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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.
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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.
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 is taking digoxin and a loop diuretic daily. When the nurse enters the room with the morning medications, the patient states, -I am seeing a funny yellow color around the lights. What is the nurse's next action?
- A. Assess the patient for symptoms of digoxin toxicity.
- B. Withhold the next dose of the diuretic.
- C. Administer the digoxin and diuretic together as ordered.
- D. Document this finding, and reassess in 1 hour.
Correct Answer: A
Rationale: Seeing colors around lights is one potential indication of developing digoxin toxicity. If a patient indicates these visual problems, the nurse needs to assess for other signs and symptoms of digoxin toxicity including bradycardia, headache, dizziness, confusion, nausea, and blurred vision, and then notify the prescriber. Administering the drug or withholding the diuretic are incorrect options.
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.
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.