,Question 1
A 72-year-old patient with chronic heart failure is prescribed digoxin (Lanoxin).
Which therapeutic effect should the nurse expect?
A. Increased heart rate and decreased contractility
B. Increased myocardial contractility and increased cardiac output
C. Decreased myocardial contractility and increased preload
D. Increased sodium retention and fluid retention
Correct Answer
B. Increased myocardial contractility and increased cardiac output
Rationale
Digoxin is a cardiac glycoside that improves the pumping ability of the failing
heart. It has a positive inotropic effect, meaning it increases the force of
myocardial contraction. As a result, cardiac output improves, allowing the heart
to pump blood more effectively to body tissues.
Additionally, digoxin slows conduction through the AV node and decreases
heart rate, allowing the ventricles more time to fill before contraction.
Why the Other Answers Are Incorrect
A. Digoxin decreases—not increases—heart rate.
C. Digoxin strengthens myocardial contraction rather than decreasing it.
D. Digoxin does not promote sodium or water retention.
Nursing Pearl
Think:
• Positive inotrope = Stronger squeeze
• Negative chronotrope = Slower heart rate
Question 2
Digoxin improves cardiac contractility primarily by:
A. Blocking beta-adrenergic receptors
,B. Inhibiting the sodium-potassium ATPase pump
C. Blocking calcium channels
D. Stimulating angiotensin II receptors
Correct Answer
B. Inhibiting the sodium-potassium ATPase pump
Rationale
Digoxin inhibits the Na⁺/K⁺-ATPase pump, leading to:
• Increased intracellular sodium
• Reduced sodium-calcium exchange
• Increased intracellular calcium
• Stronger myocardial contractions
More calcium inside cardiac muscle cells results in more forceful contractions.
Why the Other Answers Are Incorrect
• A. Beta blockers reduce heart rate but are not digoxin's mechanism.
• C. Calcium channel blockers reduce calcium entry.
• D. Angiotensin II receptors are unrelated to digoxin.
Clinical Memory Tip
Digoxin → Blocks Na/K pump → Calcium rises → Heart squeezes harder.
Question 3
Which medication regimen is commonly used in the management of chronic
heart failure?
A. Digoxin, ACE inhibitor, diuretic, and vasodilator
B. Digoxin alone
C. Antibiotic and corticosteroid
D. NSAID and calcium supplement
Correct Answer
, A. Digoxin, ACE inhibitor, diuretic, and vasodilator
Rationale
Heart failure treatment targets several physiologic problems:
• Digoxin: Improves contractility
• Diuretics: Reduce fluid overload
• ACE inhibitors: Lower blood pressure and decrease ventricular
remodeling
• Vasodilators: Reduce preload and afterload
Patients with severe heart failure may also receive dobutamine, dopamine, or
phosphodiesterase (PDE) inhibitors to improve cardiac output.
Why the Other Answers Are Incorrect
• B. Digoxin alone is insufficient for most patients.
• C. Antibiotics and steroids do not treat heart failure.
• D. NSAIDs may worsen heart failure by promoting sodium and water
retention.
Question 4
Which assessment finding is most concerning for digoxin toxicity?
A. Heart rate of 58 beats/min with nausea and yellow vision
B. Blood pressure of 124/76 mm Hg
C. Respiratory rate of 18/min
D. Mild thirst
Correct Answer
A. Heart rate of 58 beats/min with nausea and yellow vision
Rationale
Classic manifestations of digoxin toxicity include:
• Bradycardia
• Dysrhythmias
A 72-year-old patient with chronic heart failure is prescribed digoxin (Lanoxin).
Which therapeutic effect should the nurse expect?
A. Increased heart rate and decreased contractility
B. Increased myocardial contractility and increased cardiac output
C. Decreased myocardial contractility and increased preload
D. Increased sodium retention and fluid retention
Correct Answer
B. Increased myocardial contractility and increased cardiac output
Rationale
Digoxin is a cardiac glycoside that improves the pumping ability of the failing
heart. It has a positive inotropic effect, meaning it increases the force of
myocardial contraction. As a result, cardiac output improves, allowing the heart
to pump blood more effectively to body tissues.
Additionally, digoxin slows conduction through the AV node and decreases
heart rate, allowing the ventricles more time to fill before contraction.
Why the Other Answers Are Incorrect
A. Digoxin decreases—not increases—heart rate.
C. Digoxin strengthens myocardial contraction rather than decreasing it.
D. Digoxin does not promote sodium or water retention.
Nursing Pearl
Think:
• Positive inotrope = Stronger squeeze
• Negative chronotrope = Slower heart rate
Question 2
Digoxin improves cardiac contractility primarily by:
A. Blocking beta-adrenergic receptors
,B. Inhibiting the sodium-potassium ATPase pump
C. Blocking calcium channels
D. Stimulating angiotensin II receptors
Correct Answer
B. Inhibiting the sodium-potassium ATPase pump
Rationale
Digoxin inhibits the Na⁺/K⁺-ATPase pump, leading to:
• Increased intracellular sodium
• Reduced sodium-calcium exchange
• Increased intracellular calcium
• Stronger myocardial contractions
More calcium inside cardiac muscle cells results in more forceful contractions.
Why the Other Answers Are Incorrect
• A. Beta blockers reduce heart rate but are not digoxin's mechanism.
• C. Calcium channel blockers reduce calcium entry.
• D. Angiotensin II receptors are unrelated to digoxin.
Clinical Memory Tip
Digoxin → Blocks Na/K pump → Calcium rises → Heart squeezes harder.
Question 3
Which medication regimen is commonly used in the management of chronic
heart failure?
A. Digoxin, ACE inhibitor, diuretic, and vasodilator
B. Digoxin alone
C. Antibiotic and corticosteroid
D. NSAID and calcium supplement
Correct Answer
, A. Digoxin, ACE inhibitor, diuretic, and vasodilator
Rationale
Heart failure treatment targets several physiologic problems:
• Digoxin: Improves contractility
• Diuretics: Reduce fluid overload
• ACE inhibitors: Lower blood pressure and decrease ventricular
remodeling
• Vasodilators: Reduce preload and afterload
Patients with severe heart failure may also receive dobutamine, dopamine, or
phosphodiesterase (PDE) inhibitors to improve cardiac output.
Why the Other Answers Are Incorrect
• B. Digoxin alone is insufficient for most patients.
• C. Antibiotics and steroids do not treat heart failure.
• D. NSAIDs may worsen heart failure by promoting sodium and water
retention.
Question 4
Which assessment finding is most concerning for digoxin toxicity?
A. Heart rate of 58 beats/min with nausea and yellow vision
B. Blood pressure of 124/76 mm Hg
C. Respiratory rate of 18/min
D. Mild thirst
Correct Answer
A. Heart rate of 58 beats/min with nausea and yellow vision
Rationale
Classic manifestations of digoxin toxicity include:
• Bradycardia
• Dysrhythmias
