A nurse in a provider’s office is monitoring blood electrolytes for four clients who take digoxin.
Which of the following electrolyte values increases a client’s risk for digoxin toxicity?
Potassium 3.0 mEq/L.
Calcium 9.2 mg/dL.
Potassium 4.8 mEq/L.
Calcium 10.3 mg/dL.
The Correct Answer is A
This is because digoxin inhibits the Na-K-ATPase pump on the membrane of cardiac cells, which can cause extracellular potassium levels to rise. Hypokalemia (low potassium) caused by large dosages of diuretics may result in digoxin toxicity even at low serum digoxin levels. Digoxin toxicity can cause gastrointestinal, constitutional, and/or cardiovascular symptoms, as well as ECG changes such as signs of increased automaticity and atrioventricular node blockade.
Choice B is wrong because calcium 9.2 mg/dL is within the normal range of 8.5 to 10.5 mg/dL. Hypercalcemia (high calcium) can increase sensitivity to digoxin effects and lead to toxicity even with a lower concentration of serum digoxin, but this is not the case here.
Choice C is wrong because potassium 4.8 mEq/L is within the normal range of 3.5 to 5.0 mEq/L.
Hyperkalemia (high potassium) can also increase the risk of digoxin toxicity, but this is not the case here.
Choice D is wrong because calcium 10.3 mg/dL is within the normal range of 8.5 to 10.5 mg/dL. Hypercalcemia (high calcium) can increase sensitivity to digoxin effects and lead to toxicity even with a lower concentration of serum digoxin, but this is not the case here.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Terazosin is a medication that belongs to the class of alpha-adrenergic blockers, which relax the muscles in the prostate and bladder neck, making it easier to urinate.It also lowers blood pressure by relaxing the veins and arteries, allowing blood to flow more easily.Therefore, terazosin can cause dizziness or fainting, especially when getting up from a sitting or lying position.To prevent this, the patient should rise slowly and avoid standing for long periods or becoming overheated.
Choice B is wrong because terazosin is not a cure for benign prostatic hyperplasia (BPH), but a symptom reliever.Stopping the medication may cause the urinary problems to return or worsen.
The patient should continue taking terazosin as prescribed by the doctor, unless advised otherwise.
Choice C is wrong because decreasing fluid intake may increase the risk of dehydration, urinary tract infections, bladder stones, and kidney problems.
The patient should drink enough fluids to stay hydrated and flush out the urinary system.
Choice D is wrong because grapefruit juice may interact with terazosin and increase its blood levels, leading to more side effects such as low blood pressure, drowsiness, or headache.
The patient should avoid drinking grapefruit juice while taking terazosin, or consult the doctor before doing so.
Correct Answer is C
Explanation
Digibind is the trade name forantidigoxin, which is an antibody made up of anti-digoxin immunoglobulin fragments.It is thespecific antidoteto digoxin toxicity, which can occur even when the serum digoxin concentration is within the therapeutic range.Digoxin toxicity causes anorexia, nausea, vomiting, neurological symptoms and arrhythmias.
Choice A, Protamine sulfate, is wrong because it is the antidote for heparin overdose, not digoxin toxicity.
Protamine sulfate reverses the anticoagulant effect of heparin by binding to it and forming a stable complex.
Choice B, Acetylcysteine, is wrong because it is the antidote for acetaminophen overdose, not digoxin toxicity.
Acetylcysteine replenishes glutathione, which is depleted by acetaminophen metabolites that cause hepatotoxicity.
Choice D, Vitamin K, is wrong because it is the antidote for warfarin overdose, not digoxin toxicity.
Vitamin K restores the synthesis of clotting factors that are inhibited by warfarin.
Normal ranges for serum digoxin concentration are 0.6 to 1.2 nanomol/L (0.5 to 0.9 nanograms/mL) for heart failure and unknown for atrial fibrillation without heart failure.
Normal ranges for serum potassium level are 3.5 to 5.0 mmol/L and for serum magnesium level are 0.7 to 1.0 mmol/L.
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