NUR 316- PREP U CHAP 44, 46 EXAM QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026

NUR 316- PREP U CHAP 44, 46 EXAM QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026 A patient is experiencing nausea and visual disturbances when taking digoxin (Lanoxin). Which medication will be administered? Acetylsalicylic acid (aspirin) Nesiritide (Natrecor) Felbamate (Felbatol) Digoxin immune fab (Digibind) - Answers Digoxin immune fab (Digibind) Explanation: A patient who has nausea and visual changes while taking digoxin will most likely be administered digoxin immune fab (Digibind). Acetylsalicylic acid is not administered for digoxin toxicity. Nesiritide is not administered when the patient is experiencing digoxin toxicity. Felbamate is administered for the treatment of seizures. Mrs. Houston is a 78-year-old woman who resides in an assisted living facility. Her doctor prescribed digoxin at her last visit to the clinic and she has approached the nurse who makes regular visits to the assisted-living facility about this new drug. What teaching point should the nurse emphasize to Mrs. Houston? The importance of having required laboratory work performed on time The need to take the medication at the same time each day regardless of her heart rate The correct technique for using a home blood pressure cuff Timing household activities to coincide with the administration times of her digoxin - Answers The importance of having required laboratory work performed on time Explanation: Patients taking digoxin need to know the importance of having all laboratory work (serum drug levels; electrolytes) performed on time. Digoxin is not taken if the patient is bradycardic, and it does not provide an immediate or short-term increase in exercise tolerance. Blood pressure monitoring is not normally required for patients who are taking digoxin. What is the most accurate method for preventing adverse effects associated with the use of digoxin? Teach patients to take their digoxin in divided doses with each meal. Assess the patient's heart rate and hold administration if it is less than 60. Teach patients the signs and symptoms of heart failure. Monitor therapeutic effects based on echocardiogram results. - Answers Assess the patient's heart rate and hold administration if it is less than 60. Explanation: Patients should be taught to hold their digoxin if their heart rate is less than 60 (or some other defined heart rate). Divided doses are not normally used and an awareness of heart failure does not preclude adverse effects of digoxin. The nurse is to administer digoxin to a client with heart failure. The nurse auscultates an apical pulse rate of 52. What action should the nurse take? Administer medication Notify the physician Assess the blood pressure Administer half of the dose - Answers Notify the physician Explanation: Before administering each dose of digoxin, take the apical pulse rate for 60 seconds. If the apical rate is below 60 beats per minute, withhold the drug and notify the physician. Blood pressure is not affected by digoxin. Without prescriptive authority, the nurse cannot change medication dosages. After teaching a class of students about heart failure and drug therapy, the instructor determines that the teaching has been successful when the students identify which drug as most often used as treatment? - Answers Digoxin Explanation: Digoxin is the drug most often used to treat heart failure. Human B-type natriuretic peptide, nitrate, or furosemide also may be used, but these drugs are not the ones most commonly used. When educating a group of nursing students on the mechanisms of action of digitalis, the nurse identifies what as the pharmacological actions of digitalis? (Select all that apply.) - Answers It increases cardiac output by positive inotropic action It decreases the heart rate through negative chronotropic effect It retards the conduction velocity through the AV node in the heart Explanation: The pharmacological actions of digitalis are increased cardiac output, decreased heart rate, and retarding conduction velocity. Digitalis increases cardiac output by positive inotropic action. It does not have negative inotropic action. It decreases the heart rate through negative chronotropic effect. In atrial fibrillation rapid atrial contractions are seen. Digitalis is used to treat atrial fibrillation. A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient's heart rate, the nurse should prioritize assessment of the patient's intake and output. blood pressure. cognition. exercise tolerance. - Answers blood pressure. Explanation: Fluid balance, cognition, and exercise tolerance are all affected by CHF and should be regularly assessed as part of thorough nursing care. However, the combination of an ACE inhibitor, a beta blocker, and a diuretic constitutes a significant risk for hypotension and indicates a need for frequent blood pressure monitoring. Which is an adverse reaction associated with cardiotonic medications? Visual disturbances Diarrhea Constipation Restlessness - Answers Visual disturbances Explanation: Adverse reactions associated with the cardiotonic medications include headache, weakness, drowsiness, visual disturbances, nausea, anorexia, and arrhythmias. After receiving a loading dose of milrinone (Primacor), what is a client most likely to experience? (Select all that apply.) Hypertension Angina Hyperkalemia Headache Insomnia - Answers Angina Headache Explanation: The adverse reactions most likely to occur after the administration of milrinone (Primacor) to a client are ventricular arrhythmias, hypotension, angina, chest pain, and hypokalemia. The nurse recognizes that which finding is associated with right-sided heart failure? Dyspnea Nocturia Orthopnea Crackles in the lungs - Answers Nocturia Explanation: Nocturia is a symptom of right-sided heart failure. Crackles in the lungs, dyspnea, and orthopnea are symptoms related to left-sided heart failure because they are pulmonary symptoms. Which instructions would be appropriate to include in the teaching plan for a patient taking digoxin at home? (Select all that apply.) "Weigh yourself each day at the same time and wearing the same amount of clothing." "Check your pulse every day before taking the medication." "Notify the doctor if your pulse is below 60 beats per minute." "Call your doctor if you notice an irregular heart rhythm or you feel nauseated." "Take the drug with some type of food to avoid an upset stomach." - Answers "Weigh yourself each day at the same time and wearing the same amount of clothing." "Check your pulse every day before taking the medication." "Notify the doctor if your pulse is below 60 beats per minute." "Call your doctor if you notice an irregular heart rhythm or you feel nauseated." Explanation: This helps to evaluate the effectiveness of the drug and for signs and symptoms of heart failure. This is important in evaluating for digoxin toxicity. A pulse rate below 60 beats/minute might suggest digoxin toxicity. Irregular heart rhythm or nausea may indicate digoxin toxicity. Drug absorption is delayed if the drug is taken with food. A nurse is monitoring a patient who is prescribed milrinone for heart failure. Which sign in the patient indicates that the nurse should withhold the drug? Edema Hypotension Bradycardia Cyanosis - Answers Hypotension Explanation: When caring for patients taking milrinone, the development of hypotension would necessitate the nurse withholding the drug and notify the practitioner. Hypotension occurs as an adverse effect of milrinone. Edema and cyanosis need to be assessed by the nurse as part of the pre-administration assessment. Edema, bradycardia, and cyanosis are not adverse effects associated with milrinone. A patient presents to the ED with rales, wheezing, and blood-tinged sputum. The nurse suspects the patient is experiencing pulmonary edema. Pulmonary edema stems from: cardiomyopathy. right ventricular failure. valvular heart disease. left ventricular failure. - Answers left ventricular failure. Explanation: Pulmonary edema occurs when left ventricular failure (or dysfunction) results in accumulation of blood and fluid in pulmonary veins and tissues. What does the use of cardiotonics lead to? (Select all that apply.) Improved myocardial contractility Increased myocardial efficiency Increase in blood pressure Increase in peripheral edema Improved perfusion to all body tissues - Answers Improved myocardial contractility Increased myocardial efficiency Improved perfusion to all body tissues Explanation: Cardiotonics are drugs used to increase the efficiency and improve the contraction of the heart muscle, which leads to improved blood flow (perfusion) to all tissues of the body. The nurse assesses the client taking nicardipine (Cardene) for which symptoms, which may indicate heart failure? (Select all that apply.) Dyspnea Weight gain Edema Tachycardia Bradycardia - Answers Dyspnea Weight gain Edema Explanation: Symptoms of heart failure include dyspnea, weight gain, peripheral edema, abnormal lung sounds, and jugular vein distention. The heart rate may be increased, but this is not indicative of heart failure. The nurse teaches the client that antacids when taken with digoxin may have which interactions? Nausea and vomiting Increased digoxin levels Decreased digoxin levels Anorexia - Answers Decreased digoxin levels Explanation: When antacids are taken combined with digoxin, the client may experience decreased serum digitalis levels. There is no effect on the gastrointestinal system. The nurse recognizes which medications may be the cause of a digoxin level of 2.7 nanograms/mL? Cholestyramine Antacids Methotrexate Amiodarone - Answers Amiodarone Explanation: When combined with digoxin, amiodarone can cause increased serum digitalis levels leading to toxicity. Methotrexate, cholestyramine, and antacids all may cause decreased serum digitalis levels A nurse suspects that a client is experiencing left-sided heart failure. Which would the nurse assess? (Select all that apply.) Tachypnea Hemoptysis Peripheral edema Hepatomegaly Orthopnea Polyuria - Answers Tachypnea Hemoptysis Orthopnea Polyuria Explanation: Left-sided heart failure would be indicated by tachypnea, hemoptysis, orthopnea, increased urine output (polyuria), nocturia, dyspnea, and cough. Peripheral edema and hepatomegaly suggest right-sided heart failure. When preparing a care plan for chronic heart failure, the nurse bases recommendations on the newest research about prior treatment for CHF. Based on knowledge of the guidelines, which drug combination therapy has been shown to decrease mortality from CHF? Digoxin, a beta-blocker, and a diuretic Digoxin and a beta-blocker Digoxin and an ACE inhibitor An ACE inhibitor, a beta-blocker, and a diuretic - Answers An ACE inhibitor, a beta-blocker, and a diuretic Explanation: The combination of an ACE inhibitor, a beta-blocker, and a diuretic has been shown to decrease mortality from CHF. This is the recommended therapy. Digoxin does not decrease mortality from CHF but it decreases symptoms and improves exercise tolerance, thereby improving the quality of life. Cells of a failing heart due to heart failure often lack the ability to produce the energy needed for effective contraction. - Answers True Administration of a cardiotonic drug is contraindicated in which conditions? (Select all that apply.) Digitalis toxicity Hypertension Cardiac tamponade Hypotension Ventricular tachycardia - Answers Digitalis toxicity Cardiac tamponade Ventricular tachycardia Explanation: The cardiotonics are contraindicated in the presence of digitalis toxicity, clients with known drug hypersensitivity, ventricular tachycardia, cardiac tamponade, restrictive cardimyopathy, or AV block. When dosing digoxin (Lanoxin), which factors are considered? (Select all that apply.) Patient lean body weight Patient age Renal function Pharmacokinetics Pharmacodynamics - Answers Patient lean body weight Patient age Renal function Pharmacokinetics Pharmacodynamics Explanation: All of the answers are factors to consider when dosing digoxin (Lanoxin). A patient has been admitted to a health care center with reports of dyspnea. Which signs should the nurse monitor for when assessing the patient for left ventricular dysfunction? Nocturia Pitting edema Weight gain Orthopnea - Answers Orthopnea Explanation: The nurse should assess for orthopnea in patients with left ventricular dysfunction. Orthopnea is a condition where the patient experiences difficulty in breathing on lying down. The other features of left ventricular failure include a hacking cough or wheezing, restlessness, or anxiety. Nocturia, pitting edema, and weight gain are associated with right ventricular dysfunction, and not left ventricular dysfunction. Which assessment findings may indicate the client is experiencing digitalis toxicity? (Select all that apply.) Abdominal pain Diarrhea Drowsiness Increased appetite Vomiting - Answers Abdominal pain Diarrhea Drowsiness Vomiting Explanation: Signs of digitalis toxicity include anorexia, nausea, vomiting, diarrhea, weakness, lethargy, drowsiness, headache, visual disturbances, and arrhythmias. Vasodilators used to treat heart failure include nitrates and ACE inhibitors. - Answers True In heart failure, by what mechanism does the body compensate for decreased circulating blood volume? Activation of the renin-angiotensin-aldosterone system Increasing preload Decreasing afterload Increasing stroke volume - Answers Activation of the renin-angiotensin-aldosterone system Explanation: As circulating volume to the kidneys decreases in CHF, the renin-angiotensin-aldosterone system is activated as the body attempts to "correct" for the low levels of circulating volume. The nurse explains to the client that with heart failure, what may occur? Increased heart rate Decreased heart rate Visual disturbances Diarrhea - Answers Increased heart rate Explanation: Tachycardia is a symptom related to heart failure. Bradycardia, diarrhea, and visual disturbances are signs of digitalis toxicity. Which dosage forms are used for digoxin (Lanoxin) maintenance therapy? (Select all that apply.) Capsule Injection Ointment Patch Tablet - Answers Capsule Injection Tablet Explanation: Capsules and tablets are used for maintenance therapy, injections are used for rapid digitalization, and digoxin patches and ointment do not exist. A 70-year-old woman has experienced peripheral edema and decreasing stamina in recent months and has sought care from her primary care provider. The patient's subsequent diagnostic workup has resulted in a diagnosis of chronic heart failure. The woman has been prescribed digoxin and the nurse has begun patient education. What should the nurse teach the patient about her new medication? "By reducing the amount of fluid that your body contains, digoxin will make it easier for your heart to pump." "This will lessen the workload of your heart by reducing your blood pressure." "Most patients see their heart failure resolve in 2 to 4 months after they begin taking digoxin." "This drug won't cure your disease, but it will help you be able to exercise more and be more comfortable." - Answers "This drug won't cure your disease, but it will help you be able to exercise more and be more comfortable." Explanation: Digoxin is used to maintain clinical stability and improve symptoms, quality of life, and exercise tolerance in patients with all phases of CHF; it does not decrease mortality from CHF or cure the disease. Digoxin increases urine production but its therapeutic effect is not primarily gained from diuresis or blood pressure reduction. The nurse is caring for a client who takes sublingual nitroglycerin. This version of the drug typically begins acting within: one to three minutes. five to ten minutes. fifteen to twenty minutes. thirty minutes to an hour. - Answers one to three minutes. Explanation: Sublingual nitroglycerin acts within one to three minutes and lasts thirty minutes to an hour. A client with asthma has been prescribed a beta-blocker for management of angina. For what adverse reaction should the nurse observe? Bronchospasm Hypoglycemia Pleural effusion Pneumonia - Answers Bronchospasm Explanation: When taking beta blockers, patients with asthma should be observed for bronchospasm from blockage of beta2 receptors in the lung. The client is experiencing an acute onset of angina. The nurse would administer which medication? Nitrostat Nitro-Dur Norvasc Procardia - Answers Nitrostat Explanation: Nitrostat is administered for acute relief of angina. Nitro-Dur is used to prevent angina. Procardia and Norvasc are indicated for chronic angina. A client prescribed nitroglycerin reports to the nurse that he is having headaches. How should the nurse best respond? "You may experience headaches as an adverse reaction to nitroglycerin." "Do not take any more nitroglycerin. It is increasing your blood pressure." "If you lie down when taking nitroglycerin you will not experience a headache." "Nitroglycerin is dropping your blood pressure and that is causing the headache." - Answers "You may experience headaches as an adverse reaction to nitroglycerin." Explanation: An adverse reaction of nitroglycerin includes headaches. The client should not reduce or stop taking the medication. Lying down will not prevent headaches associated with taking nitroglycerin. When describing the possible adverse effects associated with nitroglycerin, what would the nurse include? Dizziness Hypertension Chills Constipation - Answers Dizziness Explanation: Dizziness is a possible adverse effect. Hypotension is a possible adverse effect. Flushing is a possible adverse effect. Constipation is not associated with nitroglycerin. Anti-anginal drugs are used in the treatment of cardiac disease for what purposes? (Select all that apply.) Relieve the pain of acute anginal attacks. Decrease serum triglyceride. Prevent angina attacks. Increase high-density lipoproteins (HDL). Treatment chronic stable angina pectoris. - Answers Relieve the pain of acute anginal attacks. Prevent angina attacks. Treatment chronic stable angina pectoris. Explanation: Anti-anginal drugs are used to relieve pain of acute anginal attacks, prevent angina attacks, and treat chronic stable angina pectoris. Antianginals have no effect on HDL or triglycerides. A patient has been prescribed a beta-adrenergic blocker to help control angina. What effect might the patient experience as a result of the drug therapy? Increased heart rate Increased oxygen consumption Decreased cardiac output Increased blood pressure - Answers Decreased cardiac output Explanation: Beta-adrenergic blockers reduce heart rate, cardiac output, and blood pressure. This reduces the heart's oxygen demand, which in turn decreases angina. A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for: Hypotension Hypertension Hyperkalemia Hypokalemia - Answers Hypotension Explanation: When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension. A male patient who uses sublingual nitroglycerin tells the nurse that when he puts it under his tongue, he feels a fizzing sensation. Which response by the nurse would be most appropriate? "That means that the drug is still potent and working." "You might have an irritation that's causing this." "You need a new supply because the drug has deteriorated." "That's a normal report we hear." - Answers "That means that the drug is still potent and working." Explanation: Fizzing indicates potency, not irritation or deterioration. Beta blockers decrease myocardial oxygen demand by increasing the heart rate and decreasing cardiac contraction. - Answers False Explanation: Beta blockers prevent the activation of sympathetic receptors, which normally would increase the heart rate, increase blood pressure, increase cardiac contraction, and increase the myocardial oxygen demand. Beta blockers block these actions. Ms. Catril is prescribed sublingual nitroglycerin by her physician for the treatment of stable angina. She contacts the physician office and states that she feels light-headed after taking the medication for an acute episode of chest pain. Based on the nurse's knowledge of nitroglycerin, what is the pathophysiology behind the patient having light-headedness? Nitroglycerin causes dilation of the arteries and veins, thereby increasing the blood flow to the brain. Nitroglycerin causes relaxation of the vascular smooth muscles, thereby preventing adequate blood flow to the brain. Nitroglycerin causes relaxation of the arteries and veins, resulting in blood pooling in the extremities and the blood pressure dropping. Nitroglycerin causes a decrease in venous return, thereby limiting the blood flow to the brain. - Answers Nitroglycerin causes relaxation of the arteries and veins, resulting in blood pooling in the extremities and the blood pressure dropping. Explanation: Nitroglycerin relaxes vascular smooth muscle and dilates both arterial and venous vessels. Dilation of veins is more predominant than dilation of arteries, resulting in peripheral pooling of blood and decreased preload. Blood pressure will decrease as a result of venous dilation. Reflex tachycardia may follow the drop in blood pressure. Which would a nurse identify as a nitrate? Metoprolol Amlodipine Nicardipine Isosorbide - Answers Isosorbide Explanation: Isosorbide is classified as a nitrate. Metoprolol is a beta-blocker. Amlodipine and nicardipine are calcium channel blockers. After teaching a group of students about angina, the instructor determines that the teaching was successful when the students describe stable angina as: Chest pain that is relieved by rest Chest pain that occurs at rest Chest pain that occurs due to vasospasm