Nokea
A nurse would administer the prescribed digoxin (Lanoxin) cautiously for a client with which electrolyte imbalances? Select all that apply.
- A. Hypokalemia
- B. Hypermagnesemia
- C. Hypocalcemia
- D. Hyperkalemia
- E. Hypomagnesemia
Correct Answer: A,C,E
Rationale: The cardiotonic drugs are given cautiously to clients with electrolyte imbalances (especially hypokalemia, hypocalcemia, and hypomagnesemia).
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When reviewing the medical record of a client who is prescribed a cardiotonic, which condition would lead the nurse to contact the primary health care provider because the drug is contraindicated for use? Select all that apply.
- A. Digitalis toxicity
- B. Hypertension
- C. Cardiac tamponade
- D. Hypotension
- E. Ventricular tachycardia
Correct Answer: A,C,E
Rationale: The cardiotonics are contraindicated in the presence of digitalis toxicity and in clients with known drug hypersensitivity, ventricular tachycardia, cardiac tamponade, restrictive cardiomyopathy, or AV block.
A nurse checks the serum digoxin level of a client and finds it to be increased. Which of the following would the nurse identify as possibly associated with this increase?
- A. Colestipol (Colestid)
- B. Verapamil (Calan)
- C. Clarithromycin (Biaxin)
- D. Calcium carbonate (Maalox)
- E. Spironolactone (Aldactone)
Correct Answer: B,C,E
Rationale: Increased serum digoxin levels can occur with verapamil, clarithromycin, and spironolactone. Antacids, such as calcium carbonate, and colestipol cause a decrease in serum digoxin levels.
After teaching a group of nursing students about digoxin, the instructor determines that the teaching was successful when the students identify which of the following as true regarding the monitoring of plasma digoxin levels? Select all that apply.
- A. Levels should be drawn immediately after the dose.
- B. Levels should be drawn immediately before the next dose.
- C. Levels should be drawn 6 to 8 hours after the last dose.
- D. Levels of greater than 2 ng/ml are considered toxic.
- E. Levels are considered therapeutic between 0.5 and 1.5 ng/ml.
Correct Answer: B,C,D
Rationale: Digoxin blood plasma level measurements should be drawn immediately before the next dose or 6 to 8 hours after the last dose regardless of route. Therapeutic digoxin levels are between 0.8 and 2 ng/ml. Plasma digoxin levels greater than 2 ng/ml are considered toxic and are reported to the physician.
A client has been admitted to a health care center with complaints of dyspnea. The nurse suspects left-sided heart failure based on assessment of which of the following?
- A. Nocturia
- B. Pitting edema
- C. Weight gain
- D. Orthopnea
Correct Answer: D
Rationale: The nurse should assess for orthopnea in clients with left-sided heart failure. Orthopnea is a condition where the client experiences difficulty in breathing on lying down. The other features of left ventricular failure include a hacking cough or wheezing, restlessness, and anxiety. Nocturia, pitting edema, and weight gain are associated with right-sided heart failure.
When caring for a client who has been digitalized for his heart failure, the nurse observes that the client is experiencing bradycardia. Which of the following would the nurse expect the primary health care provider to prescribe for the client's bradycardia?
- A. Atropine
- B. Cholestyramine
- C. Furosemide
- D. Milrinone
Correct Answer: A
Rationale: Atropine should be administered to clients who develop bradycardia. Bradycardia may be seen in digitalis toxicity. Milrinone is a miscellaneous inotropic used in heart failure. Furosemide is a loop diuretic that can be used as part of the drug therapy regimen for heart failure. Cholestyramine is used to lower blood cholesterol levels. Milrinone, furosemide, and cholestyramine are not used in the treatment of bradycardia.