Pathophysiology II Exam II
Heart Failure Drugs
1. A patient about to receive a morning dose of digoxin has an apical pulse of 53 beats/minute. 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.
2. A patient is taking digoxin (Lanoxin) 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.
3. 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
4. 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
(Digifab). 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 helps to convert the irregular heart rhythm to a more normal rhythm.”
d. “This drug is an antidote to digoxin and will help to lower the blood levels.”
5. A patient has been placed on a milrinone (Primacor) 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
6. A patient has a digoxin level of 1.4 ng/mL. The nurse interprets that this level is
a. below the therapeutic level.
b. within the therapeutic range.
c. above the therapeutic level.
d. at a toxic level.
7. The nurse is reviewing discharge teaching for a patient who will be taking digoxin (Lanoxin) 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
8. 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
9. The nurse administering the phosphodiesterase inhibitor milrinone (Primacor) 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
10. The nurse notes in a patient’s medical record that nesiritide (Natrecor) has been ordered. Based on this
order, the nurse interprets that the patient has which disorder?
a. Atrial fibrillation
b. Acutely decompensated heart failure with dyspnea at rest
c. Systolic heart failure
d. Long-term treatment of heart failure
11. When administering digoxin immune Fab (Digibind) to a patient with severe digoxin toxicity, the nurse
knows that each vial can bind with how much digoxin?
a. 0.5 mg
b. 5 mg
c. 5.5 mg
d. 15 mg
12. A patient is in the intensive care unit and receiving an infusion of milrinone (Primacor) for severe heart
failure. The prescriber has written an order for an intravenous dose of furosemide (Lasix). How will the
nurse give this drug?
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.
MULTIPLE RESPONSE
1. When a patient is experiencing digoxin toxicity, which clinical situation would necessitate the use of
digoxin immune Fab (Digifab)? (Select all that apply.)
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.
2. Which drug classes are considered first-line treatment for heart failure? (Select all that apply.)
a. Angiotensin-converting enzyme (ACE) inhibitors
b. Angiotensin II receptor blockers (ARBs)
c. Digoxin (cardiac glycoside)
d. Beta blockers
e. Nesiritide (Natrecor), the B-type natriuretic peptide
OTHER
1. The medication order for a 4-year-old child reads, “Give digoxin elixir, 15 mcg/kg, PO now.” Convert
the micrograms to milligrams.
Heart Failure Answers
1. ANS: D Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/minute or lower
or is higher than 100 beats/minute. The other options are incorrect.
2. ANS: A Seeing colors around lights is one potential indication of developing digoxin toxicity. If a
patient complains of this, 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.
3. ANS: B A negative chronotropic effect results in a reduced heart rate; this is one effect of cardiac
glycosides. The other options are incorrect.
4. ANS: D Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose. It is given
intravenously. The other options are incorrect.
5. ANS: D 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.
6. ANS: B The normal therapeutic drug level of digoxin is between 0.5 and 2 ng/mL. The other options are
incorrect.
7. ANS: D Bran, in large amounts, may decrease the absorption of oral digitalis drugs. The other foods do
not affect digoxin levels.
8. ANS: A Hypokalemia increases the chance of digitalis toxicity. The other levels listed are incorrect.
9. ANS: C Positive inotropic drugs increase myocardial contractility, thus increasing the force of cardiac
conduction. 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.
10. ANS: B Nesiritide is indicated for the treatment of acutely decompensated heart failure with dyspnea at
rest. Digoxin is used for the treatment of atrial fibrillation and systolic heart failure. Long-term treatment of
heart failure is not an indication for nesiritide.
11. ANS: A One vial of digoxin immune Fab binds 0.5 mg of digoxin. The other options are incorrect.
12. ANS: C 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.
MULTIPLE RESPONSE
1. ANS: B, D, E 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 and experiencing nausea, anorexia, fatigue, and headaches are potential adverse effects of digoxin
therapy but are not necessarily reasons for digoxin immune Fab treatment.
2. ANS: A, B, D ACE inhibitors, ARBs, and 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.
OTHERS
1. ANS: 0.015 mg