Deck 22: Positive Inotropic Drugs

Question 1

When a patient is experiencing digoxin toxicity,which clinical situations necessitate the use of digoxin immune Fab (Digibind)? Select all that apply.

A)The patient reports seeing colourful halos around lights.
B)The patient's serum potassium level is above 5 mEq/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.

Answer 1

The patient's serum potassium level is above 5 mEq/L.
The patient is experiencing long runs of ventricular tachycardia.
The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing.
The patient has taken an overdose of greater than 10 mg of digoxin.

Question 2

The nurse is assessing a patient before administration of a cardiac glycoside.Which lab result can increase the toxicity of the drug?

A)Potassium level 2.8 mEq/L
B)Potassium level 4.9 mEq/L
C)Sodium level 140 mEq/L
D)Calcium level 10 mg/dL

Answer 2

Potassium level 2.8 mEq/L

Question 3

Which of the following assessments is the most important indicator of an exacerbation of heart failure in a patient?

A)Increased weight
B)Hypokalemia
C)Increased pulse
D)Increased oxygen saturation

Answer 3

Increased weight

Question 4

A patient with atrial fibrillation has been started on digoxin (Lanoxin),and 1 week later a digoxin level is drawn.Which of the following results is within normal therapeutic levels for digoxin?

A)0.1-0.6 nmol/L
B)0.7-1.5 nmol/L
C)2.0-2.5 nmol/L
D)2.5-3.0 nmol/L

Question 5

A patient has been taking digoxin (Lanoxin)at home but has developed toxicity.The physician has ordered digoxin immune Fab (Digibind).The patient asks the nurse why the medication has been changed.Which of the following is the nurse's best response to the patient?

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."

Question 6

A patient has been placed on a milrinone infusion as part of the therapy for end-stage heart failure.Which of the following risks should the nurse keep in mind while assessing this patient during the infusion?

A)Hypotension
B)Hyperkalemia
C)Hypertension
D)Decreased urine output

Question 7

The nurse is assessing the patient before administration of a cardiac glycoside.Which of the following conditions can predispose a patient to digitalis toxicity?

A)Hypokalemia
B)Hyperkalemia
C)Hypocalcemia
D)Heart failure

Question 8

Which of the following conditions predispose a patient to digitalis toxicity?

A)Hypercalcemia and advanced age
B)Hyperthyroidism and liver dysfunction
C)Ventricular fibrillation and hyperkalemia
D)Dysrhythmias and hypernatremia

Question 9

The nurse is administering the phosphodiesterase inhibitor milrinone.Which of the following describes 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

Question 10

The nurse is assessing a patient who is receiving intravenous (IV)digitalis and recognizes that the drug has a negative chronotropic effect.How is this drug effect made evident in the patient?

A)Increased heart rate
B)Decreased heart rate
C)Decreased conduction
D)Increased ectopic beats

Question 11

A patient about to receive his morning dose of digoxin (Lanoxin)has an apical pulse of 70.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

Question 12

A patient is beginning digoxin (Lanoxin)therapy.Which of the following foods 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

Question 13

Which of the following medications results in a drug interaction if given to a patient taking digitalis?

A)acetylsalicylic acid (Aspirin)
B)acetaminophen (Tylenol)
C)Steroids
D)Vitamin K