Chapter 37: Cardiac Glycosides, Antianginals, and Antidysrhythmics
A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction will the nurse include in the patient's teaching plan? A) "apply the patch to a non-hairy area of the upper torso or arm" B) "apply the patch to the same site each day" C) "if you have a headache, remove the patch for 4 hours and then reapply" D) "if you have chest pain, apply a second patch next to the first patch"
A) "apply the patch to a non-hairy area of the upper torso or arm" A nitroglycerin patch should be applied to a non-hairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. The drug should be continued if headache occurs, as tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.
Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? A) absence of chest pain B) decreased swelling in the ankles and feet C) patient denies dizziness D) patient states that she feels stronger
A) absence of chest pain The workload in the heart should be decreased with the vasodilation from the calcium channel blocker. With less strain, the patient should have fewer incidences of angina as afterload is decreased.
A patient's serum digoxin level is noted to be 0.4 ng/mL. What is the nurse's priority action? A) administer ordered dose of digoxin B) hold future digoxin doses C) administer potassium D) call the health care provider
A) administer ordered dose of digoxin Therapeutic serum digoxin levels are 0.5-2 ng/mL. The patient should receive the next dose to bring the level into therapeutic range.
A nurse is administering digoxin, 0.125 mg, to a patient. Which nursing interventions will the nurse implement? (Select all that apply) A) checking the apical pulse rate before administration B) monitoring the patient's serum digoxin level C) instructing patient to report pulse rate less than 60 D) advising patient to avoid foods high in potassium E) always giving an antacid with digoxin to reduce GI distress
A) checking the apical pulse rate before administration B) monitoring the patient's serum digoxin level C) instructing patient to report pulse rate less than 60 The nurse should also advise the patient to increase foods high in potassium because hypokalemia can increase the risk for digoxin toxicity. Additionally, antacids should not be given with digoxin because antacids reduce the absorption of digoxin.
The nurse identifies which drug as a calcium channel blocker used for the treatment of dysrhythmias? A) diltiazem B) esmolol C) flecainide D) sotalol
A) diltiazem
A patient is taking digoxin 0.25 mg and furosemide (Lasix) 40 mg. The patient tells the nurse, there are yellow halos around the lights. Which action will the nurse take? A) evaluate digoxin levels B) withhold the furosemide C) administer potassium D) document the findings and reassess in 1 hour
A) evaluate digoxin levels Seeing yellow or green halos around lights is a symptom of digoxin toxicity. The nurse should evaluate the patient's digoxin levels.
A patient is ordered to receive digoxin to treat congestive heart failure. The nurse is most concerned about which assessment finding? A) heart rate 56 beats/min B) BP 138/90 mm Hg C) RR 18 breaths/min D) 1+ pitting edema of the lower extremities
A) heart rate 56 beats/min A heart rate below 60 beats/min is a sign of potential digoxin toxicity. The heart rate needs to be at or above 60 beats/min before the patient can receive digoxin.
Which assessment finding will alert the nurse to suspect early digitalis toxicity? A) loss of appetite with slight bradycardia B) blood pressure of 90/60 mm Hg C) heart rate of 110 beats/min D) confusion and diarrhea
A) loss of appetite with slight bradycardia Early symptoms of digitalis toxicity include anorexia, nausea and vomiting, and bradycardia.
The patient asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? A) "you can protect it from heat by placing the bottle in an ice chest" B) "it's best to keep it in its original container away from heat and light" C) "you can put a few tablets in a resealable bag and carry in your pocket" D) "it's best to lock them in the glove compartment to keep them away from heat and light"
B) "it's best to keep it in its original container away from heat and light" Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and must be kept away from light, not in a clear plastic bag.
What instruction should the nurse provide to the patient who needs to apply nitroglycerin ointment? A) use the fingers to spread the ointment evenly over a 3-inch area B) apply the ointment to a non-hairy part of the upper torso C) massage the ointment into the skin D) cover the application paper with ointment before use
B) apply the ointment to a non-hairy part of the upper torso Absorption is best over a non-hairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves and squeeze the ointment onto the application patch. Massaging in the ointment is not appropriate. The paper should not be covered with ointment. The ointment is measured as one straight line on the nitroglycerin paper and is then gently spread around and applied, but not rubbed, into the skin.
When titrating intravenous nitroglycerin for a patient, what is important for the nurse to monitor? (Select all that apply) A) continuous oxygen saturation B) continuous blood pressure C) hourly electrocardiograms D) presence of chest pain E) serum nitroglycerin levels F) visual acuity
B) continuous blood pressure D) presence of chest pain Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and systolic blood pressure <90 mm Hg are typical parameters used for titrating nitroglycerin. Pulse should also be monitored.
A patient receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action? A) assess the patient s lung sounds B) decrease the intravenous nitroglycerin by 10 mcg/min C) stop the nitroglycerin infusion for 1 h and then restart D) continue the infusion and recheck the patient's vital signs in 15 min
B) decrease the intravenous nitroglycerin by 10 mcg/min Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 min while changing the rate of the intravenous nitroglycerin infusion.
A patient has angina pectoris. The patient's BP is 100/60 mm Hg. The nurse administers nitroglycerin 0.4 mg sublingual (SL). It is most important for the nurse to assess the patient for the development of: A) bradycardia B) hypotension C) bradypnea D) hypokalemia
B) hypotension An intense side effect of nitroglycerin is hypotension because it causes vasodilation.
A nurse is preparing to administer digoxin to a patient. Which laboratory result is the nurse most concerned about? A) sodium 138 mEq/L B) potassium 3.0 mEq/L C) digitalis (digoxin) level 1.8 ng/mL D) BNP 200 pg/mL
B) potassium 3.0 mEq/L The low potassium level indicates hypokalemia and hypokalemia increases the risk for digoxin toxicity. The normal serum range for potassium is 3.5-5 mEq/L. The rest of the lab values listed are within normal range.
A nurse is caring for a patient who has been started on ibutilide. Which assessment is a priority for this patient? A) blood pressure measurement B) BUN and creatinine C) ECG and palpitations D) lung sounds
C) ECG and palpitations Ibutilide is specifically indicated for treatment of recent-onset atrial fibrillation and flutter. It is important for the nurse to obtain an ECG to see if the patient has converted to sinus rhythm and to watch for palpitations.
Before the nurse administers isosorbide dinitrate, what is a priority nursing assessment? A) assess serum electrolytes B) measure blood urea nitrogen and creatinine C) assess blood pressure D) monitor level of consciousness
C) assess blood pressure Isosorbide dinitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.
When administering antianginal drugs, the nurse identifies which as the most common response? A) tachycardia B) bradypnea C) hypotension D) dry mouth
C) hypotension
A patient is being treated for short-term management of heart failure with milrinone. What is the primary nursing action? A) administer digoxin via IV infusion with the milrinone B) administer furosemide (Lasix) via IV infusion after the milrinone C) monitor cardiac rhythm and blood pressure continuously D) maintain an infusion of lactated Ringer with milrinone infusion
C) monitor cardiac rhythm and blood pressure continuously Milrinone lactate is a phosphodiesterase inhibitor administered intravenously for short-term treatment in patients with heart failure not responding adequately to digoxin, diuretics, or other vasodilators. Blood pressure and heart rate should be closely monitored. Digoxin is not administered with the milrinone but is usually tried before treatment with milrinone. Furosemide is not necessarily administered after the milrinone, although it could be. It is not, however, administered routinely via IV infusion. Lactated Ringer does not have to be administered with milrinone.
Which statement made by the patient demonstrates a need for further instruction regarding the use of nitroglycerin? A) "if I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief" B) "I should keep my nitroglycerin in a cool, dry place" C) "I should change positions slowly to avoid getting dizzy" D) "I can take up to five tablets at 3-minute intervals for chest pain if necessary"
D) "I can take up to five tablets at 3-minute intervals for chest pain if necessary" Patients are taught to take up to three tablets every 5 min. If no relief from chest pain is obtained after one tablet, they should seek medical assistance and take up to two more tablets. All other responses demonstrate a good understanding by the patient.
Which statement indicates to the nurse that the patient understands sublingual nitroglycerin medication instructions? A) "I will take up to five doses every 3 min for chest pain" B) "I can chew the tablet for the quickest effect" C) "I will keep the tablets locked in a safe place until I need them" D) "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness"
D) "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness" Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. Three doses can be taken 5 min apart. The tablet should be placed under the tongue to dissolve. The medication should be kept in a readily accessible location for immediate use should chest pain occur.
A patient with angina and a long history of severe chronic obstructive pulmonary disease is ordered beta blocker therapy. Which beta blocker would be most effective for this patient? A) propranolol B) nadolol C) pindolol D) atenolol
D) atenolol Both atenolol and metoprolol are safe for COPD patients because they are selective beta 1 blockers.
The nurse is monitoring a patient during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? A) blood pressure 110/90 mm Hg B) flushing C) headache D) chest pain
D) chest pain The patient should not continue to have chest pain while on IV nitroglycerin. This would prompt the nurse to intervene. Blood pressure of 110/90 mm Hg is not cause for concern and is expected with nitroglycerin. Headache and flushing are common side effects of nitroglycerin.
A nurse is monitoring a patient with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? A) blood pressure of 120/80 mm Hg B) heart rate of 70 beats/min C) ECG without evidence of ST changes D) patient stating that pain is 0 out of 10
D) patient stating that pain is 0 out of 10 The patient taking nitroglycerin should expect the therapeutic effect of absence of chest pain. It is unrealistic to expect that the patient's blood pressure, heart rate, and ECG will all be in completely normal range since variations in blood pressure and heart rate will occur as part of daily life and the patient may have some underlying cardiac disease that is producing the angina.
The nurse should teach the patient to report which of the following to the health care provider immediately if experienced after taking nitroglycerin? A) dizziness B) faintness C) headache D) persistent pain
D) persistent pain Persistent pain means that the nitroglycerin isn't working.
