Lilley Chapter 25: Heart Failure Drugs Flashcards
A patient about to receive his morning dose of digoxin 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.
a. Administer the dose
The dose should only be held 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 cardiac glycoside. Which condition can predispose a patient to digitalis toxicity?
a. Hypokalemia
b. Hyperkalemia
c. Hypocalcemia
d. Heart failure
a. Hypokalemia
The nurse who is assessing a patient who is receiving 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
b. B y a decreased heart rate.
A patient has been taking digoxin 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”
d. “This new drug is an antidote to digoxin and will help to lower the blood levels”
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
a. Hypotension
A patient with atrial fibrillation has been started on digoxin, and 1 week later a digoxin level is drawn. Which result is within the normal therapeutic levels for digoxin?
a. 0.1 - 0.6
b. 0.7 - 1.5
c. 2.0 - 2.5
d. 2.5 to 3.0
c. 2.0 - 2.5
According to Lilley text: The digoxin therapeutic window is between 0.8 and 2.0.
Which medication results in a drug interaction if given to a patient taking digitalis?
a. Acetylsalicylic acid
b. Acetaminophen
c. quinidine sulphate
d. Vitamin K
c. quinidine sulphate
The most common drug-drug interactions with digoxin are with amiodarone, quinidine sulphate, and verapamil. These three drugs can increase digoxin levels by 50%.
A patient is beginning digoxin 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
d. Bran muffins
Bran muffins, in large amounts may decrease the absorption of oral digitalis drugs.
The nurse is assessing a patient before administration of 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
a. Potassium level of 2.8 mmol/L
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.
c. Increased force of cardiac contraction
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
a. Hypercalcemia and advanced age.
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
a. Increased weight
Patients should be weighed at the same time each day 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 10mg of digoxin.
h. The patient reports fatigue and headaches.
b. The patient’s serum potassium level is above 5 mmol/L
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 10mg of digoxin.
