Nokea
When a patient is experiencing digoxin toxicity, which clinical situation would necessitate the use of digoxin immune Fab?
- A. The patient reports seeing colorful halos around lights.
- B. The patient's serum potassium level is above 5 mEq/L.
- C. The patient is experiencing nausea and anorexia.
- D. The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing.
- E. The patient has received an overdose of greater than 10 mg of digoxin.
- F. The patient reports fatigue and headaches.
Correct Answer: B,D,E
Rationale: Clinical situations that would require the use of digoxin immune Fab in a patient with digoxin toxicity include serum potassium level above 5 mEq/L, severe sinus bradycardia that does not respond to cardiac pacing, or an overdose of more than 10 mg of digoxin. Seeing colorful halos around lights, nausea, anorexia, fatigue, and headaches are potential adverse effects of digoxin therapy but are not necessarily reasons for digoxin immune Fab treatment.
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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.
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 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 about to receive a morning dose of digoxin has an apical pulse of 50 beats/min. What will the nurse do next?
- A. Administer the dose.
- B. Administer the dose, and notify the prescriber.
- C. Check the radial pulse for 1 full minute.
- D. Withhold the dose, and notify the prescriber.
Correct Answer: D
Rationale: Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/min or lower or is higher than 100 beats/min. The other options are incorrect.
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.