A patient is being treated for heart failure. Labs: Sodium 146 meq/L, Potassium 4.2 mmol/L, Hemoglobin 10.5 gm/dL, White Blood Cells 12.2, digoxin level 0.8 ng/mL
VS: BP 118/66, apical heart rate 68, O2 96% on 2L nasal cannula, temperature 98.4°F
What will the nurse do with the digoxin order?
Recheck heart rate in one hour
Give the digoxin as ordered
Call prescriber and ask for chest x-ray
Hold the digoxin and call the MD
The Correct Answer is B
Choice A reason: This choice is incorrect because there is no need to recheck the heart rate in one hour before giving the digoxin. The client's apical heart rate is within the normal range (60 to 100 beats per minute) and does not indicate bradycardia (slow heart rate), which is a sign of digoxin toxicity. The nurse should check the apical heart rate for one full minute before giving the digoxin and withhold the dose if the heart rate is below 60 beats per minute.
Choice B reason: This choice is correct because the client's digoxin level is within the therapeutic range (0.5 to 2.0 ng/mL) and does not indicate digoxin toxicity or underdosing. The client's vital signs and labs are also stable and do not indicate any adverse effects of digoxin. Digoxin is a cardiac glycoside that improves the contractility and efficiency of the heart and helps to control the heart rate and rhythm in clients with heart failure. The nurse should give the digoxin as ordered and monitor the client's response and digoxin level.
Choice C reason: This choice is incorrect because there is no indication for a chest x-ray for this client. A chest x-ray is a diagnostic test that can show the size and shape of the heart and lungs and detect any abnormalities, such as fluid accumulation, infection, or tumors. The client's symptoms and labs do not suggest any pulmonary complications or worsening of heart failure that would require a chest x-ray. The nurse should follow the provider's orders and protocols for chest x-ray indications.
Choice D reason: This choice is incorrect because there is no reason to hold the digoxin and call the MD for this client. The client's digoxin level is not too high or too low and does not require dose adjustment or discontinuation. The client's vital signs and labs are also normal and do not indicate any signs of digoxin toxicity or adverse effects. Holding the digoxin could cause the client's heart failure to worsen or cause arrhythmias. The nurse should only hold the digoxin and call the MD if the client has signs of digoxin toxicity, such as nausea, vomiting, visual disturbances, confusion, or bradycardia. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Elimination is the process of removing a drug from the body, usually through the kidneys or the liver. Acute renal failure is a condition where the kidneys suddenly lose their ability to filter waste products and excess fluid from the blood. This can impair the elimination of drugs that are mainly excreted by the kidneys, leading to increased drug levels and potential toxicity. The nurse should monitor the patient's renal function and adjust the dose of drugs that are renally eliminated.
Choice B reason: Metabolism is the process of transforming a drug into one or more metabolites, usually by enzymes in the liver. Acute renal failure does not directly affect the metabolism of drugs, unless it causes liver damage or alters the blood flow to the liver. The nurse should monitor the patient's liver function and the levels of drugs that are metabolized by the liver.
Choice C reason: Distribution is the process of transferring a drug from the blood to the tissues and organs of the body. Acute renal failure can affect the distribution of drugs that are bound to plasma proteins, such as albumin. When the kidneys are damaged, they may leak protein into the urine, causing hypoalbuminemia (low levels of albumin in the blood). This can increase the amount of free or unbound drug in the blood, which may enhance the drug's effect or cause adverse reactions. The nurse should monitor the patient's serum albumin level and the effects of drugs that are highly protein bound.
Choice D reason: Absorption is the process of moving a drug from the site of administration to the bloodstream. Acute renal failure does not directly affect the absorption of drugs, unless it causes changes in the gastrointestinal tract, such as edema, bleeding, or motility disorders. The nurse should monitor the patient's gastrointestinal function and the bioavailability of drugs that are administered orally.
Correct Answer is ["8"]
Explanation
To calculate the amount of belimumab that the nurse should administer, we can use the following steps:
Convert the patient's weight from pounds to kilograms.
Multiply the patient's weight in kilograms by the dosage of belimumab (10 mg/kg) to find the total dosage required.
Determine the volume of the drug needed using the concentration of the available belimumab solution.
Given:
Patient's weight = 136 lb
Dosage of belimumab = 10 mg/kg
Available concentration of belimumab = 80 mg/mL
Let's calculate step by step:
Convert patient's weight from pounds to kilograms:
Patient's weight in kg = 136 lb × (1 kg / 2.2 lb) ≈ 61.8 kg
Calculate the total dosage required:
Total dosage = 10 mg/kg × 61.8 kg ≈ 618 mg
Determine the volume of the drug needed using the concentration of the available belimumab solution:
Volume of drug = Total dosage / Concentration of belimumab
Volume of drug = 618 mg / 80 mg/mL ≈ 7.7 mL
Rounding to the nearest whole number, the nurse should administer 8 mL of the belimumab.
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