Chapter 44: Cardiotonic Agents

A nurse must immediately report serum digoxin levels greater than:

2.0 nanograms/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 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

Which instructions would be appropriate to include in the teaching plan for a patient taking digoxin at home? (

"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."

A male client is diagnosed with renal failure secondary to diabetes mellitus. Based on the new diagnosis, how will the physician safely adjust the client's digoxin dose?

0.125 mg three times a week

Clients on digoxin need to have their digoxin level monitored. The nurse identifies the therapeutic range for digoxin as:

0.8 to 2 ng/mL.

A patient is receiving digoxin. The nurse monitors the patient's digoxin level. Which finding would the nurse interpret as therapeutic?

1.5 ng/mL

A patient is receiving milrinone IV. The nurse would administer the bolus over which time frame?

10 minutes

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.

Beta-blockers reduce both morbidity and mortality associated with heart failure. By what mechanism do they work in heart failure?

They block the sympathetic response.

A nurse assessing a patient on digoxin observes features of toxicity. Which visual disturbance should the nurse assess for in such patients?

Yellow or green vision

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.

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

on an empty stomach.

Which of the digoxin levels indicate the patient is experiencing toxicity?

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

Which assessment findings may indicate the client is experiencing digitalis toxicity?

Abdominal pain Diarrhea Drowsiness Vomiting

After receiving a loading dose of milrinone (Primacor), what is a client most likely to experience?

Angina Headache

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 physician to order what medication to treat the bradycardia?

Atropine

After teaching a group of students about cardiomyopathy as a cause of heart failure, the instructor determines the need for additional teaching when the students identify what as a cause of cardiomyopathy?

Bacterial infection

The home care nurse sees a patient for the first time. The patient has crackles in the lower lobes of the lungs, an audible S3, and pitting edema in the feet and ankles. What condition is the patient experiencing?

Congestive heart failure

When describing how vasodilators help alleviate heart failure, which would the nurse include?

Decrease afterload

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?

Decreased Cardiac Output related to altered cardiac function

A patient is being treated for heart failure. Which is indicative of improved heart failure status?

Decreased pedal edema

Which would the nurse identify as a cardiac glycoside?

Digoxin

A patient is experiencing nausea and visual disturbances when taking digoxin (Lanoxin). Which medication will be administered?

Digoxin immune fab (Digibind)

A male client is diagnosed with heart failure. The physician 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.

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

Cardiotonic drugs are used to treat which medical condition?

Heart failure Atrial fibrillation

Which is the result of positive inotropic activity?

Increased cardiac output

Digoxin (Lanoxin) exerts which effects on the heart?

Increases force of contraction Slows the conduction velocity through the atrioventricular (AV) node Decreases heart rate

Which dosage forms are used for digoxin (Lanoxin) maintenance therapy?

Injection Capsule Tablet

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

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 apical pulse

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

Nocturia

A patient has been admitted to a health care center with reports of dyspnea. Which signs should the nurse monitor for when assessing the patient for left ventricular dysfunction?

Orthopnea

When dosing digoxin (Lanoxin), which factors are considered?

Patient lean body weight Patient age Renal function Pharmacokinetics Pharmacodynamics

Which would a nurse expect to assess if a client is experiencing right-sided heart failure?

Peripheral edema

A nurse is required to monitor a patient for right ventricular dysfunction. Which is one of the most common symptoms associated with right ventricular dysfunction?

Pitting edema

A client is receiving inamrinone. Which would be most important for the nurse to monitor?

Platelet count

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

Positive inotropic

A patient with a history of congestive heart failure is being treated with digoxin (Lanoxin). This medication increases the force of contractions of the heart. What effect improves the contractility of the heart?

Positive inotropic effect

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

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