PHARMACOLOGY FINAL EXAM
REVIEW!!!!
A4patient4about4to4receive4his4morning4dose4of4digoxin4has4an4apical4pulse4of4704beats4p
er4minute.4What4will4the4nurse4do?
A.4Administer4the4dose.
B.4Administer4the4dose4and4notify4the4physician.
C.4Check4the4radial4pulse4for414full4minute.
D.4Withhold4the4dose4and4notify4the4-4ans--A.4Administer4the4dose.
In4assessing4a4patient4before4administration4of4a4cardiac4glycoside,4the4nurse4knows4that
4what4condition4can4predispose4a4patient4to4digitalis4toxicity?
A.4Hypokalemia
B.4Hyperkalemia
C.4Hypocalcemia
D.4Hypernatremia4-4ans--
A.4Hypokalemia;4control4ventricular4response4to4atrial4fibrillation4and4a4derived4from4foxgl
ove.4Digoxin4is4the4only4available4cardiac4glycoside---positive4inotropic---
inhibits4sodium4potassium4pump4(adenosine4tripphophatase)4Sodium4and4calcium4rise.4
Cholinergic4stimulation4via4the4vagus4nerve4of4Parasympathetic4nervous4system.4---
Negative4chronotropic---Negative4Dromotropic4effect
While4assessing4a4patient4who4is4receiving4intravenous4digitalis,4the4nurse4recognizes4th
at4the4drug4has4a4negative4chronotropic4effect.4How4would4this4drug4effect4be4evident4in4t
he4patient?
A.4Increased4heart4rate
B.4Decreased4heart4rate
C.4Decreased4conduction
D.4Increased4ectopic4beats4-4ans--B.4Decreased4heart4rate
A4patient4has4been4taking4digoxin4at4home4but4has4taken4an4accidental4overdose4and4ha
s4developed4toxicity.4He4has4been4admitted4to4the4telemetry4unit4where4the4physician4ha
s4ordered4digoxin4immune4Fab4(Digibind).4The4patient4asks4the4nurse4why4the4medicatio
n4is4ordered.4What4is4the4nurse's4best4response?
A.4"It4works4faster4than4digoxin."
B.4"It4is4safer4than4digoxin4and4can4be4taken4orally."
C.4"It4helps4to4convert4the4irregular4heart4rhythm4to4a4more4normal4rhythm."
D.4"This4drug4is4an4antidote4to4digoxin4and4will4help4to4lower4the4blood4levels."4-4ans--
D.4"This4drug4is4an4antidote4to4digoxin4and4will4help4to4lower4the4blood4levels."4(severe4br
adycardia,4advanced4heart4block,4ventricularr4tachycardia,4fibrillation,4and4hyperkalemia)
,;4available4in4parental4form.4Clinical4signs4and4symptoms4are4monitored4NOT4serum4leve
ls----used4for4systolic4heart4failure4and4atrial4fibrillation.
5.4A4patient4has4been4placed4on4a4milrinone4infusion4as4part4of4the4therapy4for4end-
stage4heart4failure.4What4risks4involved4with4this4drug4will4the4nurse4keep4in4mind4while4a
ssessing4this4patient4during4the4infusion?
A.4Hypertension
B.4Hyperkalemia
C.4Nausea4and4vomiting
D.4Cardiac4dysrhythmias4-4ans--
D.4Cardiac4dysrhythmias4(contraindictated4with4ventricular4tachycardia,4and4fibrillation)4u
sed4for4treatment4of4atrial4fibrillation.4Available4in4Oral4and4injection4form.
6.4A4patient4with4atrial4fibrillation4was4started4on4digoxin,4and414week4later4a4digoxin4level
4was4drawn.4Which4result4is4within4normal4therapeutic4levels4for4digoxin?
A.40.44ng/mL
B.40.74ng/mL
C.42.14ng/mL
D.42.64ng/mL4or4higher4-4ans--B.40.74ng/mL4(normal40.54to42.04ng/mL
7.4When4reviewing4the4list4of4medications4taken4by4a4patient4who4will4be4receiving4a4new4
prescription4for4digoxin,4the4nurse4would4be4concerned4about4which4medication4that4may
4interact4with4the4digoxin?
A.4aspirin
B.4acetaminophen4(Tylenol)
C.4furosemide4(Lasix)
D.4vitamin4K4-4ans--C.4furosemide4(Lasix);4(loop4Diuretics);4numerous4ones4on4page4341
8.4The4nurse4is4reviewing4discharge4teaching4for4a4patient4who4will4be4taking4digoxin4(La
noxin)4therapy.4The4patient4should4be4taught4to4avoid4which4foods4when4taking4the4digox
in?
A.4Leafy4green4vegetables
B.4Dairy4products
C.4Grapefruit4juice
D.4Bran4muffins4-4ans--D.4Bran4muffins
9.4In4assessing4a4patient4before4administration4of4a4cardiac4glycoside,4the4nurse4knows4t
hat4which4lab4result4can4increase4the4toxicity4of4the4drug?
A.4Potassium4level42.84mEq/L
B.4Potassium4level44.94mEq/L
C.4Sodium4level41404mEq/L
D.4Calcium4level4104mg/dL4-4ans--
A.4Potassium4level42.84mEq/L4(low4potassium4normal4is43.54to45.0)
10.4The4nurse4administering4the4phosphodiesterase4inhibitor4inamrinone4recognizes4that
4this4drug4should4have4a4positive4inotropic4effect.4This4effect4will4result4in4increased
, A.4heart4rate.
B.4blood4vessel4dilation.
C.4force4of4cardiac4contraction.
D.4conduction4of4electrical4impulses4across4the4heart.4-4ans--
C.4force4of4cardiac4contraction.4(increase4cAMP)4positive4inotropic4(by4more4calcium4avai
lable4in4SR)effect4and4vasodilation,4(inodilators)---
positive4chornotropic4effect);4USED4IN4ICU;4ADVERSE4EFFECT...thrombocytopenia,4dy
srhythmia,4ventricular,4hypotension4and4angina,4hypokalemia,4tremor.
11.4The4nurse4notes4in4a4patient's4medical4record4that4nesiritide4has4been4ordered.4Base
d4on4this4order,4the4nurse4interprets4that4the4patient4has4which4disorder?
A.4Atrial4fibrillation
B.4Acutely4decompensated4heart4failure4with4dyspnea4at4rest
C.4Systolic4heart4failure
D.4Long-term4treatment4of4heart4failure.4-4ans--
B.4Acutely4decompensated4heart4failure4with4dyspnea4at4rest
SELECT4ALL4THAT4APPLY:
41.4When4a4patient4is4experiencing4digoxin4toxicity,4which4clinical4situation4would4necessi
tate4the4use4of4digoxin4immune4Fab4(Digibind)?4Select4all4that4apply.
A.4The4patient4reports4seeing4colorful4halos4around4lights.
B.4The4patient's4serum4potassium4level4is4above454mEq/L.
C.4The4patient4is4experiencing4nausea4and4anorexia.
D.4The4patient4is4experiencing4severe4sinus4bradycardia4that4does4not4respond4to4cardia
c4pacing.
E.4The4patient4has4taken4an4overdose4of4greater4than4104mg4of4digoxin.4-4ans--
B.4The4patient's4serum4potassium4level4is4above454mEq/L.
D.4The4patient4is4experiencing4severe4sinus4bradycardia4that4does4not4respond4to4cardia
c4pacing.4(E)4might4be4right4as4well4a4person4taking410mg4of4digoxin4is4a4indication4of4tox
icity...page43404states4life4threatening4digoxin4overdose4in4adults4and444mg4in4children)
2.4Which4drug4classes4are4considered4first-line4treatment4for4heart4failure?
4Select4all4that4apply.
A.4Angiotensin4converting4enzyme4(ACE)4inhibitors
B.4Angiotensin4II4receptor4blockers4(ARBs)
C.4Digoxin4(cardiac4glycoside)
D.4Beta-blockers
E.4Nesiritide4(Natrecor),4the4B-type4natriuretic4peptide4-4ans--ACE
ARBS
Beta-blockers
loop4diuretics
1.When4administering4topical4nitroglycerin4ointment,4the4nurse4should4use4which4techniq
ue?
REVIEW!!!!
A4patient4about4to4receive4his4morning4dose4of4digoxin4has4an4apical4pulse4of4704beats4p
er4minute.4What4will4the4nurse4do?
A.4Administer4the4dose.
B.4Administer4the4dose4and4notify4the4physician.
C.4Check4the4radial4pulse4for414full4minute.
D.4Withhold4the4dose4and4notify4the4-4ans--A.4Administer4the4dose.
In4assessing4a4patient4before4administration4of4a4cardiac4glycoside,4the4nurse4knows4that
4what4condition4can4predispose4a4patient4to4digitalis4toxicity?
A.4Hypokalemia
B.4Hyperkalemia
C.4Hypocalcemia
D.4Hypernatremia4-4ans--
A.4Hypokalemia;4control4ventricular4response4to4atrial4fibrillation4and4a4derived4from4foxgl
ove.4Digoxin4is4the4only4available4cardiac4glycoside---positive4inotropic---
inhibits4sodium4potassium4pump4(adenosine4tripphophatase)4Sodium4and4calcium4rise.4
Cholinergic4stimulation4via4the4vagus4nerve4of4Parasympathetic4nervous4system.4---
Negative4chronotropic---Negative4Dromotropic4effect
While4assessing4a4patient4who4is4receiving4intravenous4digitalis,4the4nurse4recognizes4th
at4the4drug4has4a4negative4chronotropic4effect.4How4would4this4drug4effect4be4evident4in4t
he4patient?
A.4Increased4heart4rate
B.4Decreased4heart4rate
C.4Decreased4conduction
D.4Increased4ectopic4beats4-4ans--B.4Decreased4heart4rate
A4patient4has4been4taking4digoxin4at4home4but4has4taken4an4accidental4overdose4and4ha
s4developed4toxicity.4He4has4been4admitted4to4the4telemetry4unit4where4the4physician4ha
s4ordered4digoxin4immune4Fab4(Digibind).4The4patient4asks4the4nurse4why4the4medicatio
n4is4ordered.4What4is4the4nurse's4best4response?
A.4"It4works4faster4than4digoxin."
B.4"It4is4safer4than4digoxin4and4can4be4taken4orally."
C.4"It4helps4to4convert4the4irregular4heart4rhythm4to4a4more4normal4rhythm."
D.4"This4drug4is4an4antidote4to4digoxin4and4will4help4to4lower4the4blood4levels."4-4ans--
D.4"This4drug4is4an4antidote4to4digoxin4and4will4help4to4lower4the4blood4levels."4(severe4br
adycardia,4advanced4heart4block,4ventricularr4tachycardia,4fibrillation,4and4hyperkalemia)
,;4available4in4parental4form.4Clinical4signs4and4symptoms4are4monitored4NOT4serum4leve
ls----used4for4systolic4heart4failure4and4atrial4fibrillation.
5.4A4patient4has4been4placed4on4a4milrinone4infusion4as4part4of4the4therapy4for4end-
stage4heart4failure.4What4risks4involved4with4this4drug4will4the4nurse4keep4in4mind4while4a
ssessing4this4patient4during4the4infusion?
A.4Hypertension
B.4Hyperkalemia
C.4Nausea4and4vomiting
D.4Cardiac4dysrhythmias4-4ans--
D.4Cardiac4dysrhythmias4(contraindictated4with4ventricular4tachycardia,4and4fibrillation)4u
sed4for4treatment4of4atrial4fibrillation.4Available4in4Oral4and4injection4form.
6.4A4patient4with4atrial4fibrillation4was4started4on4digoxin,4and414week4later4a4digoxin4level
4was4drawn.4Which4result4is4within4normal4therapeutic4levels4for4digoxin?
A.40.44ng/mL
B.40.74ng/mL
C.42.14ng/mL
D.42.64ng/mL4or4higher4-4ans--B.40.74ng/mL4(normal40.54to42.04ng/mL
7.4When4reviewing4the4list4of4medications4taken4by4a4patient4who4will4be4receiving4a4new4
prescription4for4digoxin,4the4nurse4would4be4concerned4about4which4medication4that4may
4interact4with4the4digoxin?
A.4aspirin
B.4acetaminophen4(Tylenol)
C.4furosemide4(Lasix)
D.4vitamin4K4-4ans--C.4furosemide4(Lasix);4(loop4Diuretics);4numerous4ones4on4page4341
8.4The4nurse4is4reviewing4discharge4teaching4for4a4patient4who4will4be4taking4digoxin4(La
noxin)4therapy.4The4patient4should4be4taught4to4avoid4which4foods4when4taking4the4digox
in?
A.4Leafy4green4vegetables
B.4Dairy4products
C.4Grapefruit4juice
D.4Bran4muffins4-4ans--D.4Bran4muffins
9.4In4assessing4a4patient4before4administration4of4a4cardiac4glycoside,4the4nurse4knows4t
hat4which4lab4result4can4increase4the4toxicity4of4the4drug?
A.4Potassium4level42.84mEq/L
B.4Potassium4level44.94mEq/L
C.4Sodium4level41404mEq/L
D.4Calcium4level4104mg/dL4-4ans--
A.4Potassium4level42.84mEq/L4(low4potassium4normal4is43.54to45.0)
10.4The4nurse4administering4the4phosphodiesterase4inhibitor4inamrinone4recognizes4that
4this4drug4should4have4a4positive4inotropic4effect.4This4effect4will4result4in4increased
, A.4heart4rate.
B.4blood4vessel4dilation.
C.4force4of4cardiac4contraction.
D.4conduction4of4electrical4impulses4across4the4heart.4-4ans--
C.4force4of4cardiac4contraction.4(increase4cAMP)4positive4inotropic4(by4more4calcium4avai
lable4in4SR)effect4and4vasodilation,4(inodilators)---
positive4chornotropic4effect);4USED4IN4ICU;4ADVERSE4EFFECT...thrombocytopenia,4dy
srhythmia,4ventricular,4hypotension4and4angina,4hypokalemia,4tremor.
11.4The4nurse4notes4in4a4patient's4medical4record4that4nesiritide4has4been4ordered.4Base
d4on4this4order,4the4nurse4interprets4that4the4patient4has4which4disorder?
A.4Atrial4fibrillation
B.4Acutely4decompensated4heart4failure4with4dyspnea4at4rest
C.4Systolic4heart4failure
D.4Long-term4treatment4of4heart4failure.4-4ans--
B.4Acutely4decompensated4heart4failure4with4dyspnea4at4rest
SELECT4ALL4THAT4APPLY:
41.4When4a4patient4is4experiencing4digoxin4toxicity,4which4clinical4situation4would4necessi
tate4the4use4of4digoxin4immune4Fab4(Digibind)?4Select4all4that4apply.
A.4The4patient4reports4seeing4colorful4halos4around4lights.
B.4The4patient's4serum4potassium4level4is4above454mEq/L.
C.4The4patient4is4experiencing4nausea4and4anorexia.
D.4The4patient4is4experiencing4severe4sinus4bradycardia4that4does4not4respond4to4cardia
c4pacing.
E.4The4patient4has4taken4an4overdose4of4greater4than4104mg4of4digoxin.4-4ans--
B.4The4patient's4serum4potassium4level4is4above454mEq/L.
D.4The4patient4is4experiencing4severe4sinus4bradycardia4that4does4not4respond4to4cardia
c4pacing.4(E)4might4be4right4as4well4a4person4taking410mg4of4digoxin4is4a4indication4of4tox
icity...page43404states4life4threatening4digoxin4overdose4in4adults4and444mg4in4children)
2.4Which4drug4classes4are4considered4first-line4treatment4for4heart4failure?
4Select4all4that4apply.
A.4Angiotensin4converting4enzyme4(ACE)4inhibitors
B.4Angiotensin4II4receptor4blockers4(ARBs)
C.4Digoxin4(cardiac4glycoside)
D.4Beta-blockers
E.4Nesiritide4(Natrecor),4the4B-type4natriuretic4peptide4-4ans--ACE
ARBS
Beta-blockers
loop4diuretics
1.When4administering4topical4nitroglycerin4ointment,4the4nurse4should4use4which4techniq
ue?
