Deck 19: Heart Failure and Digoxin

Question 1

A patient comes to the clinic with a recent onset of nocturnal and exertional dyspnea.The primary care nurse practitioner (NP)auscultates S₃ heart sounds but does not palpate hepatomegaly.The patient has mild peripheral edema of the ankles.The NP should consult a cardiologist to discuss prescribing a(n):

A) b-blocker.
B) loop diuretic.
C) angiotensin-converting enzyme (ACE) inhibitor.
D) angiotensin receptor blocker (ARB).

Answer 1

loop diuretic.

Question 2

A patient has heart failure.A recent echocardiogram reveals decreased compliance of the left ventricle and poor ventricular filling.The patient takes low-dose furosemide and an ACE inhibitor.The primary care NP sees the patient for a routine physical examination and notes a heart rate of 92 beats per minute and a blood pressure of 100/60 mm Hg.The NP should:

A) order serum electrolytes.
B) obtain renal function tests.
C) consider prescribing a b-blocker.
D) call the patient's cardiologist to discuss adding digoxin to the patient's regimen.

Answer 2

order serum electrolytes.

Question 3

A patient who has heart failure has been treated with furosemide and an ACE inhibitor.The patient's cardiologist has added digoxin to the patient's medication regimen.The primary care NP who cares for this patient should expect to monitor:

A) serum electrolytes.
B) blood glucose levels.
C) serum thyroid levels.
D) complete blood counts (CBCs).

Answer 3

serum electrolytes.

Question 4

A primary care NP is preparing to order digoxin for an 80-year-old patient who has systolic heart failure.The NP obtains renal function tests,which are normal.The NP should:

A) prescribe a digoxin 0.125 mg tablet once daily.
B) give an initial dose of 0.5 mg digoxin tablet and then 0.125 mg every 6 hours × 4.
C) administer a digoxin 0.6 mg capsule once and then 0.3 mg every 8 hours × 3.
D) administer a loading dose of intravenous digoxin in the clinic and then give 0.125 mg once daily.

Question 5

A primary care NP sees a patient who is being treated for heart failure with digoxin,a loop diuretic,and an ACE inhibitor.The patient reports having nausea.The NP notes a heart rate of 60 beats per minute and a blood pressure of 100/60 mm Hg.The NP should:

A) decrease the dose of the diuretic to prevent further dehydration.
B) obtain a serum potassium level to assess for hyperkalemia.
C) hold the ACE inhibitor until the patient's blood pressure stabilizes.
D) obtain a digoxin level before the patient takes the next dose of digoxin.

Question 6

A patient who takes spironolactone for heart failure has begun taking digoxin (Lanoxin)for atrial fibrillation.The primary care NP provides teaching for this patient and asks the patient to repeat back what has been learned.Which statement by the patient indicates understanding of the teaching?

A) "I should avoid high-sodium foods."
B) "I should eat foods high in potassium."
C) "I need to take a calcium supplement every day."
D) "I should use a salt substitute while taking these medications."

Question 7

A patient who has been taking digoxin 0.25 mg daily for 6 months reports that it is not working as well as it did initially.The primary care NP should:

A) recommend a reduced potassium intake.
B) increase the dose of digoxin to 0.5 mg daily.
C) hold the next dose of digoxin and obtain a serum digoxin level.
D) contact the patient's pharmacy to ask if generic digoxin was dispensed.