Question 1

The nurse is preparing to administer digoxin to a patient who has HF.The patient reports nausea,vomiting,and a headache.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

Nausea,vomiting,and headache are common signs of digoxin toxicity as is a heart rate less than 60 beats per minute.The nurse should hold the dose and notify the provider.

Question 2

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

Avoiding extreme weather conditions is important to help prevent anginal attacks.Patients should be instructed to avoid strenuous exercise; avoid alcohol,which can enhance hypotensive effects of nitrates; and use nitroglycerin at the first sign of pain.

Question 3

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 and is used to relax coronary artery spasm in patients with variant angina.It does not facilitate coronary muscle oxygen use,improve renal function,or increase cardiac contractility.

Question 4

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?

Accepted Answer

The antidysrhythmics phenytoin and lidocaine are effective in treating digoxin-induced ventricular dysrhythmias.Digoxin immune Fab is used to treat severe digitalis toxicity,characterized by bradycardia,nausea,and vomiting.Unless a potassium deficit is present,giving potassium could worsen the dysrhythmia.

Question 5

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

The patient should show improvement in breathing and oxygenation.Urine output should increase.Blood pressure and heart rate will decrease.

Question 6

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

Accepted Answer

Because nitroglycerin can cause hypotension,patients should be cautioned to take them while sitting or lying down.If pain is not better or has worsened 5 minutes after the first dose,patients should call 911.The tablets must dissolve under the tongue and should not be swallowed.

Question 7

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 a potassium-sparing diuretic that blocks production of aldosterone,causing improved heart rate variability and decreased myocardial fibrosis.It is given in congestive HF for its cardioprotective effects.Spironolactone does not directly alter cardiac contractility but may slightly decrease contractility if fluid volume is decreased.It is a mild diuretic but is not given in this instance to minimize fluid losses.

Question 8

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

Patients who stop taking this drug abruptly can experience palpitations.Diuretics do not decrease drug effectiveness.Dizziness and nausea and vomiting are common side effects.

Question 9

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

The therapeutic range of digoxin is between 0.8 and 2 ng/mL.This patient's level is high,indicating toxicity.The nurse should not give the next dose or request a change in dose.

Question 10

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

The BNP is used to differentiate that dyspnea is due to HF and not lung dysfunction.The other tests will all be a part of the diagnostic workup but do not help with this distinction.

Question 11

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 given sublingually to avoid first-pass metabolism by the liver,which would occur if the drug is swallowed.It does not prevent hypotension.Gastrointestinal upset and hepatotoxicity usually do not occur.

Question 12

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

Accepted Answer

Digoxin is given for atrial fibrillation to restore a normal heart rhythm.To prevent thromboemboli,warfarin is given concurrently.Hydrochlorothiazide is a diuretic medication.Inamrinone and milrinone are inotropic agents that would be used instead of digoxin.

Question 13

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

Accepted Answer

Hypotension is a common effect of calcium channel blockers and is more common with nifedipine.It is less common with diltiazem,so the provider may order that drug.Adding digoxin,changing to a beta blocker,or ordering serum liver enzymes are not indicated.

Question 14

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

The pounding headache is related to vasodilation of the cerebral vessels.Nitrates decrease blood pressure.

Question 15

A patient who has Wolff-Parkinson-White syndrome is given intravenous adenosine (Adenocard).The nurse will explain that the medication is effective because it

Accepted Answer

Adenosine is a class III drug that prolongs repolarization by increasing the refractory period and prolonging the action potential to slow heart rate.It does not control atrial flutter,deepen myocardial excitability,or prevent multifocal contractions.

Question 16

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 given to decrease venous blood return to the heart,resulting in decreased cardiac filling and decreased ventricular stretching,in turn reducing preload,contractility,and oxygen demand of the heart.

Question 17

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

Accepted Answer

Headaches are one of the most common side effects of nitroglycerin,but they may become less frequent; acetaminophen is generally recommended for pain.The headaches are not an emergency,and the patient does not need to call 911 or notify the provider.The patch is applied once daily.

Question 18

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

Alcohol should either be completely avoided or restricted to no more than one per day.Mild exercise,such as walking,is recommended.All nicotines deprive the heart of oxygen.Salt should be limited to no more than one teaspoon per day.

Question 19

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

Patients should be taught to rotate application sites when using the transdermal nitroglycerin.Transdermal nitroglycerin is not used as needed.Patients should remove the patch at bedtime to provide an 8- to 12-hour nitrate-free interval.Patients should use the patch even when symptom-free unless otherwise instructed by the provider.

Question 20

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

Accepted Answer

If a patient is taking digoxin and a potassium-wasting diuretic such as thiazide,the patient should also take a potassium supplement to prevent hypokalemia that could result in digoxin toxicity.It is not necessary to take cortisone,lidocaine,or nitroglycerin unless the patient has symptoms that warrant these drugs.

Quiz 37: Cardiac Glycosides, Antianginals, and Antidysrhythmics

The nurse is preparing to administer digoxin to a patient who has HF.The patient reports nausea,vomiting,and a headache.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?

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?

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?

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?

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?

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

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?

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?

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?

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?

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

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

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

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?

A patient who has Wolff-Parkinson-White syndrome is given intravenous adenosine (Adenocard) .The nurse will explain that the medication is effective because it

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

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

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?

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

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