Chapter 44 Questions

Digoxin has been prescribed for an outclient with symptomatic heart failure. What is the priority teaching point to convey to this client? -"Try to limit the number of high-potassium foods in your diet." -"Make sure to take your pulse for a minute before taking your digoxin." -"Plan to take your digoxin on an empty stomach to make sure it's fully absorbed." -"If the swelling in your feet gets worse, you can take up twice your normal dose for 1 day."

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

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."

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 2.2 ng/mL 2.5 ng/mL 3.1 ng/mL

1.5 ng/mL .5-2 therapeutic

A client is receiving furosemide. When monitoring daily laboratory values, what should the potassium level be for this client? 1.5 to 2.0 mEq/L 3.5 to 5.0 mEq/L 5.0 to 7.5 mEq/L 6.0 to 6.5 mEq/L

3.5 to 5

A nurse is administering digoxin intravenously as ordered. The nurse would administer the drug over which time frame? 2 minutes 3 minutes 4 minutes 5 minutes

5 minutes

ACE inhibitors and other vasodilators are used in the early treatment of HF. They act to a. decrease workload on the heart by lowering preload and afterload. b. increase arterial pressure and perfusion. c. cause pooling of the blood and decreased venous return to the heart. d. increase the release of aldosterone and improve fluid balance.

A

When assessing a patient with right-sided HF, the nurse would expect to find edema a. in gravity-dependent areas. b. in the hands and fingers. c. around the eyes. d. when the patient is lying down.

A

HF occurs when the heart fails to pump effectively. Which could cause HF? (select all that apply) a. Coronary artery disease b. Chronic hypertension c. Cardiomyopathy d. Fluid overload e. Pneumonia f. Cirrhosis

A, B, C

A client develops left-sided HF after an MI. Which would the nurse expect to find during the client assessment? (select all that apply) a. Orthopnea b. Polyuria c. Tachypnea d. Dyspnea e. Blood-tinged sputum f. Swollen ankles

A, C, D, E

A nurse assessing a patient with HF would expect to find? a. cardiac arrest. b. congestion of blood vessels. c. an MI. d. a pulmonary embolism.

B

A nurse would instruct a patient taking Lanoxin (digoxin) for the treatment of HF to take which action? a. Make up any missed doses the next day. b. Report changes in heart rate. c. Avoid exposure to the sun. d. Switch to generic tablets if less expensive.

B

A nurse is about to administer Lanoxin to a patient whose apical pulse is 48 beats/min. He or she should a. administer the drug and notify the prescriber that the heart rate is low. b. retake the pulse in 15 minutes and give the drug if the pulse has not changed. c. retake the pulse in 1 hour and withhold the drug if the pulse is still less than 60 beats/min. d. withhold the drug and notify the prescriber that the heart rate is below 60 beats/min.

C

Calcium is needed in the cardiac muscle a. to break apart actin-myosin bridges. b. to activate troponin. c. to promote contraction via sliding. d. to maintain the electrical rhythm

C

A nurse is preparing to administer a prescribed cardiac glycoside to a patient based on the understanding that this group of drugs acts in which way? a. They block the sympathetic nervous system. b. They block the renin-angiotensin system. c. They block the parasympathetic influence on the heart muscle. d. They affect intracellular calcium levels in the heart muscle.

D

How does ivabradine (Corlanor) work in the body? a. Blocks beta-receptors to slow the heart rate b. Slows influx of calcium to decrease force of contraction c. Slows influx of calcium and relaxes blood vessels d. Reduces heart rate by inhibiting action potentials at the SA node

D

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

T or F The primary treatment for congestive heart failure is to make the heart beat harder and faster

False Primary treatment involves increasing muscle contractility, bringing the system back into balance

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

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 caring for a patient who has presented to the emergency department with signs and symptoms of an acute MI. While making an initial assessment of this patient the nurse notes the patient has had adverse reactions to digoxin and a history of congestive heart failure. The physician writes admission orders. Which of the following drugs would be of concern? a. furosemide (lasix) b. Milrinone (Primacor) c. Propranolol (inderal) d. Aspirin

Milrinone (primacor) they are contraindication in the following conditions: severe aortic or pulmonic valvular disease, which would be exacerbated by increased contraction; acute MI, which could be exacerbated by increased oxygen consumption and increase force of contraction; fluid volume deficit, which could be made worse by increased renal perfusion; and ventricular arrhythmias, which could be exacerbated by these drugs

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? -Administer medication -Notify the health care provider -Assess the blood pressure -Administer half of the dose

Notify 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 -Hemoptysis -Dyspnea -Polyuria

Peripheral Edema

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? -Electrocardiogram results -Potassium levels -Sodium levels -Liver enzymes

Potassium levels Although it is important to monitor the client's ECG, it is more important to closely monitor potassium levels when the client is taking a drug that promotes the loss of potassium, such as thiazide or loop diuretics.

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.

Vasodilators used to treat heart failure include nitrates and ACE inhibitors. True False

True

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

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 is receiving digoxin and experiences severe bradycardia. Which medication would the nurse anticipate administering if prescribed? -atropine -milrinone (primacor) -activated charcoal -propafenone

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.

Which medication will be administered to a client experiencing severe digitalis poisoning? -acetylsalicylic acid -nesiritide -felbamate -digoxin immune fab

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? -pneumonia -liver disease -heart failure -myocardial infarction

heart failure The cardinal manifestations of heart failure are dyspnea and fatigue, which can lead to exercise intolerance and fluid retention. Fluid retention results in the development of pulmonary congestion and peripheral edema. An audible S3 is often present. The client is not presenting with myocardial infarction symptoms since there is no mention of chest pain. Neither pneumonia nor liver failure would present with the audible S3 sound.

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

intravenous

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 more accurately gauge the effect of digoxin on the client's cardiac function -to rapidly bring the client's serum digoxin levels up to therapeutic levels -to confirm that the client does not have a hypersensitivity to digoxin -to mitigate the potential for adverse effects

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