Nursing Pharmacology: Cardiovascular Drugs 2026 Exam
1. Question
Which of the following clients is at greatest risk for digitalis toxicity?
A. A 25-year-old client with congenital heart disease.
B. A 50-year-old client with CHF.
Incorrect
C. A 60-year-old client after myocardial infarction.
D. An 80-year-old client with CHF.
Correct Answer
Incorrect
Correct Answer: D. An 80-year-old client with CHF.
Extremely old clients are at greater risk for digitalis toxicity. Remember when it
comes to adversity, the very old and very young are always at the highest risk.
There are no evidence-based guidelines for the management of mild to moderate
toxicity so there is a wide variation in treatment. Severe toxicity requires hospital
admission and consideration of the need for digoxin-specific antibody fragments.
Although digoxin-specific antibody fragments are safe and effective, randomized
trials have not been performed.
,Option A: Digoxin toxicity can emerge during long-term therapy as well as after an
overdose. It can occur even when the serum digoxin concentration is within the
therapeutic range.
Option B: The clinical features of toxicity are often non-specific. They commonly
include lethargy, confusion, and gastrointestinal symptoms (anorexia, nausea,
vomiting, diarrhea, and abdominal pain). Visual effects (blurred vision, color
disturbances, halos, and scotomas) are rarer in contemporary practice. Cardiac
arrhythmias account for most deaths.
Option C: Digoxin increases intracellular calcium in myocardial cells indirectly, by
inhibiting the sodium-potassium pump in the cell membrane. Increased
intracellular calcium increases cardiac contractility, but also the risk of
tachyarrhythmias. Inhibition of this pump causes hyperkalemia commonly seen in
toxicity. Digoxin also causes an increase in vagal activity, reducing activity in the
sinus node and prolonging conduction in the atrioventricular node.
2. Question
Which of the following is a contraindication for digoxin administration?
A. Blood pressure of 140/90.
B. Heart rate above 80.
C. Heart rate below 60.
Correct Answer
,D. Respiratory rate above 20.
Incorrect
Incorrect
Correct Answer: C. Heart rate below 60.
The apical heart rate must be monitored during therapy with digoxin, and the
drug held for a pulse below 60 and above 120. Remember that digoxin lowers the
heart rate; therefore, the choice that reflects a low heart rate is the best
selection. Digoxin toxicity is clinically relevant as it can lead to fatal cardiac
arrhythmias. The estimated frequency is at about 0.8 to 4% of patients on steady
digoxin therapy. The rate of toxicity increases as serum digoxin concentration
reaches over 2.0 ng/ml.
Option A: However, toxicity can also occur at lower levels, especially in the setting
of other risk factors such as low body weight, advanced age, decreased renal
function, and hypokalemia.
Option B: It increases the force of contraction of the heart by reversibly inhibiting
the activity of the myocardial Na-K ATPase pump, an enzyme that controls the
movement of ions into the heart. Digoxin induces an increase in intracellular
sodium that will drive an influx of calcium in the heart and cause an increase in
contractility. Cardiac output increases with a subsequent decrease in ventricular
filling pressures.
, Option D: Digoxin has vagomimetic effects on the AV node. By stimulating the
parasympathetic nervous system, it slows electrical conduction in the
atrioventricular node, therefore, decreases the heart rate. The rise in calcium
levels leads to prolongation of phase 4, and phase 0 of the cardiac action
potential thus increases the refractory period of the AV node. Slower conduction
through the AV node carries a decreased ventricular response.
3. Question
The action of medication is inotropic when it:
A. Decreased afterload.
B. Increases heart rate.
C. Increases the force of contraction.
Correct
D. Is used to treat CHF.
Correct
Correct Answer: C. Increases the force of contraction.
Inotropic drugs increase the force of contraction. Preload, not afterload, is
decreased. Chronotropic drugs increase heart rate. Treatment of CHF is an
indication for use not an action of the inotropic drug. Inotropes increase cardiac
1. Question
Which of the following clients is at greatest risk for digitalis toxicity?
A. A 25-year-old client with congenital heart disease.
B. A 50-year-old client with CHF.
Incorrect
C. A 60-year-old client after myocardial infarction.
D. An 80-year-old client with CHF.
Correct Answer
Incorrect
Correct Answer: D. An 80-year-old client with CHF.
Extremely old clients are at greater risk for digitalis toxicity. Remember when it
comes to adversity, the very old and very young are always at the highest risk.
There are no evidence-based guidelines for the management of mild to moderate
toxicity so there is a wide variation in treatment. Severe toxicity requires hospital
admission and consideration of the need for digoxin-specific antibody fragments.
Although digoxin-specific antibody fragments are safe and effective, randomized
trials have not been performed.
,Option A: Digoxin toxicity can emerge during long-term therapy as well as after an
overdose. It can occur even when the serum digoxin concentration is within the
therapeutic range.
Option B: The clinical features of toxicity are often non-specific. They commonly
include lethargy, confusion, and gastrointestinal symptoms (anorexia, nausea,
vomiting, diarrhea, and abdominal pain). Visual effects (blurred vision, color
disturbances, halos, and scotomas) are rarer in contemporary practice. Cardiac
arrhythmias account for most deaths.
Option C: Digoxin increases intracellular calcium in myocardial cells indirectly, by
inhibiting the sodium-potassium pump in the cell membrane. Increased
intracellular calcium increases cardiac contractility, but also the risk of
tachyarrhythmias. Inhibition of this pump causes hyperkalemia commonly seen in
toxicity. Digoxin also causes an increase in vagal activity, reducing activity in the
sinus node and prolonging conduction in the atrioventricular node.
2. Question
Which of the following is a contraindication for digoxin administration?
A. Blood pressure of 140/90.
B. Heart rate above 80.
C. Heart rate below 60.
Correct Answer
,D. Respiratory rate above 20.
Incorrect
Incorrect
Correct Answer: C. Heart rate below 60.
The apical heart rate must be monitored during therapy with digoxin, and the
drug held for a pulse below 60 and above 120. Remember that digoxin lowers the
heart rate; therefore, the choice that reflects a low heart rate is the best
selection. Digoxin toxicity is clinically relevant as it can lead to fatal cardiac
arrhythmias. The estimated frequency is at about 0.8 to 4% of patients on steady
digoxin therapy. The rate of toxicity increases as serum digoxin concentration
reaches over 2.0 ng/ml.
Option A: However, toxicity can also occur at lower levels, especially in the setting
of other risk factors such as low body weight, advanced age, decreased renal
function, and hypokalemia.
Option B: It increases the force of contraction of the heart by reversibly inhibiting
the activity of the myocardial Na-K ATPase pump, an enzyme that controls the
movement of ions into the heart. Digoxin induces an increase in intracellular
sodium that will drive an influx of calcium in the heart and cause an increase in
contractility. Cardiac output increases with a subsequent decrease in ventricular
filling pressures.
, Option D: Digoxin has vagomimetic effects on the AV node. By stimulating the
parasympathetic nervous system, it slows electrical conduction in the
atrioventricular node, therefore, decreases the heart rate. The rise in calcium
levels leads to prolongation of phase 4, and phase 0 of the cardiac action
potential thus increases the refractory period of the AV node. Slower conduction
through the AV node carries a decreased ventricular response.
3. Question
The action of medication is inotropic when it:
A. Decreased afterload.
B. Increases heart rate.
C. Increases the force of contraction.
Correct
D. Is used to treat CHF.
Correct
Correct Answer: C. Increases the force of contraction.
Inotropic drugs increase the force of contraction. Preload, not afterload, is
decreased. Chronotropic drugs increase heart rate. Treatment of CHF is an
indication for use not an action of the inotropic drug. Inotropes increase cardiac
