CCMA EXAM 2 MODULE 5 QUIZ RATED
A
A client with heart failure is receiving furosemide and digoxin at 0900. What assessment findings would
indicate a need to withhold the morning dose of digoxin and furosemide? SELECT
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CCMA EXAM 2 MODULE 5 QUIZ RATED
A
A client with heart failure is receiving furosemide and digoxin at 0900. What assessment findings would
indicate a need to withhold the morning dose of digoxin and furosemide? SELECT ALL THAT APPLY
Correct Answer--Apical pulse 58 beats per minute
-Potassium level 2.8mEq/L
-Digoxin level 2.5 ng/mL
-Furosemide interacts with digoxin because it wastes potassium, which potentiates the effects of digoxin
(makes the digoxin work better), which can lead to digoxin toxicity.Signs of digoxin toxicity include
anorexia, nausea, vomiting, diarrhea, bradycardia, and yellow, green or purple halo vision.Normal
potassium level is 3.5-5 mEq/ L. Low potassium can lead to digoxin toxicity, and furosemide wastes
potassium.The therapeutic digoxin level is 0.5-2.0 ng/mL. Anything greater than 2 is considered toxic
and the dose should be withheld.
The nurse is providing education to a client being discharge on digoxin. What information should the
nurse provide about symptoms to report to the healthcare provider? SELECT ALL THAT APPLY Correct
Answer-Visual disturbances of yellow, green, or purple halos
-Weight gain of 5 pounds in 2 days
-Heart rate greater than 120beats per minute
-Shortness of breath and worsening ankle edema
Digoxin has a narrow therapeutic window and the client needs to be aware of signs of toxicity: anorexia,
vomiting, nausea, diarrhea, bradycardia, lethargy, and yellow, green, or purple halo vision.The client
should weigh themselves daily and record it in a notebook. Weight gain of 5 pounds or more in 2 daysshould be reported the the healthcare provider.While bradycardia is a common sign of toxicity with
digoxin, tachycardia can also be a sign of digoxin toxicity. It can also be a sign that the dose is not
controlling the symptoms of heart failure. Tachycardia should be reported to the healthcare provider so
the etiology of the increased heart rate can be identified.If you watched the video on heart failure, you
are aware that fluid retention is a big part of the disease process. If the client is experiencing shortness
of breath and ankle edema, these are signs of worsening heart failure and should be reported.While the
blood pressure is a little lower than normal, a failing heart will struggle meeting the demands of the
body. A blood pressure of 100/50 is life sustaining and may be the best that a patient with heart failure
can produce.
A nurse is providing education to a client with heart failure. What non-pharmacological interventions
should the nurse include in the information about disease management? SELECT ALL THAT APPLY
Correct Answer--Exercise daily, as possible.
-Stop smoking
-Decrease saturated fat intake
-Limit alcohol intake
Non-pharmacological treatment for heart failure includes: Decreasing sodium to less than 2 grams per
day, mild exercise as the client is able, decreasing saturated fat intake, limit alcohol intake.
The nurse is reviewing the client's medical record before providing discharge instructions. Find the
information below:
Admitting DiagnosisDehydration
Past Medical Diagnosis:Heart Failure, chronic stable angina, hypertensionDischarge Medication Orders:digoxin 0.125 mg PO dailyfurosemide 40 mg PO BID at 0900 and 1700
metoprolol 25 mg PO daily
isosorbide dinitrate 20 mg PO daily
nitroglycerin 0.4 mg SL PRN chest pain. What information should the nurse include in the discharge
instructions? SELECT ALL THAT APPLY Correct Answer--Smoking cessation will help with disease
management.
-Take your pulse every day before taking your morning medications and notify your healthcare provider
if heart rate is less than 60 beats per minute
-Increase foods high in potassium because furosemide increases potassium loss
-Rise slowly, in stages, because metoprolol and isosorbide dinitrate can cause low blood pressure upon
standing.
-Store the nitroglycerin in original container, keeping it away from heat and moisture.
Report yellow, green, or purple halos around lights as this could be a sign of digoxin toxicity
-Based on the discharge medications, the nurse must educate the client on potential adverse effects and
when/what to report to the healthcare provider.With angina and heart failure, smoking cessation is part
of disease management. Taking the pulse daily and reporting heart rate less than 60 is important since it
can be a sign of digoxin toxicity, and metoprolol can also lower the heart rate. Since the cllient will be on
furosemide and digoxin, the client should increase foods high in potassium to help prevent hypokalemia
and the potential for digoxin toxicity related to hypokalemia. Since the client is on a beta blocker and a
nitrate, the client is at risk for orthostatic hypotension and should be taught to rise slowly, in stages.
Storage of nitroglycerine includes keeping it in the original container, or a specially made
dark, moisture resistant container, keeping the medication at room temperature and away from
moisture. SL nitroglycerin should be taken 5 minutes apart, with a maximum of 3 doses. The client
should call 9-1-1 after the second dose if chest pain persists (also book has another location that says
after first dose).The client should weigh themselves daily and report a weight gain of 5 pounds or more
in 2 days.The client needs to be taught about signs of digoxin toxicity and to report them to their HCP.A client will be starting on a transdermal patch for treatment of chronic stable angina. What education
should the nurse provide the client? SELECT ALL THAT APPLY Correct Answer-Remove the old patch
before applying the new patch
-Cleanse the previous patch site to prevent irritation
-Do not apply the patch to the same location every day.
-Apply the patch at the same time each day
-Avoid saunas and hot tubs because these increase vasodilation
-When applying a transdermal nitroglycerin patch, the client needs to : rotate sites, avoid the areas
distal of the elbows and knees, clean the previous site area, apply the patch at the same time every day.
The client should avoid saunas and hot tubs as they can increase vasodilation, which can lead to fainting
and orthostatic hypotension.
A client diagnosed with heart failure is being taught about drug interactions that can occur with digoxin.
Match the medication or herbal supplement with the resulting interaction. Correct Answer-Potassium
wasting diuretics: Causes low potassium that potentiates the effects of digoxin, leading to digoxin
toxicity
Ginseng: Increases digoxin levels, leading to digoxin toxicity
Saint John's Wort: Decreases digoxin levels, leading to uncontrolled disease process
Beta blockers: Enhances bradycardic effect of digoxin
Amiodorone: Decreases excretion of digoxin, leading to a 50% increase in digoxin levelsA client with a history of angina, type 2 diabetes mellitus, and heart failure is to have surgery. Which
medication should be administered on the morning of surgery? Correct Answer-metoprolol
Beta blockers are administered on the morning of surgery because of their cardioprotective effects. The
patient takes the beta blocker with a small sip of water. ACE inhibitors, angiotensin II receptor blockers
and metformin should all be held on the morning of surgery.
After providing education about the newly prescribed metoprolol for a client with angina, what
statement made by the client would indicate a need for additional education? Correct Answer-"I should
take this medication to stop an attack of angina."
Beta-blockers decrease the workload of the heart, preventing angina and myocardial infarctions. They
are not indicated to treat an acute angina attack.XL on any medication designates this as a sustained
release medication and all sustained release medications should not be crushed or cut because this can
cause a bolus of the medication, causing overdose symptoms.Orthostatic hypotension is common with
beta-blockers, so the client will need to be careful with position changes.When on a beta-blocker, the
client should count their pulse daily and report heart rate less than 60.
What medication can cause a fatal drop in blood pressure if taken with nitroglycerin? Correct A
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