Cardiovasc

Question 1

A client has been given a prescription for furosemide 40 mg every day in conjunction with digoxin. Which concern would prompt the nurse to ask the health care provider about potassium supplements?

A. Digoxin causes significant potassium depletion.
B. The liver destroys potassium as digoxin is detoxified.
C. Lasix requires adequate serum potassium to promote diuresis.
D. Digoxin toxicity occurs rapidly in the presence of hypokalemia.

Answer 1

D. Digoxin toxicity occurs rapidly in the presence of hypokalemia.

Furosemide promotes potassium excretion, and low potassium (hypokalemia) increases
cardiac excitability. Digoxin is more likely to cause dysrhythmias when potassium is low.
Digoxin does not affect potassium excretion. Furosemide causes potassium excretion.
Potassium is excreted by the kidneys, not destroyed by the liver. Furosemide causes
diuresis and consequent potassium loss regardless of the serum potassium level.

Question 2

A client takes furosemide and digoxin for heart failure. Why would the nurse advise the client to drink a glass of orange juice every day?
A. Maintaining potassium levels
B. Preventing increased sodium levels
C. Limiting the medications’ synergistic effects
D. Correcting the associated dehydration

Answer 2

A. Maintaining potassium levels

Orange juice is an excellent source of potassium. Furosemide promotes excretion of potassium, which can result in hypokalemia. Digoxin toxicity can occur in the presence of hypokalemia.

Question 3

A client is admitted to the hospital for a new onset of supraventricular tachycardia (SVT) and is prescribed digoxin. For which laboratory finding should the nurse notify the healthcare provider immediately?
A. Potassium level of 3.1 mEq/L.
B. Sodium level of 132 mEq/L.
C. Calcium level of 8.6 mg/dL.
D. Magnesium level of 1.2 mEq/L.

Answer 3

A. Potassium level of 3.1 mEq/L.

Hypokalemia affects myocardial contractility and places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum sodium, calcium, and magnesium can effect cardiac rhythm, the greatest risk for a client receiving digoxin is low potassium.

Question 4

The nurse is caring for a client prescribed furosemide and digoxin for the treatment of heart failure. The client reports seeing halos and bright lights. Which laboratory result would be anticipated?
A. Low sodium level
B. Low digitalis level
C. Low potassium level
D. Low serum osmolality

Answer 4

C. Low potassium level

Clients with heart failure who take digoxin are commonly given diuretics. Hypokalemia can increase the risk of digitalis toxicity. Digitalis toxicity may also develop in the presence of hypomagnesemia. Clients with dig toxicity would have elevated digoxin levels. Sodium would likely be normal. The serum osmolality would likely be normal or high in a client on a diuretic.

Question 4

The nurse is providing care for a client admitted to the hospital with a diagnosis of digoxin toxicity. The client reports more than usual urine output over the previous 48 hours, because of the prescribed diuretic. Which assessment finding does the nurse anticipate?
A. Muscle weakness or cramping
B. Blood in the urine
C. Hypertension
D. Tinnitus

Answer 4

A. Muscle weakness or cramping

Symptoms of hypokalemia include muscle weakness and cramping. The digoxin toxicity will not cause blood in the urine, or tinnitus or hypertension.

Question 5

An 80-year-old client who is taking digoxin reports nausea, vomiting, abdominal cramps and halo vision. Which laboratory result should the nurse evaluate first?
A. Potassium levels
B. Blood pH
C. Magnesium levels
D. Blood urea nitrogen

Answer 5

A. Potassium levels

Nausea, vomiting, abdominal cramps and halo vision are classic signs of digitalis toxicity. The most common cause of digitalis toxicity is a low potassium level.

Question 6

A nurse is preparing to administer morning medications to a client with heart failure. The morning lab values are: sodium 142 mEq/L (142 mmol/L), potassium 2.9 mEq/L (2.9 mmol/L), digoxin level 1.4 ng/mL. Which of the following medications should the nurse not administer until after speaking with the health care provider?
A. Spironolactone
B. Carvedilol (Coreg)
C. Digoxin (Lanoxin)
D. Ferrous sulfate

Answer 6

C. Digoxin (Lanoxin)

Because the potassium levels are low (normal is 3.5 to 5 mEq/L or 3.5 to 5 mmol/L), the nurse should not give the digoxin; hypokalemia can predispose a person to digoxin toxicity.

Question 7

The nurse is preparing to administer digoxin to a client with recurring atrial fibrillation. Which laboratory value should be of highest concern for the nurse?
A. Hemoglobin 9.4 g/dL
B. Serum potassium 3.1 mEq/L
C. Serum creatinine 1.9 mg/dL
D. B-type natriuretic peptide 140 pg/mL

Answer 7

B. Serum potassium 3.1 mEq/L

Although all of the lab values are outside of normal range, the low potassium level (normal range 3.5-5.0 mEq/L) should be of highest concern for the client at this time.

Question 8

A client recently diagnosed with heart failure has been prescribed digoxin and furosemide. Which of the following foods should the nurse teach the client to eat at least one serving a day?
A. Blueberries
B. Wheat cereal
C. Tomato juice
D. Pear nectar

Answer 8

C. Tomato juice

Of the food choices, tomato juice is the highest in potassium. To reduce the risk of potassium depletion, the client should be encouraged to drink at least 1/2 cup of tomato juice every day which is about 400 mg of potassium.

Question 9

A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication?

A. “I can walk a mile a day.”

B. “I’ve had a backache for several days.”

C. “I am urinating more frequently.”

D. “I feel nauseated and have no appetite.”

Answer 9

D. “I feel nauseated and have no appetite.”

Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.

Question 10

A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?

A. Check the client’s vital signs.

B. Request a dietitian consult.

C. Suggest that the client rests before eating the meal.

D. Request an order for an antiemetic.

Answer 10

A. Check the client’s vital signs.

It is possible that the client’s nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity.

Question 11

The client with hypokalemia reports nausea, vomiting, and seeing a yellow light around objects. Which of the client’s medications is the likely cause of the client’s symptoms?
A. Digoxin
B. Furosemide
C. Propranolol
D. Spironolactone

Answer 11

A. Digoxin

These are signs of digitalis toxicity, which is more likely to occur in the presence of hypokalemia.

Question 12

A client who takes multiple medications complains of severe nausea, and the client’s heartbeat is irregular and slow. The nurse determines that these signs and symptoms are toxic effects of which medication?
A. Digoxin
B. Captopril
C. Furosemide
D. Morphine sulfate

Answer 12

A. Digoxin

Signs of digoxin toxicity include cardiac dysrhythmias, anorexia, nausea, vomiting, and visual disturbances.

Question 13

The nurse is providing discharge medication teaching to a client who will be taking furosemide and digoxin after discharge from the hospital. Which information is important for the nurse to include in the teaching plan?
A. Maintenance of a low-potassium diet
B. Avoidance of foods high in cholesterol
C. Signs and symptoms of digoxin toxicity
D. Importance of monitoring output

Answer 13

C. Signs and symptoms of digoxin toxicity

The risk of digoxin toxicity increases when the client is receiving digoxin and furosemide, a loop diuretic; loop diuretics can cause hypokalemia, which potentiates the effects of digoxin, leading to toxicity.

Question 14

Digoxin is prescribed for a client with heart failure. The nurse will assess for signs and symptoms that indicate digoxin toxicity? Which of the following is NOT a sign or symptom of digoxin toxicity.
A. Nausea
B. Yellow vision
C. Irregular pulse
D. Increased urine output

Answer 14

D. Increased urine output

Increased urine output is an expected effect of improved cardiac output.

Question 15

A child being treated with cardiac medications developed vomiting, bradycardia, anorexia, and dysrhythmias. The nurse understands which medication toxicity is responsible for these symptoms?
A. Digoxin
B. Nesiritide
C. Dobutamine
D. Spironolactone

Answer 15

A. Digoxin

Digoxin helps improve pumping efficacy of the heart, but an overdose can cause toxicity leading to nausea, vomiting, bradycardia, anorexia, and dysrhythmias.

Question 16

A nurse is preparing to administer prescribed maintenance dose of digoxin to a client who has heart failure. Which action should the nurse to take?
A. Withhold the medication if the heart rate is above 100/min
B. Instruct the client to eat foods that are low in potassium
C. Measure apical pulse rate for 30 seconds before administration
D. Evaluate the client for nausea, vomiting, and anorexia

Answer 16

D. Evaluate the client for nausea, vomiting, and anorexia

Digoxin is used to decrease heart rate and should be held if the heart rate is less than 60 beats per minute. When administering digoxin, the nurse should measure the client’s apical pulse for a full minute. A client with heart failure who is prescribed digoxin should be assessed for digoxin toxicity.

Question 17

A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate?

A. Withholding the medication if the heart rate is above 100/min

B. Instructing the client to eat foods that are low in potassium

C. Measuring apical pulse rate for 30 seconds before administration

D. Evaluating the client for nausea, vomiting, and anorexia

Answer 17

D. Evaluating the client for nausea, vomiting, and anorexia

Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity. The nurse should measure the apical pulse rate for 1 min.

Question 18

The nurse is reviewing medication instructions with a client who is taking digoxin. The nurse should reinforce to the client to report which of the following side effects?
A. Rash, dyspnea, edema
B. Nausea, vomiting
C. Hunger, dizziness, diaphoresis
D. Polyuria, thirst, dry skin

Answer 18

B. Nausea, vomiting

Common manifestations of digoxin toxicity include nausea, vomiting and fatigue.

Question 19

An infant with congenital heart disease is prescribed digoxin and furosemide upon discharge. Which sign would the nurse instruct the parents to be alert for?
A. Difficulty feeding with vomiting
B. Cyanosis during periods of crying
C. Daily naps lasting more than 3 hours
D. A pulse rate faster than 100 beats/min

Answer 19

A. Difficulty feeding with vomiting

Vomiting and feeding issues are early signs of digoxin toxicity.

Question 20

The nurse is monitoring a 6-year-old child for toxicity precipitated by digoxin. Which sign of digoxin toxicity would the nurse monitor for?
A. Oliguria
B. Vomiting
C. Tachypnea
D. Splenomegaly

Answer 20

B. Vomiting

Vomiting is a sign of digoxin toxicity in children.

Question 21

A health care provider prescribes digoxin for a client. The nurse teaches the client to be alert for which common early indication of acute digoxin toxicity?
A. Vomiting
B. Urticaria
C. Photophobia
D. Respiratory distress

Answer 21

A. Vomiting

Nausea, vomiting, anorexia, and abdominal pain are early indications of acute toxicity in approximately 50% of clients who take a cardiac glycoside, such as digoxin.

Question 22

One week after being hospitalized for an acute myocardial infarction, a client reports nausea and loss of appetite. Which of the client’s prescribed medications would be withheld and the health care provider notified?
A. Digoxin
B. Propranolol
C. Furosemide
D. Spironolactone

Answer 22

A. Digoxin

Toxic levels of digoxin stimulate the medullary chemoreceptor trigger zone, resulting in anorexia, nausea, and vomiting.

Question 23

The nurse is reviewing medication instructions with parents of an infant receiving digoxin and spironolactone. Which parental response indicates instructions have been understood?
A. Activity should be restricted.
B. Orange juice should be given daily.
C. Vomiting should be reported to the health care provider.
D. Anti-inflammatory medications should be avoided.

Answer 23

C. Vomiting should be reported to the health care provider.

Vomiting is a classic sign of digoxin toxicity, and the health care provider must be notified.

Question 24

A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention? A. Heartburn. B. Headache. C. Constipation. D. Vomiting.

Answer 24

D. Vomiting. ## Footnote Vomiting, anorexia, and abdominal pain are early indications of digitalis toxicity. Since Lipitor increases the risk for digitalis toxicity, this finding requires the most immediate intervention by the nurse

Question 25

A nurse in a clinic is caring for a client who has a prescription for digoxin. Which of the following statements indicates the client is experiencing digoxin toxicity? A. "I am gaining weight." B. "I am constipated." C. "My vision seems yellow." D. "My tongue is red and beefy."

Answer 25

C. "My vision seems yellow." ## Footnote Blurred and yellow vision is an indication of digoxin toxicity. Weight loss & diarrhea may occur while on digoxin.

Question 26

When teaching a client about digoxin, which symptom will the nurse include as a reason to withhold the digoxin? A. Fatigue B. Yellow vision C. Persistent hiccups D. Increased urinary output

Answer 26

B. Yellow vision ## Footnote Digoxin toxicity is a common and dangerous effect. Visual disturbances, most notably yellow vision, may be evidence of digoxin toxicity.

Question 27

A client has been receiving digoxin. The client calls the clinic and complains of 'yellow vision.' Which response would the nurse provide? A. 'This is related to your illness rather than to your medication.' B. 'This is an expected side effect; you will become accustomed to it over time.' C. 'This side effect is only temporary. You should continue the medication.' D. 'The medication may need to be discontinued. Come to the clinic this afternoon.'

Answer 27

D. 'The medication may need to be discontinued. Come to the clinic this afternoon.' ## Footnote Yellow vision indicates digoxin toxicity; the medication should be withheld until the health care provider can assess the client and check the digoxin blood level.

Question 28

A client who takes furosemide and digoxin reports to the nurse that everything looks yellow. Which response by the nurse is most appropriate? A. 'This is related to your heart problems, not to the medication.' B. 'I will hold the medication until I consult with your health care provider.' C. 'It is a medication that is necessary, and that side effect is only temporary.' D. 'Take this dose, and when I see your health care provider, I will ask about it.'

Answer 28

B. 'I will hold the medication until I consult with your health care provider.' ## Footnote The response 'I will hold the medication until I consult with your health care provider' is a safe practice because yellow vision indicates digitalis toxicity.

Question 29

Which response would a nurse give to a client who takes furosemide and digoxin and reports that everything looks yellow? A. "This is related to your heart problems, not to the medication." B. "I will hold the medication until I consult with your health care provider." C. "It is a medication that is necessary, and that side effect is only temporary." D. "Take this dose, and when I see your health care provider, I will ask about it."

Answer 29

B. "I will hold the medication until I consult with your health care provider." ## Footnote The response "I will hold the medication until I consult with your health care provider" is a safe practice because yellow vision indicates digitalis toxicity.

Question 30

Which clinical finding indicates that a client taking digoxin may have developed digoxin toxicity? A. Constipation B. Decreased urination C. Cardiac dysrhythmias D. Metallic taste in the mouth

Answer 30

C. Cardiac dysrhythmias ## Footnote The development of cardiac dysrhythmias is often a sign of digoxin toxicity.

Question 31

When a client with type 1 diabetes develops heart failure, digoxin is prescribed. Which nursing action is important to include when planning care? A. Administer the digoxin 1 hour after the client’s morning insulin. B. Monitor the client for cardiac dysrhythmias. C. Monitor for increased risk of hyperglycemia. D. Increase digoxin dosage if insulin requirements are increased.

Answer 31

B. Monitor the client for cardiac dysrhythmias. ## Footnote The speed of conduction is decreased when digoxin is given, and this can result in a variety of cardiac dysrhythmias.

Question 32

A client is prescribed furosemide and digoxin for heart failure. The nurse should monitor the client for which potential adverse drug effect? A. Pulmonary hypertension B. Acute arterial occlusion C. Acute kidney injury D. Cardiac dysrhythmias

Answer 32

D. Cardiac dysrhythmias ## Footnote Digoxin is a cardiac glycoside, or positive inotrope that increases myocardial contractility. Potassium ions compete with digoxin and a low potassium level can cause digoxin toxicity, leading to lethal cardiac dysrhythmias.

Question 33

A nurse is caring for a client who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take? A. Offer the client a light snack. B. Measure the client's blood pressure. C. Measure the client's apical pulse. D. Weigh the client.

Answer 33

C. Measure the client's apical pulse. ## Footnote The nurse should hold the medication and notify the provider if the client's heart rate is below 60/min or if a change in heart rhythm is detected.

Question 34

Which assessment will the nurse conduct before administering digoxin to a client? A. Apical heart rate B. Radial pulse C. Difference between carotid and radial pulses D. Difference between apical and radial pulses

Answer 34

A. Apical heart rate ## Footnote Because digoxin slows the heart rate, the apical pulse should be counted for 1 minute before administration. If the apical rate is below a preset parameter (usually 60 beats/minute), digoxin should be withheld because its administration may further decrease the heart rate.

Question 35

A nurse is planning to administer digoxin to a client who has heart failure. Which of the following laboratory results is the priority for the nurse to review prior to administering the medication? A. Potassium B. Hemoglobin C. Creatinine D. Blood urea nitrogen

Answer 35

A. Potassium ## Footnote During therapy, the nurse should closely monitor the client’s potassium level as hypokalemia increases the risk of digitalis toxicity and cardiac arrhythmias.

Question 36

The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with heart failure. Which intervention should the nurse implement prior to administering the digoxin? A. Observe respiratory rate and depth. B. Assess the serum potassium level. C. Obtain the client's blood pressure. D. Monitor the serum glucose level.

Answer 36

B. Assess the serum potassium level. ## Footnote Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin.

Question 37

The client diagnosed with heart failure is prescribed oral digoxin. What is the priority nursing assessment for this medication? A. Monitor serum electrolytes and creatinine B. Measure apical pulse prior to administration C. Maintain accurate intake and output ratios D. Monitor blood pressure every 4 hours

Answer 37

B. Measure apical pulse prior to administration ## Footnote Digoxin is an antiarrhythmic and an inotropic drug. It works to increase cardiac output and slow the heart rate. The priority assessment is to measure the apical pulse for one minute prior to administering the drug.

Question 38

The home care nurse is reviewing the medical record of a new client with a history of chronic obstructive pulmonary disease, atrial fibrillation and gout. After reviewing the client's medication list, for which medication should the nurse arrange to monitor blood levels? A. Beclomethasone B. Digoxin D. Allopurinol E. Montelukast

Answer 38

B. Digoxin ## Footnote It is necessary to monitor blood levels for digoxin to prevent toxicity.

Question 39

The nurse is preparing to administer digoxin to a client admitted for acute decompensated heart failure. Which action is the priority before giving this drug? A. Monitor oxygen saturation on room air B. Assess the client's weight and compare to the baseline C. Auscultate the lungs for crackles in the bases D. Assess the apical pulse for a full minute

Answer 39

D. Assess the apical pulse for a full minute ## Footnote Digoxin, a cardiac glycoside, is used to slow the heart rate and increase the force of contraction. The priority for the nurse is to count the client's apical pulse for one full minute, even if the heart rhythm is regular.

Question 40

A client receives a cardiac glycoside, a diuretic, an angiotensin-converting enzyme (ACE) inhibitor, and a vasodilator. The client’s apical pulse rate is 44 beats/minute. The nurse concludes that the decreased heart rate is caused by which medication? A. Diuretic/furosemide B. Vasodilator/nitroglycerin C. ACE inhibitor/ “ace” to -pril D. Cardiac glycoside/digoxin

Answer 40

D. Cardiac glycoside/digoxin ## Footnote A cardiac glycoside such as digoxin decreases the conduction speed within the myocardium and slows the heart rate.

Question 41

A client with heart failure is to receive digoxin. Which therapeutic effect is associated with this medication? A. Reduces edema B. Increases cardiac conduction C. Increases rate of ventricular contractions D. Slows and strengthens cardiac contractions

Answer 41

D. Slows and strengthens cardiac contractions ## Footnote Digoxin improves cardiac function by increasing the strength of myocardial contractions (positive inotropic effect) and, by altering the electrophysiological properties of the heart, slows the heart rate (negative chronotropic effect).

Question 42

Which nursing intervention is NOT important when caring for clients receiving intravenous (IV) digoxin? A. Monitor the heart rate closely. B. Check the blood levels of digoxin. C. Administer the dose over 1 minute. D. Monitor the serum potassium level.

Answer 42

C. Administer the dose over 1 minute. ## Footnote Digoxin should be given over a 5-minute period through a Y-tube or three-way stopcock.

Question 42

Digoxin is prescribed for a client. Which therapeutic effect of digoxin would the nurse expect? A. Decreased cardiac output B. Decreased stroke volume of the heart C. Increased contractile force of the myocardium D. Increased electrical conduction through the atrioventricular (AV) node

Answer 42

C. Increased contractile force of the myocardium ## Footnote Digoxin increases the strength of myocardial contractions (positive inotropic effect) and slows the heart rate (negative chronotropic effect); these effects increase the stroke volume of the heart.

Question 43

A client with left ventricular heart failure and supraventricular tachycardia is prescribed digoxin 0.25 mg daily. Which changes would the nurse NOT expect to find if this medication is therapeutically effective? A. Diuresis B. Tachycardia C. Decreased edema D. Decreased pulse rate

Answer 43

B. Tachycardia ## Footnote Because of digoxin’s inotropic and chronotropic effects, the heart rate will decrease.

Question 44

A client is given a loading dose of digoxin and placed on a maintenance dose of digoxin 0.25 mg by mouth daily. Which responses would the nurse expect the client to exhibit when a therapeutic effect of digoxin is achieved? A. Resolution of heart failure symptoms B. Decreased anginal episodes C. Conversion of atrial fibrillation D. Decreased blood pressure

Answer 44

A. Resolution of heart failure symptoms ## Footnote Digoxin improves cardiac output to improve heart failure symptoms. Digoxin is not an antianginal medication; if it decreases angina as a result of controlling heart failure, it is a secondary effect. Digoxin may be given to control a rapid ventricular response to atrial fibrillation, but it does not convert the rhythm. Digoxin has a negligible effect on blood pressure; therefore it is not an antihypertensive medication.

Question 45

The nurse is caring for a client diagnosed with heart failure who will begin treatment with digoxin. Which therapeutic effect would the nurse expect to find after administering this medication? A. Decreased chest pain with decreased blood pressure B. Increased heart rate with increased respirations C. Improved respiratory status with increased urinary output D. Diaphoresis with decreased urinary output

Answer 45

C. Improved respiratory status with increased urinary output ## Footnote Digoxin (Lanoxin), a cardiac glycoside, is used in clients with heart failure to slow and strengthen the heartbeat. As cardiac output is improved, renal perfusion is improved and urinary output increases. The other findings are related to adverse, not therapeutic, effects related to digoxin or are not typically seen at all with digoxin.

Question 46

The nurse provides medication discharge instructions to a client who received a prescription for digoxin. Which statement by the client leads the nurse to conclude that the teaching was effective? A. 'I will avoid foods high in potassium.' B. 'I must increase my intake of vitamin K.' C. 'I should adjust the dosage according to my activities.' D. 'It will be important to check my pulse rate daily.'

Answer 46

D. 'It will be important to check my pulse rate daily.' ## Footnote Checking the pulse rate daily is necessary for monitoring cardiac function; digoxin slows and strengthens the heart rate. Digoxin should be withheld, and the health care provider notified, if the pulse rate falls below a predetermined rate (e.g., 60 beats per minute).

Question 47

hich advice will the nurse include when teaching a client about digoxin for left ventricular failure? A. Sleep flat in bed. B. Follow a low-potassium diet. C. Take the pulse three times a day. D. Report increasing fatigue.

Answer 47

D. Report increasing fatigue ## Footnote Treatment with digoxin should improve fatigue associated with heart failure; if fatigue increases, it may reflect complications of therapy.

Question 48

A nurse is caring for a client who is taking digoxin for heart failure and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer? A. Fab antibody fragments B. Flumazenil C. Acetylcysteine D. Naloxone

Answer 48

A. Fab antibody fragments ## Footnote Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity.