Abrams' Clinical Drug Therapy
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1
The nurse is preparing to administer an initial dose of
ivabradine to a patient with chronic heart failure. Which clinical
finding would require the nurse to withhold the medication and
contact the healthcare provider?
A. Heart rate of 54 beats/minute
B. Blood pressure of 142/88 mmHg
C. Serum potassium level of 3.8 mEq/L
D. Ejection fraction of 32%
Correct Answer: A
Rationale: Ivabradine works by selectively inhibiting the
hyperpolarization-activated cyclic nucleotide-gated ($I_f$)
channels in the sinoatrial node, which slows the heart rate
without affecting myocardial contractility or repolarization. It is
contraindicated or should be withheld if the resting heart rate is
below 60 beats/minute prior to treatment, as it can cause
severe bradycardia. A blood pressure of 142/88 mmHg, a
normal-ish serum potassium level, and a low ejection fraction
(which defines heart failure with reduced ejection fraction) are
expected or not contraindications for this specific medication.
Question 2
,A patient taking digoxin for heart failure reports seeing yellow-
green halos around lights, accompanied by nausea and
abdominal discomfort. Which action should the nurse take first?
A. Administer the scheduled dose of digoxin.
B. Check the patient's serum digoxin level.
C. Assess the patient's apical pulse and obtain a 12-lead ECG.
D. Encourage the patient to consume foods high in potassium.
Correct Answer: C
Rationale: The patient is exhibiting classic signs of digoxin
toxicity (visual disturbances like yellow-green halos,
gastrointestinal distress). The nurse's immediate priority is to
assess the clinical status of the patient by checking the apical
pulse for bradycardia or dysrhythmias and obtaining an ECG, as
digoxin toxicity can cause life-threatening arrhythmias.
Checking the serum digoxin level is appropriate but comes after
stabilizing or assessing the acute cardiac status. Administering
the dose would exacerbate toxicity, and modifying diet does not
address the immediate potential emergency.
Question 3
The nurse is reviewing the laboratory results of a patient who is
receiving continuous intravenous milrinone for acute
decompensated heart failure. Which laboratory value requires
immediate intervention?
, A. Platelet count of $95,000/\text{mm}^3$
B. Serum sodium of 136 mEq/L
C. Blood urea nitrogen (BUN) of 22 mg/dL
D. Serum calcium of 9.2 mg/dL
Correct Answer: A
Rationale: Milrinone is a phosphodiesterase inhibitor that can
cause thrombocytopenia as an adverse effect. A platelet count
of $95,000/\text{mm}^3$ is below the normal range
($150,000\text{--}450,000/\text{mm}^3$) and indicates
thrombocytopenia, putting the patient at risk for bleeding. The
other laboratory values (sodium, BUN, calcium) are within or
very close to normal limits and do not indicate an acute adverse
effect of milrinone.
Question 4
A nurse is providing discharge teaching to a patient newly
prescribed sacubitril/valsartan for heart failure. Which
statement by the patient demonstrates a correct understanding
of the medication regimen?
A. "I can take this medication right after stopping my lisinopril."
B. "I should avoid using a potassium-based salt substitute while
taking this drug."
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1
The nurse is preparing to administer an initial dose of
ivabradine to a patient with chronic heart failure. Which clinical
finding would require the nurse to withhold the medication and
contact the healthcare provider?
A. Heart rate of 54 beats/minute
B. Blood pressure of 142/88 mmHg
C. Serum potassium level of 3.8 mEq/L
D. Ejection fraction of 32%
Correct Answer: A
Rationale: Ivabradine works by selectively inhibiting the
hyperpolarization-activated cyclic nucleotide-gated ($I_f$)
channels in the sinoatrial node, which slows the heart rate
without affecting myocardial contractility or repolarization. It is
contraindicated or should be withheld if the resting heart rate is
below 60 beats/minute prior to treatment, as it can cause
severe bradycardia. A blood pressure of 142/88 mmHg, a
normal-ish serum potassium level, and a low ejection fraction
(which defines heart failure with reduced ejection fraction) are
expected or not contraindications for this specific medication.
Question 2
,A patient taking digoxin for heart failure reports seeing yellow-
green halos around lights, accompanied by nausea and
abdominal discomfort. Which action should the nurse take first?
A. Administer the scheduled dose of digoxin.
B. Check the patient's serum digoxin level.
C. Assess the patient's apical pulse and obtain a 12-lead ECG.
D. Encourage the patient to consume foods high in potassium.
Correct Answer: C
Rationale: The patient is exhibiting classic signs of digoxin
toxicity (visual disturbances like yellow-green halos,
gastrointestinal distress). The nurse's immediate priority is to
assess the clinical status of the patient by checking the apical
pulse for bradycardia or dysrhythmias and obtaining an ECG, as
digoxin toxicity can cause life-threatening arrhythmias.
Checking the serum digoxin level is appropriate but comes after
stabilizing or assessing the acute cardiac status. Administering
the dose would exacerbate toxicity, and modifying diet does not
address the immediate potential emergency.
Question 3
The nurse is reviewing the laboratory results of a patient who is
receiving continuous intravenous milrinone for acute
decompensated heart failure. Which laboratory value requires
immediate intervention?
, A. Platelet count of $95,000/\text{mm}^3$
B. Serum sodium of 136 mEq/L
C. Blood urea nitrogen (BUN) of 22 mg/dL
D. Serum calcium of 9.2 mg/dL
Correct Answer: A
Rationale: Milrinone is a phosphodiesterase inhibitor that can
cause thrombocytopenia as an adverse effect. A platelet count
of $95,000/\text{mm}^3$ is below the normal range
($150,000\text{--}450,000/\text{mm}^3$) and indicates
thrombocytopenia, putting the patient at risk for bleeding. The
other laboratory values (sodium, BUN, calcium) are within or
very close to normal limits and do not indicate an acute adverse
effect of milrinone.
Question 4
A nurse is providing discharge teaching to a patient newly
prescribed sacubitril/valsartan for heart failure. Which
statement by the patient demonstrates a correct understanding
of the medication regimen?
A. "I can take this medication right after stopping my lisinopril."
B. "I should avoid using a potassium-based salt substitute while
taking this drug."
