Exam 3 Review 2022

Digoxin has a positive inotropic action and a negative chronotropic action. This indicates to the nurse which outcome?

• Increased conduction and decreased contractility of the heart muscle

• Increased contractility and decreased heart rate

• Increased heart rate and decreased conduction of cardiac impulses

• Increased conduction of cardiac impulses and decreased cardiac contractility

Answer explanation

A positive inotropic and negative chronotropic action indicates that the contractility of the cardiac muscle will be increased however the heart rate will slow down. Essentially digoxin slow down the heart rate and makes the heart work more efficiently as a pump.

What is the priority lab value for the nurse to assess prior to administering furosemide?

• Serum potassium

• Serum BUN

• Serum creatinine

• Serum NA

Answer explanation

The priority lab for the nurse to monitor is serum potassium. Although kidney function is important for effective action hypokalemia is more prevalent than altered kidney function.

Which assessment findings indicate the client is experiencing digoxin toxicity? Select all that apply.

• Tachycardia

• Vision changes

• Nausea

• Weakness

• Irregular Heart Rate

Answer explanation

Assessment findings associated with digoxin toxicity include vison changes (yellow/green halos), bradycardia, anorexia, nausea, vomiting, irregular heart rate and depression/personality changes.

What are priority actions of the nurse when administering digoxin. Select all that apply.

• Assess serum potassium

• Assess BUN and creatinine levels

• Assess for trends in daily weights

• Assess apical pulse for a full minute and hold if less than 60

• Assess blood pressure and hold if systolic is below 100

Answer explanation

Low serum potassium levels can increase risk of digoxin toxicity. Digoxin has a negative chronotropic effect and will decrease HR, the nurse will hold if less than 60. BP, BUN/creatinine are not impacted by the drug. Although daily weights are part of the treatment plan for a client with HR it signifies fluid retention and is not a SE of dig.

The nurse is caring for a client prescribed propranolol. What information in the health history is of concern?

• COPD

• Hypertension

• Chronic Heart Failure

• Mitral Valve Stenosis

Answer explanation

Propranolol is a non-selective beta blocker. There is a risk that beta 2 receptors on the lungs may be impacted, in client with COPD bronchoconstriction is a potential problem. The drug may be administered for given for HTN, Chronic HF. There is no contraindication for mitral valve stenosis.

Which assessment finding is of concern to the nurse caring for a client with chronic heart failure newly prescribed ivabradine?

• Ejection fraction 32%

• Blood Pressure 108/62

• Apical pulse 68

• Dyspnea

Answer explanation

Ivabradine is indicated in client with chronic HF with ejection fraction of 35% or lower and HR of 75 or greater with sinus rhythm. The nurse is concerned about bradycardia. Dyspnea is expected in a client with CHF.

Which labs will the nurse monitor when caring for a client prescribed vancomycin to evaluate side/adverse effects?

• Liver Function Test

• BUN & creatinine

• White Blood Cell Count

• Serum drug levels

• Platelets

Answer explanation

The client prescribed vancomycin is at risk for nephrotoxicity, BUN and Creatinine should be monitored. The drug has a narrow therapeutic index which also requires monitoring serum drug levels.

Which side/adverse effects are associated with ceftriaxone? Select all that apply

• Nephrotoxicity

• C-Diff

• Hepatotoxicity

• Hypersensitivity

  Reaction

Answer explanation

All side effects listed are associated with use of ceftriaxone

Which reaction is associated with rapid administration of vancomycine?

Answer explanation

Red Man or Red Neck Syndrome

What information will the nurse include during a teaching session with a client prescribed ivabradine? Select all that apply.

• Weight yourself every day

• Take the drug with meals

• Monitor BP and pulse

• Do not take with grapefruit juice

• The drug may cause bruising

Answer explanation

Ivabradine is prescribed for clients with CHF. The client should monitor wts daily and report 3 lb weight gain in 24 hours to provider. The drug can cause hypertension and bradycardia the nurse will instruct to monitor values at home and report changes. Grapefruit juice will interfere with drug action. The drug does not impact platelets so bruising or bleeding is not of concern