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Chapter 19 - Pharmacology for the Primary Care Provider - Test Bank

Uploaded: 6 years ago
Contributor: karaabunassar
Category: Nursing
Type: Test / Midterm / Exam
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Filename:   Chapter 19 - Pharmacology for the Primary Care Provider - Test Bank.rtf (22.42 kB)
Page Count: 3
Credit Cost: 1
Views: 129
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Description
4th Edition
Transcript
Chapter 19: Heart Failure and Digoxin Test Bank MULTIPLE CHOICE 1. A patient comes to the clinic with a recent onset of nocturnal and exertional dyspnea. The primary care nurse practitioner (NP) auscultates S3 heart sounds but does not palpate hepatomegaly. The patient has mild peripheral edema of the ankles. The NP should consult a cardiologist to discuss prescribing a(n): a. b-blocker. b. loop diuretic. c. angiotensin-converting enzyme (ACE) inhibitor. d. angiotensin receptor blocker (ARB). ANS: B This patient shows signs of systolic heart failure. Treatment for heart failure should begin with a loop diuretic, with an ACE inhibitor added after the diuretic has been taken. b-Blockers are used in patients with minimal fluid retention and would be added later. ARBs are used if ACE inhibitors are not tolerated or are ineffective. DIF: Cognitive Level: Applying (Application) REF: 251 2. A patient who has heart failure has been treated with furosemide and an ACE inhibitor. The patient?s cardiologist has added digoxin to the patient?s medication regimen. The primary care NP who cares for this patient should expect to monitor: a. serum electrolytes. b. blood glucose levels. c. serum thyroid levels. d. complete blood counts (CBCs). ANS: A Hypokalemia makes the myocardium more sensitive to digoxin. These levels should be monitored closely in patients taking furosemide, which can deplete potassium. Serum glucose, thyroid levels, and a CBC should be monitored if indicated by other conditions. DIF: Cognitive Level: Applying (Application) REF: 254 3. A patient who takes spironolactone for heart failure has begun taking digoxin (Lanoxin) for atrial fibrillation. The primary care NP provides teaching for this patient and asks the patient to repeat back what has been learned. Which statement by the patient indicates understanding of the teaching? a. ?I should avoid high-sodium foods.? b. ?I should eat foods high in potassium.? c. ?I need to take a calcium supplement every day.? d. ?I should use a salt substitute while taking these medications.? ANS: A Patients should be taught to reduce their overall sodium intake by avoiding salty foods and not adding salt while cooking. Spironolactone is a potassium-sparing diuretic and carries a risk of hyperkalemia, which can make the myocardium more sensitive to the effects of digoxin. Hypercalcemia can predispose the patient to digoxin toxicity. Salt substitutes are high in potassium. DIF: Cognitive Level: Applying (Application) REF: 254 4. A patient has heart failure. A recent echocardiogram reveals decreased compliance of the left ventricle and poor ventricular filling. The patient takes low-dose furosemide and an ACE inhibitor. The primary care NP sees the patient for a routine physical examination and notes a heart rate of 92 beats per minute and a blood pressure of 100/60 mm Hg. The NP should: a. order serum electrolytes. b. obtain renal function tests. c. consider prescribing a b-blocker. d. call the patient?s cardiologist to discuss adding digoxin to the patient?s regimen. ANS: A Patients with diastolic heart failure are sensitive to fluid depletion, which can cause decreased preload and stroke volume. This patient has a rapid heart rate and a low blood pressure, which can indicate dehydration, so serum electrolytes should be obtained. Renal function tests are not indicated. b-Blockers are used in patients who are stable. Digoxin should not be used in patients with diastolic failure. DIF: Cognitive Level: Applying (Application) REF: 251 5. A primary care NP is preparing to order digoxin for an 80-year-old patient who has systolic heart failure. The NP obtains renal function tests, which are normal. The NP should: a. prescribe a digoxin 0.125 mg tablet once daily. b. give an initial dose of 0.5 mg digoxin tablet and then 0.125 mg every 6 hours ´ 4. c. administer a digoxin 0.6 mg capsule once and then 0.3 mg every 8 hours ´ 3. d. administer a loading dose of intravenous digoxin in the clinic and then give 0.125 mg once daily. ANS: A In primary care settings, slow digitalization rather than a loading dose is generally recommended because of the risk of toxicity. Digitalization may be achieved within 1 week with the use of small daily maintenance doses. DIF: Cognitive Level: Applying (Application) REF: 245| Table 19-5 6. A primary care NP sees a patient who is being treated for heart failure with digoxin, a loop diuretic, and an ACE inhibitor. The patient reports having nausea. The NP notes a heart rate of 60 beats per minute and a blood pressure of 100/60 mm Hg. The NP should: a. decrease the dose of the diuretic to prevent further dehydration. b. obtain a serum potassium level to assess for hyperkalemia. c. hold the ACE inhibitor until the patient?s blood pressure stabilizes. d. obtain a digoxin level before the patient takes the next dose of digoxin. ANS: D To monitor for toxicity, the health care provider must be alert to early signs of toxicity and must obtain a serum level. Nausea is an early sign of toxicity. DIF: Cognitive Level: Applying (Application) REF: 253 - 254 7. A patient who has been taking digoxin 0.25 mg daily for 6 months reports that it is not working as well as it did initially. The primary care NP should: a. recommend a reduced potassium intake. b. increase the dose of digoxin to 0.5 mg daily. c. hold the next dose of digoxin and obtain a serum digoxin level. d. contact the patient?s pharmacy to ask if generic digoxin was dispensed. ANS: D Clinicians should be aware that generic digoxin marketed by different companies may not be bioequivalent to the branded digoxin (Lanoxin). Patients with hyperkalemia would show intensified effects, not diminished effects of digoxin. Patients with diminished effects may have received a generic brand. It is not correct to increase the dose of digoxin without first obtaining a digoxin level. Because this patient is reporting decreased effects, it is unnecessary to suspect toxicity. DIF: Cognitive Level: Applying (Application) REF: 254

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