Question 1

A patient asks the nurse why nitroglycerin is given sublingually. The nurse will explain that nitroglycerin is administered by this route for which reason?

Accepted Answer

Nitroglycerin is administered sublingually to increase the rate of absorption as it allows for rapid onset and quick relief of symptoms in case of angina. It bypasses the liver, which usually breaks down medications before they enter the systemic circulation. Sublingual administration also minimizes gastrointestinal upset and does not affect blood pressure.

Question 2

The nurse is caring for a patient who is taking digoxin to treat HF. The patient's ECG shows a ventricular dysrhythmia. The nurse will notify the provider and will anticipate an order for which medication to treat a digoxin-induced ventricular dysrhythmia?

Accepted Answer

Phenytoin (Dilantin) is used to treat digoxin-induced ventricular dysrhythmias.

Question 3

A patient with chronic obstructive pulmonary disease (COPD) has increasing dyspnea and is being evaluated for HF. Which test will be ordered to help differentiate between dyspnea due to lung dysfunction and dyspnea due to HF?

Accepted Answer

Brain natriuretic peptide (BNP) level is the best choice to differentiate between dyspnea due to lung dysfunction and dyspnea due to heart failure (HF). BNP is a hormone secreted by the heart in response to increased pressure and volume. Elevated levels of BNP indicate the presence of HF, while normal levels suggest that dyspnea is likely due to lung dysfunction. ANH is also a hormone secreted by the heart, but it is not as specific as BNP in diagnosing HF. Cardiac enzymes and ECG may not necessarily differentiate between dyspnea due to lung dysfunction or HF.

Question 4

A patient who takes digoxin to treat HF will begin taking a vasodilator. The patient asks the nurse why this new drug has been ordered. The nurse will explain that the vasodilator is used to:

Accepted Answer

Vasodilators are prescribed to decrease ventricular stretching and improve cardiac output by reducing peripheral resistance and decreasing afterload. This helps the heart work more efficiently and can aid in the treatment of heart failure. Vasodilators do not generally promote peripheral fluid loss, and while improved renal perfusion may be a potential benefit of the medication, it is not the primary reason for its use in treating heart failure.

Question 5

A patient who has HF receives digoxin (Lanoxin) and an angiotensin-converting enzyme (ACE) inhibitor. The patient will begin taking spironolactone (Aldactone). The patient asks why the new drug is necessary. The nurse will tell the patient that spironolactone will be given for which reason?

Accepted Answer

Spironolactone is used in patients with heart failure to provide cardioprotective effects. It is an aldosterone antagonist that has been shown to decrease morbidity and mortality in patients with severe heart failure. It works by blocking the effects of aldosterone on the heart and blood vessels, leading to improved cardiac function and decreased fluid retention. It can also help regulate potassium levels in patients with heart failure.

Question 6

A patient is diagnosed with heart failure (HF), and the prescriber has ordered digoxin. The patient asks what lifestyle changes will help in the management of this condition. The nurse will recommend which changes?

Accepted Answer

Lifestyle modifications that can improve the management of heart failure include limiting alcohol to no more than one drink per day, reducing sodium intake to less than 2-3 grams per day, and engaging in moderate exercise as tolerated. Cigarette and pipe smoking should be avoided altogether. Aerobic exercise and weight lifting should be done only with the guidance of a healthcare provider.

Question 7

The nurse performs a medication history and learns that the patient takes a loop diuretic and digoxin (Lanoxin). The nurse will question the patient to ensure that the patient is also taking which medication?

Accepted Answer

Loop diuretics, such as furosemide, can cause potassium depletion. Since digoxin increases the contractility of the heart muscle, potassium depletion can increase the risk of digoxin toxicity. Therefore, the nurse will question the patient to ensure they are also taking potassium supplementation.

Question 8

The nurse is teaching a patient about the use of a transdermal nitroglycerin patch. Which statement by the patient indicates understanding of the teaching?

Accepted Answer

Option A is incorrect because the patch should be applied on a regular basis as prescribed by the healthcare provider and not as needed. Option B is incorrect because the patch should be changed after a certain number of hours as prescribed by the healthcare provider, not just at bedtime each day. Option D is incorrect because stopping the use of transdermal nitroglycerin abruptly can lead to rebound angina, and patients should gradually decrease the dosage. Option C is correct because rotating sites when changing the patch can help prevent skin irritation.

Question 9

A patient who has atrial fibrillation is taking digoxin. The nurse expects which medication to be given concurrently to treat this condition?

Accepted Answer

Warfarin (Coumadin) is often prescribed concurrently with digoxin in patients with atrial fibrillation to prevent the formation of blood clots, which is a common complication of atrial fibrillation.

Question 10

The nurse is preparing to administer digoxin to a patient who has a serum digoxin level of 2.5 ng/mL. The patient takes 0.25 mg of digoxin per day. What action will the nurse take?

Accepted Answer

A serum digoxin level of 2.5 ng/mL is above the therapeutic range (0.5-2.0 ng/mL) and indicates digoxin toxicity. The nurse should not administer the next dose and immediately notify the provider.

Question 11

A patient who has begun taking nifedipine (Procardia) to treat variant angina has had a recurrent blood pressure of 90/60 mm Hg or less. The nurse will anticipate that the provider will do which of the following?

Accepted Answer

Nifedipine is a calcium channel blocker that causes vasodilation and can lower blood pressure. In this patient, the recurrent blood pressure of 90/60 mm Hg or less suggests that the nifedipine dose may need to be adjusted or a different medication may need to be considered. Diltiazem is another calcium channel blocker that can be used to treat variant angina and has less of an effect on blood pressure compared to nifedipine. Adding digoxin or ordering serum liver enzymes would not address the low blood pressure issue, and changing to a beta blocker may not be appropriate for variant angina.

Question 12

A patient who has been taking nitroglycerin for angina has developed variant angina, and the provider has added verapamil (Calan) to the patient's regimen. The nurse will explain that verapamil is given for which purpose?

Accepted Answer

Verapamil is a calcium channel blocker that works by relaxing coronary arteries, thereby increasing blood flow to the heart muscles and reducing the frequency and severity of angina attacks.

Question 13

The nurse administers a dose of digoxin (Lanoxin) to a patient who has HF and returns to the room later to reassess the patient. Which finding indicates that the medication is effective?

Accepted Answer

Dyspnea (difficulty breathing) is a classic symptom of heart failure. Digoxin works by increasing the strength and efficiency of heart contractions, which can lead to improved cardiac output and decreased dyspnea. Decreased urine output (B) and increased blood pressure (C) are not desirable effects of digoxin and may indicate toxicity. Increased heart rate (D) is also not necessarily an indicator of effectiveness and may indicate adverse effects such as tachycardia or arrhythmias.

Question 14

The nurse is teaching a patient about sublingual nitroglycerin administration. What information will the nurse include when teaching this patient?

Accepted Answer

The first dose of sublingual nitroglycerin should be taken while sitting or lying down to prevent dizziness or fainting from a sudden drop in blood pressure. Option A is incorrect because the patient should call 911 if pain does not improve after one dose, not three. Option B is incorrect because a second dose should only be taken if symptoms continue, and the patient should wait 5 minutes before taking the second dose. Option C is incorrect because the tablet should be placed under the tongue and allowed to dissolve, not swallowed with water.

Question 15

A patient who just started using transdermal nitroglycerin reports having headaches. The nurse will counsel the patient to perform which action?

Accepted Answer

Headaches are a common side effect of nitroglycerin due to its vasodilating effects, which can cause increased blood flow to the brain. Taking acetaminophen as needed is a recommended approach to manage this side effect.

Question 16

A patient who has stable angina pectoris is given nitroglycerin to use as needed. In addition to pharmacotherapy, the nurse will give the patient which instruction?

Accepted Answer

Nitroglycerin is commonly prescribed for patients with stable angina pectoris to help relieve chest pain. Patients are advised to avoid extremes in weather because both very hot and very cold temperatures can trigger angina attacks by increasing the workload on the heart.

Question 17

The nurse provides teaching for a patient who has a ventricular dysrhythmia who is prescribed acebutolol (Spectral) 200 mg twice daily. Which statement by the patient indicates understanding of the teaching?

Accepted Answer

Stopping acebutolol abruptly can lead to rebound hypertension or angina, so it is important for the patient to not stop taking the medication suddenly. Option A is incorrect because diuretics do not affect the effectiveness of acebutolol. Option B is incorrect because dizziness, nausea, and vomiting are common side effects of acebutolol and do not necessarily indicate a severe reaction. Option C is incorrect because although potassium is important for heart health, there is no specific dietary recommendation for increasing potassium intake while taking acebutolol.

Question 18

The nurse is preparing to administer digoxin to a patient who has HF. The patient reports nausea, vomiting, and visual halos around objects. The nurse notes a respiratory rate of 18 breaths per minute, a heart rate of 58 beats per minute, and a blood pressure of 120/78 mm Hg. What will the nurse do next?

Accepted Answer

The symptoms reported by the patient (nausea, vomiting, and visual halos) as well as the vital signs (heart rate of 58 beats per minute) may indicate digoxin toxicity. Therefore, the nurse should hold the dose and notify the provider for further instructions. Administering the next dose could worsen the toxicity, and reassuring the patient is not appropriate. There is no indication for an antiemetic or an analgesic medication in this case.

Question 19

A patient is ordered to receive a nitrate to relieve stable angina. What side effect(s) will the nurse anticipate in a patient receiving this medication?

Accepted Answer

Nitrate medications such as nitroglycerin commonly cause headache as a side effect. Other potential side effects may include dizziness, flushing, and hypotension.

Quiz 37: Cardiac Glycosides, Antianginals, and Antidysrhythmics