Heart Failure Drugs Flashcards
. A patient about to receive his morning dose of digoxin (Lanoxin®) has an apical pulse of 70 beats per minute. What should the nurse do?
a. Administer the dose
b. Withhold the dose and notify the physician
c. Notify the physician and monitor the patient’s vital signs
d. Recheck the pulse, making sure to count for 1 full minute
ANS: A
Administer the dose if the apical pulse is 70 beats per minute; the dose should be held and the physician notified if the apical pulse is 60 beats per minute or less or higher than 120 beats per minute.
The nurse is assessing the patient before administration of a cardiac glycoside. Which condition can predispose a patient to digitalis toxicity?
a. Hypokalemia
b. Hyperkalemia
c. Hypocalcemia
d. Heart failure
ANS: A
Hypokalemia and hypercalcemia are two conditions that predispose a patient to digitalis toxicity. Heart failure is a therapeutic use for digitalis.
The nurse who is assessing a patient who is receiving intravenous (IV) digitalis recognizes that the drug has a negative chronotropic effect. How is a negative chronotropic effect evident in a patient?
a. By an increased heart rate
b. By a decreased heart rate
c. By decreased conduction
d. By increased ectopic beats
ANS: B
A negative chronotropic effect results in a reduced heart rate, which is one effect of cardiac glycosides.
- A patient has been taking digoxin (Lanoxin) at home but has developed toxicity. The physician has ordered digoxin immune Fab. The patient asks the nurse why the medication has been changed. Which is the nurse’s best response?
a. “It works faster than digoxin.”
b. “It is safer than digoxin and can be taken orally.”
c. “It helps to convert the fibrillating atria to a more normal rhythm.”
d. “This new drug is an antidote to digoxin and will help to lower the blood levels
ANS: D
Digoxin immune Fab, which is available as an IV dose only, is the antidote for a severe digoxin overdose.
A patient has been placed on a milrinone infusion as part of the therapy for end-stage heart failure. What risk should the nurse keep in mind while assessing this patient during the infusion?
a. Hypotension
b. Hyperkalemia
c. Hypertension
d. Decreased urine output
ANS: A
Milrinone may cause significant hypotension.
A patient with atrial fibrillation has been started on digoxin (Lanoxin), and 1 week later a digoxin level is drawn. Which result is within the normal therapeutic levels for digoxin?
a. 0.6 ng/mL
b. 1.5 ng/mL
c. 2.5 ng/mL
d. 3.0 ng/mL
ANS: B
The digoxin therapeutic window is between 0.8 and 2 ng/mL.
Which medication results in a drug interaction if given to a patient taking digitalis?
a. acetylsalicylic acid (Aspirin®)
b. acetaminophen (Tylenol®)
c. quinidine sulphate
d. Vitamin K
ANS: C
The most common drug–drug interactions with digoxin are with amiodarone hydrochloride, quinidine sulphate, and verapamil hydrochloride. These three drugs can increase digoxin levels by 50%.
A patient is beginning digoxin (Lanoxin) therapy. Which food should the nurse tell this patient to avoid when taking the digoxin dose?
a. Cooked vegetables
b. Canned fruits
c. Fried foods
d. Bran muffins
ANS: D
Bran, in large amounts, may decrease the absorption of oral digitalis drugs.
- The nurse is assessing a patient before administration of a cardiac glycoside. Which laboratory result can increase the toxicity of the drug?
a. Potassium level of 2.8 mmol/L
b. Potassium level of 4.9 mmol/L
c. Sodium level of 140 mmol/L
d. Calcium level of 10 mmol/L
ANS: A
Hypokalemia increases the chance of digitalis toxicity.
The nurse is administering the phosphodiesterase inhibitor milrinone. What is the drug’s positive inotropic effect?
a. Increased heart rate
b. Increased blood vessel dilation
c. Increased force of cardiac contraction
d. Increased conduction of electrical impulses across the heart
ANS: C
Positive inotropic drugs increase myocardial contractility
Which condition predisposes a patient to digitalis toxicity?
a. Hypercalcemia and advanced age
b. Hyperthyroidism and liver dysfunction
c. Ventricular fibrillation and hyperkalemia
d. Dysrhythmias and hypernatremia
ANS: A
Advanced age, atrioventricular block, dysrhythmias, hypercalcemia, hypokalemia, hypothyroid, respiratory or kidney disease, liver dysfunction, use of a pacemaker, and ventricular fibrillation are conditions that predispose a patient to digitalis toxicity.
Which assessment result is the most important indicator of an exacerbation of heart failure?
a. Increased weight
b. Hypokalemia
c. Increased pulse
d. Increased oxygen saturation
ANS: A
Patients should be weighed at the same time each day and with the same amount of clothing because weight is an important indicator of fluid volume overload or the exacerbation of heart failure
When a patient is experiencing digoxin toxicity, which clinical situations necessitate the use of digoxin immune Fab? (Select all that apply.)
a. The patient reports seeing colourful halos around lights.
b. The patient’s serum potassium level is above 5 mmol/L.
c. The patient is experiencing nausea and anorexia.
d. The patient’s heart rhythm is atrial flutter with a rate of 115 per minute.
e. The patient is experiencing long runs of ventricular tachycardia.
f. The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing.
g. The patient has taken an overdose of greater than 10 mg of digoxin.
h. The patient reports fatigue and headaches.
ANS: B, E, F, G
Clinical situations that require the use of digoxin immune Fab in a patient with digoxin toxicity include a serum potassium level above 5 mmol/L, long runs of ventricular tachycardia, severe sinus bradycardia that does not respond to cardiac pacing, and an overdose of greater than 10 mg of digoxin. Seeing colourful halos around lights, experiencing nausea and anorexia, and experiencing fatigue and headaches are potential adverse effects of digoxin therapy but are not necessarily reasons for digoxin immune Fab treatment. Digoxin immune Fab is the antidote for severe digoxin overdose and is indicated for the reversal of life-threatening cardiotoxic effects; fatigue and headache are not life-threatening.
