Chapter 42: Cardiac Glycosides, Antianginals, and Antidysrhythmics Nursing School Test Banks

Chapter 42: Cardiac Glycosides, Antianginals, and Antidysrhythmics
Test Bank

MULTIPLE CHOICE

1. A patient who has atrial fibrillation is taking digoxin. The nurse expects which medication to be given concurrently to treat this condition?
a. Hydrochlorothiazide (HydroDIURIL)
b. Inamrinone (Inocor)
c. Milrinone (Primacore)
d. Warfarin (Coumadin)
ANS: D
Digoxin is given for atrial fibrillation to restore a normal heart rhythm. To prevent thromboemboli, warfarin is given concurrently. Hydrochlorothiazide is a diuretic medication. Inamrinone and milrinone are inotropic agents that would be used instead of digoxin.

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A patient is diagnosed with heart failure, and the prescriber has ordered digoxin. The patient asks what lifestyle changes will help in the management of this condition. The nurse will recommend which changes?
a. Aerobic exercise and weight lifting 2 or 3 times weekly
b. Changing from cigarette smoking to pipe smoking
c. Consuming 2 teaspoons or less of salt every day
d. Having no more than one alcoholic beverage per day
ANS: D
Alcohol should either be completely avoided or restricted to no more than one per day. Mild exercise, such as walking, is recommended. All nicotine deprives the heart of oxygen. Salt should be limited to no more than one teaspoon per day.

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient with chronic obstructive pulmonary disease (COPD) has increasing dyspnea and is being evaluated for heart failure (HF). Which test will be ordered to help differentiate between dyspnea due to lung dysfunction and dyspnea due to HF?
a. Atrial natriuretic hormone (ANH) level
b. Brain natriuretic peptide (BNP) level
c. Cardiac enzymes
d. Electrocardiogram (ECG)
ANS: B
The BNP is used to differentiate that dyspnea is due to HF and not lung dysfunction. The other tests will all be a part of the diagnostic workup but do not help with this distinction.

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TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pathophysiology

4. The nurse is preparing to administer digoxin to a patient who has heart failure. The patient reports nausea, vomiting, and a headache. The nurse notes a respiratory rate of 18 breaths per minute, a heart rate of 58 beats per minute, and a blood pressure of 120/78 mm Hg. What will the nurse do next?
a. Administer the next dose as ordered since these are mild side effects.
b. Hold the dose and notify the provider of possible digoxin toxicity.
c. Reassure the patient that these are common, self-limiting side effects.
d. Request an order for an antiemetic and an analgesic medication.
ANS: B
Nausea, vomiting, and headache are common signs of digoxin toxicity as is a heart rate less than 60 beats per minute. The nurse should hold the dose and notify the provider.

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is caring for a patient who is taking digoxin to treat heart failure. The patients electrocardiogram shows a ventricular dysrhythmia. The nurse will notify the provider and will anticipate an order for which medication?
a. Digoxin immune Fab (Digibind)
b. Furosemide (Lasix)
c. Phenytoin (Dilantin)
d. Potassium
ANS: C
The antidysrhythmics phenytoin and lidocaine are effective in treating digoxin-induced ventricular dysrhythmias. Digoxin immune Fab is used to treat severe digitalis toxicity, characterized by bradycardia, nausea, and vomiting. Unless a potassium deficit is present, giving potassium could worsen the dysrhythmia.

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TOP: NURSING PROCESS: Planning/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A patient who takes digoxin to treat heart failure will begin taking a vasodilator. The patient asks the nurse why this new drug has been ordered. The nurse will explain that the vasodilator is used to
a. decrease ventricular stretching.
b. improve renal perfusion.
c. increase cardiac output.
d. promote peripheral fluid loss.
ANS: A
Vasodilators are given to decrease venous blood return to the heart, resulting in decreased cardiac filling and decreased ventricular stretching, in turn reducing preload, contractility, and oxygen demand on the heart.

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The nurse performs a medication history and learns that the patient takes a thiazide diuretic and digoxin (Lanoxin). The nurse will question the patient to ensure that the patient is also taking which medication?
a. Cortisone
b. Lidocaine
c. Nitroglycerin
d. Potassium
ANS: D
If a patient is taking digoxin and a potassium-wasting diuretic such as thiazide, the patient should also take a potassium supplement to prevent hypokalemia that could result in digoxin toxicity. It is not necessary to take cortisone, lidocaine, or nitroglycerin unless the patient has symptoms that warrant these drugs.

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MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse administers a dose of digoxin (Lanoxin) to a patient who has heart failure and returns to the room later to reassess the patient. Which finding indicates that the medication is effective?
a. Decreased dyspnea
b. Decreased urine output
c. Increased blood pressure
d. Increased heart rate
ANS: A
The patient should show improvement in breathing and oxygenation. Urine output should increase. Blood pressure and heart rate will decrease.

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TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A patient who has heart failure receives digoxin (Lanoxin) and an angiotension-converting enzyme (ACE) inhibitor. The patient will begin taking spironolactone (Aldactone). The patient asks why the new drug is necessary. The nurse will tell the patient that spironolactone will be given for which reason?
a. To enhance potassium excretion
b. To increase cardiac contractility
c. To minimize fluid losses
d. To provide cardioprotective effects
ANS: D
Spironolactone is a potassium-sparing diuretic that blocks production of aldosterone, causing improved heart rate variability and decreased myocardial fibrosis. It is given in congestive heart failure for its cardioprotective effects. Spironolactone does not directly alter cardiac contractility but may slightly decrease contractility if fluid volume is decreased. It is a mild diuretic but is not given in this instance to minimize fluid losses.

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TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A patient who has stable angina pectoris is given nitroglycerin to use as needed. In addition to pharmacotherapy, the nurse will give the patient which instruction?
a. Avoid extremes in weather.
b. Begin a rigorous exercise program.
c. Drink glass of red wine daily.
d. Seek medical care at first sign of pain.
ANS: A
Avoiding extreme weather conditions is important to help prevent anginal attacks. Patients should be instructed to avoid strenuous exercise; avoid alcohol, which can enhance hypotensive effects of nitrates; and use nitroglycerin at the first sign of pain.

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TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The nurse is teaching a patient about the use of a transdermal nitroglycerin patch. Which statement by the patient indicates understanding of the teaching?
a. I will apply the patch as needed when I experience anginal pain.
b. I will remove the old patch and replace it with a new one at bedtime each day.
c. I should rotate sites when changing the patch to prevent skin irritation.
d. When I am symptom-free, I may stop using the patch on a regular basis.
ANS: C
Patients should be taught to rotate application sites when using the transdermal nitroglycerin. Transdermal nitroglycerin is not used as needed. Patients should remove the patch at bedtime to provide an 8- to 12-hour nitrate-free interval. Patients should use the patch even when symptom-free unless otherwise instructed by the provider.

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TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. The nurse is teaching a patient about sublingual nitroglycerin administration. What information will the nurse include when teaching this patient?
a. Call 911 if pain does not improve after three doses.
b. If pain persists after one dose, administer a second dose.
c. Swallow the tablet with small sips of water.
d. Take the first tablet while sitting or lying down.
ANS: D
Because nitroglycerin can cause hypotension, patients should be cautioned to take them while sitting or lying down. If pain is not better or has worsened 5 minutes after the first dose, patients should call 911. The tablets must dissolve under the tongue and should not be swallowed.

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TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. A patient who uses transdermal nitroglycerin reports having headaches. The nurse will counsel the patient to perform which action?
a. Call 911 when this occurs.
b. Notify the provider.
c. Reapply the patch three times daily.
d. Take acetaminophen as needed.
ANS: D
Headaches are one of the most common side effects of nitroglycerin, but they may become less frequent; acetaminophen is generally recommended for pain. The headaches are not an emergency, and the patient does not need to call 911 or notify the provider. The patch is applied once daily.

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TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A patient is ordered to receive a nitrate to relieve stable angina. What side effect(s) will the nurse anticipate in a patient receiving this medication?
a. Nausea and vomiting
b. Increased blood pressure
c. Pruritus and skin rash
d. Pounding headache
ANS: D
The pounding headache is related to vasodilation of the cerebral vessels. Nitrates decrease blood pressure.

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TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. A patient asks the nurse why nitroglycerin is given sublingually. The nurse will explain that nitroglycerin is administered by this route for which reason?
a. To avoid hypotension
b. To increase absorption
c. To minimize gastrointestinal upset
d. To prevent hepatotoxicity
ANS: B
Nitroglycerin is given sublingually to avoid first-pass metabolism by the liver, which would occur if the drug is swallowed. It does not prevent hypotension. Gastrointestinal upset and hepatotoxicity usually do not occur.

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TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. A patient who has been taking nitroglycerin for angina has developed variant angina, and the provider has added verapamil (Calan) to the patients regimen. The nurse will explain that verapamil is given for which purpose?
a. To facilitate oxygen use by the heart
b. To improve renal perfusion
c. To increase cardiac contractility
d. To relax coronary arteries
ANS: D
Verapamil is a calcium channel blocker and is used to relax coronary artery spasm in patients with variant angina. It does not facilitate coronary muscle oxygen use, improve renal function, or increase cardiac contractility.

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TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. A patient who has begun taking nifedipine (Procardia) to treat variant angina has had a recurrent blood pressure of 90/60 mm Hg or less. The nurse will anticipate that the provider will
a. add digoxin to the drug regimen.
b. change to a beta blocker.
c. order serum liver enzymes.
d. switch to diltiazem (Cardizem).
ANS: D
Hypotension is a common effect of calcium channel blockers and is more common with nifedipine. It is less common with diltiazem, so the provider may order that drug. Adding digoxin, changing to a beta blocker, or ordering serum liver enzymes are not indicated.

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TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. The nurse is preparing to administer digoxin to a patient who has a serum digoxin level of 2.5 ng/mL. The patient takes 0.25 mg of digoxin per day. What action will the nurse take?
a. Administer the next dose as ordered.
b. Notify the provider of digoxin toxicity.
c. Request an order to decrease the digoxin dose.
d. Suggest that the patient may need an increased digoxin dose.
ANS: B
The therapeutic range of digoxin is between 0.5 and 2 mg/mL. This patients level is high, indicating toxicity. The nurse should not give the next dose or request a change in dose.

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TOP: NURSING PROCESS: Evaluation/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. A patient who has Wolff-Parkinson-White syndrome is given intravenous adenosine (Adenocard). The nurse will explain that the medication is effective because it
a. controls atrial flutter.
b. deepens myocardial excitability.
c. prevents multifocal ventricular contractions.
d. prolongs repolarization.
ANS: D
Adenosine is a class III drug that prolongs repolarization by increasing the refractory period and prolonging the action potential to slow heart rate. It does not control atrial flutter, deepen myocardial excitability, or prevent multifocal contractions.

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TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

20. The nurse provides teaching for a patient who has a ventricular dysrhythmia who is prescribed acebutolol (Spectral) 200 mg twice daily. Which statement by the patient indicates understanding of the teaching?
a. Diuretics may decrease the effectiveness of this drug.
b. Dizziness, nausea, and vomiting indicate a severe reaction.
c. I should eat fruits and vegetables to increase potassium intake.
d. I should not stop taking this drug abruptly to avoid palpitations.
ANS: D
Patients who stop taking this drug abruptly can experience palpitations. Diuretics do not decrease drug effectiveness. Dizziness and nausea and vomiting are common side effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 617
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. A patient has congestive heart failure and has been taking digoxin (Lanoxin) for 9 years. The patient is admitted with signs and symptoms of digoxin toxicity. Which signs and symptoms are associated with digoxin toxicity? (Select all that apply.)
a. Dysuria
b. Vomiting
c. Tachycardia
d. Yellow haloes in the visual field
e. Diarrhea
f. Insomnia
ANS: B, D, E
Vomiting, yellow haloes in the visual field, and diarrhea are classic signs of digoxin toxicity. Bradycardia, not tachycardia, will likely be noted.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 603
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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