Chapter 37: Cardiotonic and Antiarrhythmic Drugs Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. A client has been admitted to a health care center with reports of dyspnea. The nurse suspects left-sided heart failure based on which assessment finding? a. Nocturia b. Pitting edema c. Weight gain d. Orthopnea Answer: D Rationale: The nurse should assess for orthopnea in clients with left-sided heart failure. Orthopnea is a condition where the client has difficulty breathing when lying down. The other features of left ventricular failure include a hacking cough or wheezing, restlessness, and anxiety. Nocturia, pitting edema, and weight gain are associated with right-sided heart failure. Question format: Multiple Choice Chapter: 37 Learning Objective: 1 Cognitive Level: Apply Client Needs: Physiological Integrity: Physiological Adaptation Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 474, Heart Failure 2. A nurse is assessing the serum digoxin level of a client who is receiving treatment for atrial fibrillation. Which result should the nurse prioritize and report to the primary health care provider? a. 1.6 ng/mL b. 1.8 ng/mL c. 2.0 ng/mL d. 2.2 ng/mL Answer: D Rationale: A serum digoxin level of more than 2 ng/mL would require the nurse to report to the primary health care provider; therefore, serum digitalis levels of 2.2 ng/mL indicate digoxin toxicity. The therapeutic levels range from 0.5 to 2 ng/mL. Question format: Multiple Choice Chapter: 37 Learning Objective: 8 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Communication and Documentation Reference: p. 482, Promoting an Optimal Response to Therapy 3. A nurse is preparing to administer ivabradine to a client with heart failure. Which preadministration assessment should the nurse prioritize for this client? a. Inspect joints for swelling. b. Check for jugular vein distention. c. Inspect skin for rash. d. Obtain blood glucose levels. Answer: B Rationale: The nurse should check for jugular vein distention as part of the preadministration assessment for the client prescribed a cardiotonic. Inspecting the joints for swelling should occur on the ongoing assessment to evaluate for possible adverse reactions, especially if the client is also receiving a diuretic. Inspecting the skin would be necessary if there were any indications of a possible adverse reaction, but this would also occur after the drug's administration. Obtaining blood glucose levels is not necessary for heart failure but would be indicated if the client also had diabetes. Question format: Multiple Choice Chapter: 37 Learning Objective: 5 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 481, Preadministration Assessment 4. The nurse is completing a teaching session with a client with heart failure. The nurse determines that additional teaching is needed about the cardiotonic drug therapy when the client makes which comment? a. “I will take the drug at the same time each day.” b. “I can crush the tablet and mix it with food.” c. “I should call if my pulse rate is below 80 beats per minute.” d. “I need to notify my health care provider if I have blurred vision.” Answer: C Rationale: Cardiotonics normally should be withheld if the pulse rate is below 60 bpm or above 100 bpm. The client should take the drug at the same time each day, crush the tablet and mix with food, and notify the primary health care provider if blurred vision occurs. Question format: Multiple Choice Chapter: 37 Learning Objective: 8 Cognitive Level: Analyze Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Teaching/Learning Reference: p. 482, Ongoing Assessment 5. A client with arrhythmias is prescribed an antiarrhythmic. About which finding on the ongoing assessment should the nurse instruct the client to immediately notify the primary health care provider? a. Sudden change in mental state b. A pulse rate of 90 bpm c. Dry mouth and gums d. Increased restlessness Answer: A Rationale: The nurse should report any sudden change in mental status to the health care provider as a decrease in dosage may be necessary. A pulse rate above 100 bpm or below 60 bpm should be immediately reported to the health care provider. Dry mouth and gums are expected adverse reactions for which the nurse should recommend the client take frequent sips of water or chew sugarless gum. Somnolence—not restlessness—is a possible adverse reaction to antiarrhythmic drugs. Question format: Multiple Choice Chapter: 37 Learning Objective: 8 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Teaching/Learning Reference: p. 484, Monitoring Pulse Rate 6. The nurse is teaching a client with arrhythmia about the prescribed verapamil. Which potential adverse reaction should the nurse point out to the client? a. Diarrhea b. Hyperactivity c. Peripheral edema d. Hypertension