitting edema increased skin turgor heart rate of 52 improved sensorium

decreased pitting edema (The absence of pitting edema, decreased size of ankles and abdominal girth, and decreased weight improves circulation and increases renal blood flow.)

A male client who is prescribed digoxin asks the nurse how he should take the drug. Which instruction would be most appropriate?

"Take the drug on an empty stomach at the same time each day."

A male client who is prescribed digoxin asks the nurse how he should take the drug. Which instruction would be most appropriate? "Take the medicine with an antacid at any time of the day." "Take the drug after eating your breakfast." "Eat a small snack just before taking the drug." "Take the drug on an empty stomach at the same time each day."

"Take the drug on an empty stomach at the same time each day."

The nurse identifies the therapeutic range for digoxin as:

0.8 to 2 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? 0.5 nanograms per milliliter 1.0 nanograms per milliliter 2.0 nanograms per milliliter 4.0 nanograms per milliliter

4.0 nanograms per milliliter

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

5 minutes

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

Activation of the renin-angiotensin-aldosterone system

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

After receiving a loading dose of milrinone (Primacor), what is a client most likely to experience? (Select all that apply.)

Angina Headache

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. Assess the client's heart rate and hold administration if it is less than 60. Teach clients the signs and symptoms of heart failure. Monitor therapeutic effects based on echocardiogram results.

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 Nifedipine Nitroglycerin Nesiritide

Atropine (Atropine or isoproterenol, used in the management of bradycardia or conduction defects, may be administered to clients with digoxin toxicity.)

A patient is prescribed a cardiotonic medication. Which pre-administration assessment should the nurse perform on this patient?

Check for jugular vein distention.

A patient is prescribed a cardiotonic medication. Which pre-administration assessment should the nurse perform on this patient? Inspect joints for swelling. Check for jugular vein distention. Inspect skin for rash. Obtain blood glucose levels.

Check for jugular vein distention.

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.

A client has a history of severe renal failure. Recently, the client has been placed on digoxin for atrial dysrhythmia. Based on the client's history, the nurse anticipates which action? Digoxin will need to be changed to another medication, as it is contraindicated in the case. Digoxin dose will need to be reduced. Digoxin dose will need to be increased and Lasix will need to be added. Digoxin dose will need to be reduced and potassium supplements will need to be added.

Digoxin dose will need to be reduced. (Dosage must be reduced in the presence of renal failure because most of the digoxin is excreted unchanged by the kidneys to prevent drug accumulation and 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? Furosemide Digoxin immune fab Captopril Dopamine

Digoxin immune fab

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.

After teaching a group of students about possible hypersensitivity reactions associated with milrinone, the students demonstrate a need for additional teaching when they identify: cellulitis. vasculitis. pericarditis. ascites.

cellulitis.

A nurse is caring for a patient admitted to the intensive care unit because of heart failure. The patient is prescribed digoxin. Which nursing diagnosis would be appropriate for this patient? Risk for Hyperthyroidism related to adverse effects of drug therapy Decreased Cardiac Output related to altered cardiac function Acute Pain and Headache related to adverse effects of the drug therapy Risk of Constipation related to adverse effects of the drug therapy

Decreased Cardiac Output related to altered cardiac function

Vasodilators used to treat heart failure include nitrates and ACE inhibitors. The medication is at a subtherapeutic drug level. A therapeutic drug level has been achieved. Digitalis toxicity is a possibility. A loading dose of digoxin has been given.

Digitalis toxicity is a possibility. (The normal digoxin level is 0.5 to 2.0 ng/mL.)

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 short half-life increases the risk for toxicity. 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 long half-life makes therapeutic serum levels difficult to obtain without loading.

The nurse is teaching a female patient about newly prescribed digoxin. The patient tells the nurse that she occasionally uses herbal therapies. The nurse should caution the patient against using therapies that involve which herbs? Black cohosh Ginseng Saw palmetto Valerian

Ginseng (Patients taking digoxin should avoid licorice, ginseng, or hawthorn because concomitant use of those products can increase drug effects or cause toxicity.)

A nurse is preparing to administer inamrinone. The nurse would administer this drug most likely by which route?

Intravenous

A nurse is preparing to administer inamrinone. The nurse would administer this drug most likely by which route? Oral Subcutaneous Intramuscular Intravenous

Intravenous

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

Low

The nurse is caring for a patient receiving cardiotonic drugs. The patient has edema. Which intervention should be taken to alleviate edema? Auscultation of the lungs Measurement of intake and output Observation of respiratory rate Observation of pulse rate

Measurement of intake and output

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 respiratory rate Monitor the infant's blood pressure Monitor the infant's temperature Monitor the infant's apical pulse

Monitor the infant's apical pulse

A 59-year-old female client has been prescribed digoxin. The nurse assigned to the client will instruct her to avoid: grapefruit juice. protein-rich foods. one glass of red wine per day. OTC cold remedies.

OTC cold remedies. (The nurse should instruct the client to avoid OTC antacids and cough, cold, allergy, and diet drugs unless prescribed, because these drugs frequently contain antihistamines that may interact with digoxin.)

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 with high fiber meals. Report to the center if the pulse is less than 70 bpm. Take antacids promptly to avoid gastric problems. Take the drug regularly without skipping a dose.

Take the drug regularly without skipping a dose.

The nurse monitors which client for an increased risk of digoxin toxicity? The client with liver dysfunction The client with renal dysfunction The client with an integumentary dysfunction The client with a peripheral vascular dysfunction

The client with renal dysfunction

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's digoxin dosage will be reduced. The patient will be given digoxin immune fab. 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 dysrhythmias, several drugs may be used, including potassium chloride (if serum potassium is low) and digoxin immune fab (if toxicity is serious).)

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? Decreased cardiac output Decreased afterload Increased ventricular rate Increased force of heart contraction

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?

Vasodilators used to treat heart failure include nitrates and ACE inhibitors. T/F?

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.

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 Diarrhea Constipation Restlessness

Visual disturbances (Adverse reactions associated with cardiotonic medications include headache, weakness, drowsiness, visual disturbances, nausea, anorexia, and arrhythmias.)

A nurse assessing a client on digoxin suspects toxicity. Which visual disturbances would the nurse expect to assess? Complete loss of vision Double vision Yellow or green vision Difficulty of near vision

Yellow or green vision

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? heart failure myocardial infarction digitalis toxicity acute renal failure

digitalis toxicity People diagnosed with hypokalemia can develop digitalis toxicity even when digoxin levels are not considered elevated.

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

hypokalemia

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

hypokalemia

To maximize absorption of digoxin, the nurse would instruct the patient to take the drug:

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?

positive inotropic effect