Nokea
The medication order for a 5-year-old child reads, -Give digoxin elixir, 15 mcg/kg, PO now. Convert the 15 micrograms to milligrams.
Correct Answer: 0.015 mg
Rationale: 1000 mcg : 1 mg :: 15 mcg : x mg; (1000 * x) = (1 * 15); 1000x = 15; x = 15/1000 = 0.015 mg.
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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.
The nurse notes in a patient's medical record that ivabradine has been ordered. Based on this order, the nurse interprets that the patient has which disorder?
- A. Heart failure with atrial fibrillation
- B. Early stages of heart failure
- C. Stable, symptomatic heart failure with an ejection fraction of 35% or less
- D. Unstable heart failure with an ejection fraction of less than 15%
Correct Answer: C
Rationale: Ivabradine is indicated for the treatment of stable, symptomatic heart failure with an ejection fraction of 35% or less. A potential adverse effect is atrial fibrillation. The other options are not indications for ivabradine.
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.
The nurse is reviewing discharge teaching for a patient who will be taking digoxin therapy. The nurse will teach the patient to avoid which foods when taking the digoxin?
- A. Leafy green vegetables
- B. Dairy products
- C. Grapefruit juice
- D. Bran muffins
Correct Answer: D
Rationale: Bran, in large amounts, may decrease the absorption of oral digitalis drugs. The other foods do not affect digoxin levels.
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. Decreased blood pressure
- B. Decreased heart rate
- C. Decreased conduction
- D. Decreased ectopic beats
Correct Answer: B
Rationale: A negative chronotropic effect results in a decreased heart rate, which is one effect of cardiac glycosides. The other options are incorrect.