Nokea
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.
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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.
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.
A patient has been placed on a milrinone 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?
- A. Hypertension
- B. Hyperkalemia
- C. Nausea and vomiting
- D. Cardiac dysrhythmias
Correct Answer: D
Rationale: The primary adverse effects seen with milrinone are cardiac dysrhythmias, mainly ventricular. It may also cause hypotension, hypokalemia, and other effects, but not nausea and vomiting.
A patient has a digoxin level of 1.1 ng/mL. Which interpretation by the nurse is correct?
- A. It is below the therapeutic level.
- B. It is within the therapeutic range.
- C. It is above the therapeutic level.
- D. It is at a toxic level.
Correct Answer: B
Rationale: The normal therapeutic drug level of digoxin is between 0.5 and 2 ng/mL. The other options are incorrect.
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.