Nokea
A patient in the intensive care unit is on a dobutamine infusion and is to receive furosemide 40 mg IV now. What is the nurse's best action to administer the furosemide?
- A. Infuse the drug into the same intravenous line as the milrinone.
- B. Stop the milrinone, flush the line, and then administer the furosemide.
- C. Administer the furosemide in a separate intravenous line.
- D. Notify the prescriber that the furosemide cannot be given at this time.
Correct Answer: C
Rationale: Furosemide must not be injected into an intravenous line with milrinone because it will precipitate immediately. The infusion must not be stopped because of the patient's condition. A separate line will be needed. The other options are incorrect.
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When administering digoxin immune Fab to a patient with severe digoxin toxicity, the nurse knows that each vial can bind with how much digoxin?
- A. 0.5 mg
- B. 1 mg
- C. 1.5 mg
- D. 2 mg
Correct Answer: A
Rationale: Each vial of digoxin immune Fab (Digifab) can bind approximately 0.5 mg of digoxin, helping to neutralize the drug in cases of severe toxicity.
The nurse administering the phosphodiesterase inhibitor milrinone recognizes that this drug will have a positive inotropic effect. Which result reflects this effect?
- A. Increased heart rate
- B. Increased blood vessel dilation
- C. Increased force of cardiac contractions
- D. Increased conduction of electrical impulses across the heart
Correct Answer: C
Rationale: Positive inotropic drugs increase myocardial contractility, thus increasing the force of cardiac contractions. Positive chronotropic drugs increase the heart rate. Positive dromotropic drugs increase the conduction of electrical impulses across the heart. Blood vessel dilation is not affected.
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. The patient asks the nurse why the medication is ordered. What is the nurse's best response?
- A. It will increase your heart rate.
- B. This drug helps to lower your potassium levels.
- C. It causes your heart to beat at a slower rate.
- D. This drug is an antidote to digoxin and will help your heart to return to normal functioning.
Correct Answer: D
Rationale: Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose and is given to reverse the life-threatening cardiotoxic effects. The other options are incorrect.
Which drug classes are considered first-line treatment for heart failure?
- A. Angiotensin-converting enzyme (ACE) inhibitors
- B. Angiotensin II receptor blockers (ARBs)
- C. Digoxin, a cardiac glycoside
- D. Beta blockers
- E. Nesiritide, the B-type natriuretic peptide
Correct Answer: A,B,D
Rationale: ACE inhibitors, ARBs, and certain beta blockers are now considered the first-line treatments for heart failure. Digoxin is used when the first-line treatments are not successful; nesiritide is considered a last-resort treatment.
In assessing a patient before administration of a cardiac glycoside, the nurse knows that which lab result can increase the toxicity of the drug?
- A. Potassium level 2.8 mEq/L
- B. Potassium level 4.9 mEq/L
- C. Sodium level 140 mEq/L
- D. Calcium level 10 mg/dL
Correct Answer: A
Rationale: Hypokalemia increases the chance of digitalis toxicity. The other levels listed are incorrect.