Lilley Chapter 25: Heart Failure Drugs Flashcards
A pediatric patient weighing 66 lb is prescribed digoxin (Lanoxin) 12 mcg/kg in 3 evenly divided doses. How much will the nurse administer per dose?
120 mcg
The nurse is preparing to administer digoxin (Lanoxin®) 0.25 mg intravenous push to a patient. Which is an expected patient outcome related to the administration of digoxin?
A. Reduced urine output
B. Decreased heart rate
C. Low serum potassium
D. Increased blood pressure
B. Decreased heart rate
Digoxin has a negative chronotropic effect (decreased heart rate).
The patient’s serum digoxin level is 0.4 ng/mL. How does the nurse interpret this laboratory value result for digoxin?
A. Normal therapeutic level
B. Below the therapeutic level
C. Above the therapeutic level
D. A toxic serum blood level
B. Below the therapeutic level
Therapeutic serum digoxin levels are 0.8 to 2 ng/mL.
A patient prescribed digoxin (Lanoxin®) 0.25 mg and furosemide 40 mg for the treatment of systolic heart failure states, “I am starting to see yellow halos around lights.” Which action will the nurse take?
A. Document the finding and reassess in 1 hour.
B. Perform a visual acuity test on each eye.
C. Prepare to administer digoxin immune Fab (Digifab®).
D. Assess for other symptoms of digoxin toxicity.
D. Assess for other symptoms of digoxin toxicity.
Seeing yellow-green halos around objects is a symptom of digoxin toxicity. Other signs and symptoms of digoxin toxicity include headache, dizziness, confusion, nausea, and blurred vision. Electrocardiogram findings show heart block, atrial tachycardia with block, or ventricular dysrhythmias.
A patient weighing 44 lb is prescribed a digoxin (Lanoxin) loading dose of 0.03 mg/kg to be administered in three divided doses. How much will the nurse administer in each dose?
A. 0.4 mg
B. 0.6 mg
C. 0.3 mg
D. 0.2 mg
D. 0.2 mg
44 lb is converted to kilograms by dividing 44 by 2.2 kg, which equals 20 kg. Multiplying 0.03 mg/kg by 20 kg results in 0.6 mg, and then dividing 0.6 mg by 3 doses equals 0.2 mg/dose.
What are therapeutic effects of digoxin?
A. Positive inotropic, positive chronotropic, and negative dromotropic
B. Positive inotropic, negative chronotropic, and positive dromotropic
C. Positive inotropic, negative chronotropic, and negative dromotropic
D. Negative inotropic, negative chronotropic, and negative dromotropic
C. Positive inotropic, negative chronotropic, and negative dromotropic
Digoxin increases cardiac contractility (positive inotropic effect), decreases heart rate (negative chronotropic effect), and decreases conductivity (negative dromotropic effect).
Phosphodiesterase inhibitors (PDIs) have an added advantage in treating heart failure: these drugs cause a positive inotropic effect. What other effect do they cause?
A. Vasoconstriction
B. Bronchodilation
C. Platelet inhibition
D. Vasodilation
D. Vasodilation
PDIs are also called “inodilators” because they have both positive inotropic and vasodilatory effects.
The nurse reviews an adult patient’s laboratory values and notes a digoxin level of 11 ng/mL and a serum potassium level of 6.2 mmol/L. The nurse would notify the health care provider and anticipate that which medication will be prescribed to administer?
A. epinephrine
B. sodium polystyrene sulfonate
C. digoxin immune Fab
D. atropine
C. digoxin immune Fab
Digoxin immune Fab is indicated for severe digoxin toxicity in patients with the following clinical findings: hyperkalemia (serum potassium level higher than 5 mmol/L) with digoxin toxicity; life-threatening digoxin overdose (more than 10 mg digoxin in adults; more than 4 mg digoxin in children); and life-threatening cardiac dysrhythmias, sustained ventricular tachycardia or fibrillation, and severe sinus bradycardia or heart block unresponsive to atropine treatment or cardiac pacing.
The nurse would question the use of milrinone in a patient with which condition?
A. Aortic regurgitation
B. Mitral valve prolapse
C. Acute renal failure
D. Systolic heart failure
A. Aortic regurgitation
Milrinone, a PDI, is contraindicated in severe aortic or pulmonary valvular disease and in diastolic heart failure.
When teaching a patient regarding the administration of digoxin (Lanoxin), the nurse instructs the patient not to take this medication with which food?
A. Wheat bran
B. Bananas
C. Scrambled eggs
D. French toast
A. Wheat bran
Encourage patients to avoid using antacids or eating ice cream, milk products, yogourt, cheese (dairy products), or bran for 2 hours before or 2 hours after taking medication, to avoid interference with the drugs absorption.
For a patient receiving a positive inotropic drug, which nursing assessments should be performed? (Select all that apply.)
Select all that apply.
A. Obtain daily weights.
B. Monitor serum electrolytes.
C. Review red blood cell count.
D. Auscultate lung sounds.
E. Check apical pulse.
A, B, D, E.
All of these assessments are appropriate for patients receiving a positive inotropic drug. Lung sounds and daily weight measurement are appropriate assessments related to the treatment of heart failure with inotropic drugs. Apical pulse and serum electrolytes are important assessments related to potential adverse reactions (bradycardia, toxicity with hypokalemia).
Signs and symptoms of cardiac glycoside toxicity. What manifestations should be informed?
A. visual changes such as photophobia
B. flickering lights or halos around lights
C. dizziness when standing up
D. Increased urine output
B.
During assessment of a patient wh is receiving digoxin, which findings would indicate toxicty?
A. Apical pulse 62 beats/min
B. digoxin level of 1.5 ng/ml
C. serum potassum level of 2
D. Serum calcium evel of 4.8 mmol/L
C.
When monitoring a patient receiving IV milrinone, which adverse effect will the nurse closely monitor for?
A. Anemia
B. Proteinuria
C. Thrombocytopenia
D. Decreased blood urea nitrogen and creatinine levels
C.
A patient is taking a beta blocker as treatment for heart failure. the nurse knows that the purpose of beta blocker for this patient is to do which of the following?
A. increase urine output
B. prevent stimulation of the heart by catecholamines
C. increase the contractility of the heart muscle
D. cause peripheral dilation
B.
