The nurse is caring for a patient with chronic heart failure who has been prescribed digoxin (Lanoxin). The patient’s apical pulse rate is 58 beats/min. What should the nurse do next?

Administer the medication as ordered.

Hold the medication and notify the provider.

Check the patient’s serum digoxin level.

Give an additional dose of digoxin.

Answer and Explanation

The Correct Answer is B

Digoxin (Lanoxin) is a cardiac glycoside that is used to improve the contractility of the heart and slow down the heart rate in patients with chronic heart failure. However, digoxin has a narrow therapeutic range and can cause toxicity if the dose is too high or if the patient has low potassium levels. A normal serum digoxin level is 0.5 to 2 ng/mL and a normal serum potassium level is 3.5 to 5 mEq/L. A low heart rate (less than 60 beats/min) is a sign of digoxin toxicity and the nurse should withhold the medication and report it to the provider. The nurse should also check the patient’s serum digoxin and potassium levels to determine if they are within normal limits.

Choice A is wrong because administering the medication as ordered could worsen the patient’s condition and increase the risk of digoxin toxicity.

Choice C is wrong because checking the patient’s serum digoxin level is not enough to prevent digoxin toxicity. The nurse should also check the patient’s serum potassium level and heart rate before giving digoxin.

Choice D is wrong because giving an additional dose of digoxin could cause a fatal overdose and lead to cardiac arrest. The nurse should never give more than the prescribed dose of digoxin without consulting the provider.

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Correct Answer is C

Explanation

Angiotensin II receptor blockers (ARBs) block the binding of angiotensin II to its receptors on blood vessels and adrenal glands, preventing its vasoconstrictive and aldosterone-stimulating effects

Choice A is wrong because beta blockers do not block angiotensin II receptors, but rather beta-adrenergic receptors, which are involved in the sympathetic nervous system.Beta blockers reduce heart rate and blood pressure by inhibiting the effects of adrenaline and noradrenaline

Choice B is wrong because calcium channel blockers do not block angiotensin II receptors, but rather calcium channels, which are involved in the contraction of smooth muscle cells.Calcium channel blockers relax blood vessels and lower blood pressure by reducing the influx of calcium into the cells

Choice D is wrong because direct acting vasodilators do not block angiotensin II receptors, but rather act directly on the smooth muscle cells of blood vessels, causing them to relax and dilate.Direct acting vasodilators lower blood pressure by decreasing peripheral resistance

A. Administer diltiazem as ordered by physician B. Instruct patient to change positions slowly C. Notify physician immediately D. Hold diltiazem and notify physician if symptoms persist. E. Hold diltiazem and notify physician if symptoms persist.

Correct Answer is B

Explanation

This is because diltiazem (Cardizem) is a calcium channel blocker that lowers blood pressure and can cause orthostatic hypotension, which is a sudden drop in blood pressure when standing up from a sitting or lying position. This can lead to dizziness and lightheadedness, which can increase the risk of falls and injuries. Changing positions slowly can help prevent or reduce these symptoms by allowing the body to adjust to the change in blood pressure.

Choice A) Administer diltiazem as ordered by physician is wrong because it does not address the patient’s complaint of dizziness and lightheadedness, which are side effects of the medication.

The nurse should monitor the patient’s blood pressure and heart rate before and after administering diltiazem, and report any abnormal findings to the physician.

Choice C) Notify physician immediately is wrong because it is not necessary to notify the physician immediately for a common and mild side effect of diltiazem, unless the patient has other signs of severe hypotension, such as fainting, chest pain, or confusion.

The nurse should educate the patient about the possible side effects of diltiazem and how to prevent or manage them.

Choice D) Hold diltiazem and notify physician if symptoms persist is wrong because it is not appropriate to hold a prescribed medication without a valid reason or an order from the physician.

Holding diltiazem could cause the patient’s blood pressure to rise and increase the risk of complications from atrial fibrillation, such as stroke or heart failure.

The nurse should administer diltiazem as ordered and monitor the patient’s response.

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The nurse is caring for a patient with chronic heart failure who has been prescribed digoxin (Lanoxin). The patient’s apical pulse rate is 58 beats/min. What should the nurse do next?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which drug blocks the binding of angiotensin II to its receptors on blood vessels and adrenal glands, preventing its vasoconstrictive and aldosterone-stimulating effects?

Correct Answer is C

Explanation

The nurse is caring for a patient with atrial fibrillation who has been prescribed diltiazem (Cardizem). The patient reports feeling dizzy and lightheaded when standing up quickly from a sitting position or when getting out of bed in the morning. What action should the nurse take?

Correct Answer is B

Explanation

A nurse is teaching a client who has heart failure and is prescribed captopril. Which of the following instructions should the nurse include? (Select all that apply.).

A nurse is evaluating a client who has hypertension and is taking lisinopril, an angiotensin II receptor blocker (ARB). Which of the following outcomes indicates that the medication is effective?

A nurse is planning to administer mannitol to a client who has heart failure and pulmonary edema. Which of the following actions should the nurse take before giving the medication?

A nurse is caring for a client who has heart failure and is receiving carvedilol (Coreg). The nurse should monitor which of the following laboratory values to determine therapeutic effectiveness of this medication?

A nurse is evaluating a client who has heart failure and is receiving warfarin. Which of the following statements by the client indicates a need for further teaching?

A patient with atrial fibrillation has been prescribed digoxin (Lanoxin). The nurse should monitor which laboratory value to evaluate therapeutic effectiveness?

A nurse is caring for a client who has hypertension and is prescribed metoprolol, a beta blocker. The nurse should monitor the client for which of the following adverse effects?

The nurse is reviewing the discharge instructions with a patient who has heart failure and is prescribed losartan (Cozaar). Which of the following statements by the patient indicates understanding of the teaching? (Select all that apply.)