Question 1

A patient has been taking digoxin at home but took an accidental overdose and has developed toxicity.The patient has been admitted to the telemetry unit,where the physician has ordered digoxin immune Fab (Digifab).The patient asks the nurse why the medication is ordered.What is the nurse's best response?

Accepted Answer

Digifab is used as an antidote to digoxin toxicity. It works by binding to the digoxin in the bloodstream, which helps to remove it from the body and lower the blood levels. This can help to reverse the toxic effects of digoxin on the heart and other organs.

Question 2

While assessing a patient who is receiving intravenous digitalis,the nurse recognizes that the drug has a negative chronotropic effect.How would this drug effect be evident in the patient?

Accepted Answer

Digitalis has a negative chronotropic effect, meaning it decreases the heart rate. Therefore, the most evident effect of this drug would be a decreased heart rate in the patient.

Question 3

A patient has a digoxin level of 1.1 ng/mL.Which interpretation by the nurse is correct?

Accepted Answer

The therapeutic level for digoxin is 0.5-2.0 ng/mL, so a value of 1.1 ng/mL is within this range and considered therapeutic.

Question 4

In assessing a patient before administration of a cardiac glycoside,the nurse knows that which lab result can increase the toxicity of the drug?

Accepted Answer

Low potassium levels (hypokalemia) can increase the toxicity of cardiac glycosides by increasing the affinity of the glycoside for its receptor in the heart. A potassium level of 2.8 mEq/L is significantly low and increases the risk of toxicity. Therefore, it is important for the nurse to monitor and correct the patient's potassium levels before administering the drug.

Question 5

When administering digoxin immune Fab (Digibind)to a patient with severe digoxin toxicity,the nurse knows that each vial can bind with how much digoxin?

Accepted Answer

One vial of digoxin immune Fab binds 0.5 mg of digoxin. The other options are incorrect.

Question 6

Which drug classes are considered first-line treatment for heart failure? (Select all that apply.)

Accepted Answer

The first-line treatment options for heart failure include:
- Angiotensin-converting enzyme (ACE) inhibitors: These medications help to relax the blood vessels and improve blood flow, which reduces the workload on the heart. They also help to prevent the progression of heart failure and improve survival.
- Angiotensin II receptor blockers (ARBs): These medications work in a similar way to ACE inhibitors, but they block the effects of a hormone called angiotensin II directly at the receptor sites. They can be used in patients who cannot tolerate ACE inhibitors.
- Beta blockers: These medications slow down the heart rate and reduce the workload on the heart, which can help to improve symptoms and prevent worsening of heart failure. They also improve survival.
Therefore, A, B, and D are the best choices for first-line treatment of heart failure. Digoxin and nesiritide are not typically considered first-line agents, but may be used in certain cases as additional or alternative therapies.

Question 7

A patient is taking digoxin (Lanoxin)and a loop diuretic daily.When the nurse enters the room with the morning medications,the patient states,"I am seeing a funny yellow color around the lights." What is the nurse's next action?

Accepted Answer

The patient's statement of seeing a yellow color around lights is a potential symptom of digoxin toxicity. The nurse should assess the patient further for other signs of toxicity, such as nausea, vomiting, dizziness, and changes in heart rate. Withholding the diuretic would not address the potential digoxin toxicity, and administering both medications together without further assessment could cause harm. Documenting the finding without further action would delay appropriate intervention.

Question 8

The medication order for a 4-year-old child reads,"Give digoxin elixir,15 mcg/kg,PO now." Convert the micrograms to milligrams._______

Accepted Answer

The answer of The medication order for a 4-year-old child...

Question 9

A patient about to receive a morning dose of digoxin has an apical pulse of 53 beats/min.What will the nurse do next?

Accepted Answer

A pulse rate below 60 beats/min is considered bradycardia, and the nurse should withhold the dose and notify the prescriber. Digoxin can cause further slowing of the heart rate, so it is important to check with the prescriber before administering the medication to avoid potential harm to the patient. Checking the radial pulse for 1 full minute is a step in the right direction, but it does not change the fact that the apical pulse is still below the normal range. Therefore, administering the dose without consulting the prescriber is not appropriate.

Question 10

The nurse is reviewing discharge teaching for a patient who will be taking digoxin (Lanoxin)therapy.The nurse will teach the patient to avoid which foods when taking the digoxin?

Accepted Answer

Bran, in large amounts, may decrease the absorption of oral digitalis drugs. The other foods do not affect digoxin levels.

Question 11

The nurse notes in a patient's medical record that nesiritide (Natrecor)has been ordered.Based on this order,the nurse interprets that the patient has which disorder?

Accepted Answer

Nesiritide (Natrecor) is used in the treatment of acutely decompensated heart failure with dyspnea at rest. It is a synthetic form of the hormone B-type natriuretic peptide, which helps to improve cardiac function and reduce fluid buildup in the lungs. Nesiritide is not typically used for atrial fibrillation, systolic heart failure, or chronic, stable heart failure.

Question 12

A patient has been placed on a milrinone (Primacor)infusion as part of the therapy for end-stage heart failure.What adverse effect of this drug will the nurse watch for when assessing this patient during the infusion?

Accepted Answer

Milrinone can cause cardiac dysrhythmias, so the nurse should closely monitor the patient's cardiac rhythm during the infusion. Hypertension, hyperkalemia, nausea, and vomiting are not common adverse effects of this medication.

Question 13

The nurse administering the phosphodiesterase inhibitor milrinone (Primacor)recognizes that this drug will have a positive inotropic effect.Which result reflects this effect?

Accepted Answer

Milrinone is a phosphodiesterase inhibitor that helps increase the force of cardiac contractions, leading to a positive inotropic effect. This means that the heart is better able to contract and pump blood effectively. Milrinone does not affect heart rate (A), blood vessel dilation (B), or electrical conduction (D).

Question 14

A patient is in the intensive care unit and receiving an infusion of milrinone (Primacor)for severe heart failure.The prescriber has written an order for an intravenous dose of furosemide (Lasix).How will the nurse give this drug?

Accepted Answer

Milrinone and furosemide are both high alert medications and should not be mixed in the same line to avoid potential incompatibilities and adverse effects. Administering the furosemide in a separate intravenous line will ensure safe administration of the medication without interruption of the milrinone infusion.

Quiz 24: Heart Failure Drugs

While assessing a patient who is receiving intravenous digitalis,the nurse recognizes that the drug has a negative chronotropic effect.How would this drug effect be evident in the patient?

A patient has a digoxin level of 1.1 ng/mL.Which interpretation by the nurse is correct?

In assessing a patient before administration of a cardiac glycoside,the nurse knows that which lab result can increase the toxicity of the drug?

When administering digoxin immune Fab (Digibind) to a patient with severe digoxin toxicity,the nurse knows that each vial can bind with how much digoxin?

Which drug classes are considered first-line treatment for heart failure? (Select all that apply.)

A patient is taking digoxin (Lanoxin) and a loop diuretic daily.When the nurse enters the room with the morning medications,the patient states,"I am seeing a funny yellow color around the lights." What is the nurse's next action?

The medication order for a 4-year-old child reads,"Give digoxin elixir,15 mcg/kg,PO now." Convert the micrograms to milligrams._______

A patient about to receive a morning dose of digoxin has an apical pulse of 53 beats/min.What will the nurse do next?

The nurse is reviewing discharge teaching for a patient who will be taking digoxin (Lanoxin) therapy.The nurse will teach the patient to avoid which foods when taking the digoxin?

The nurse notes in a patient's medical record that nesiritide (Natrecor) has been ordered.Based on this order,the nurse interprets that the patient has which disorder?

A patient has been placed on a milrinone (Primacor) infusion as part of the therapy for end-stage heart failure.What adverse effect of this drug will the nurse watch for when assessing this patient during the infusion?

The nurse administering the phosphodiesterase inhibitor milrinone (Primacor) recognizes that this drug will have a positive inotropic effect.Which result reflects this effect?

A patient is in the intensive care unit and receiving an infusion of milrinone (Primacor) for severe heart failure.The prescriber has written an order for an intravenous dose of furosemide (Lasix) .How will the nurse give this drug?