A patient taking Digoxin is experiencing severe bradycardia, nausea and vomiting. A lab draw shows that their Digoxin level is 4 ng/mi (0.8-2.0 ng/ml). What management does the nurse anticipate the physician to order? Select all that apply.

Hydration with IV fluids

Nothing as the digoxin level is within normal ranges

Hold the Digoxin

Digibind

Narcan

Answer and Explanation

Correct Answer : A

A) Hydration with IV fluids:
IV hydration may be ordered to improve kidney function and help facilitate the excretion of excess digoxin from the body. Digoxin toxicity is often related to impaired renal clearance, so improving hydration can promote renal perfusion and enhance the elimination of the drug. This is a common supportive measure to help in managing digoxin toxicity.

B) Nothing as the digoxin level is within normal ranges:
This is incorrect because the patient's digoxin level is 4 ng/ml, which is significantly above the normal therapeutic range of 0.8–2.0 ng/ml. A level of 4 ng/ml is toxic, and immediate action is required. Symptoms like severe bradycardia, nausea, and vomiting are indicative of digoxin toxicity, and they necessitate prompt intervention.

C) Hold the Digoxin:
In the case of digoxin toxicity, it is crucial to hold the digoxin. Digoxin should be discontinued immediately if toxicity is suspected, as continuing the medication could worsen symptoms like bradycardia and increase the risk of potentially life-threatening arrhythmias. This step is essential to prevent further complications.

D) Digibind:
Digibind (Digoxin immune fab) is a digoxin-specific antibody used in cases of severe digoxin toxicity or overdose. It binds to the digoxin molecules and helps to neutralize its effects. Given the elevated level of digoxin (4 ng/ml) and the presence of symptoms like severe bradycardia, nausea, and vomiting, Digibind is likely to be ordered to reverse the effects of the toxicity.

E) Narcan:
Narcan (naloxone) is used to reverse opioid overdoses, not digoxin toxicity. There is no indication for the use of Narcan in this scenario, as digoxin toxicity does not involve opioid overdose. This intervention would be inappropriate and irrelevant to the management of digoxin toxicity.

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Correct Answer is D

Explanation

A) Sodium 136 mEq/L:
A sodium level of 136 mEq/L is within the normal reference range of 135–145 mEq/L. While clients with heart failure may experience fluid shifts and altered sodium levels, this result does not immediately require reporting to the provider. Sodium at this level is considered normal.

B) Potassium 4.5 mEq/L:
A potassium level of 4.5 mEq/L is within the normal range of 3.5–5.0 mEq/L, making it a safe and appropriate level. There is no immediate concern regarding potassium levels here, so no action is required. This value does not need to be reported to the provider.

C) Calcium 10 mg/dL:
The normal range for calcium is generally between 8.5–10.5 mg/dL. A calcium level of 10 mg/dL is within this normal range, so this finding does not require further action. No reporting is necessary to the provider.

D) Potassium 2.9 mEq/L:
A potassium level of 2.9 mEq/L is below the normal range (3.5–5.0 mEq/L) and is considered hypokalemia. Furosemide is a loop diuretic that can cause potassium depletion by increasing renal excretion of potassium. This is a serious concern because hypokalemia can lead to dangerous cardiac arrhythmias, muscle weakness, and other complications. The nurse should immediately report this low potassium level to the provider so that potassium supplementation or adjustments in diuretic therapy can be made.

A. Stop taking, ordered corticosteroid once symptoms resolve. B. Apply warm compresses to the affected several times a day. C. Cover the affected eye with eye eye protective shield or patch at night. D. Chew food only on the affected side. E. Place artificial tears or lubricant to help decrease dryness in the eyes

Correct Answer is ["B","C","E"]

Explanation

A) Stop taking ordered corticosteroid once symptoms resolve:
Corticosteroids, such as prednisone, are commonly prescribed to reduce inflammation in Bell’s Palsy, especially during the acute phase. However, it is important to complete the full course of corticosteroids as prescribed, even if symptoms improve. Abruptly stopping corticosteroids can lead to rebound inflammation and potentially worsen the condition.

B) Apply warm compresses to the affected area several times a day:
Warm compresses can help to reduce pain and inflammation in the affected side of the face. Applying them several times a day can also help improve circulation and ease the discomfort associated with Bell's Palsy. This is a recommended self-care strategy that can help provide relief and improve overall comfort for the client during recovery.

C) Cover the affected eye with an eye protective shield or patch at night:
Bell's Palsy can lead to paralysis of the facial muscles, which may make it difficult for the client to fully close the eyelid on the affected side, leaving the eye vulnerable to dryness and injury. Covering the eye with a protective shield or patch at night helps prevent corneal damage and protects the eye from exposure during sleep. This is an essential part of eye care for a client with Bell’s Palsy to prevent complications.

D) Chew food only on the affected side:
There is no medical recommendation to limit chewing to the unaffected side. In fact, clients should be encouraged to use both sides of their mouth for chewing to prevent muscle atrophy and maintain function. There is no evidence to support that chewing food only on the affected side provides any benefit.

E) Place artificial tears or lubricant to help decrease dryness in the eyes:
Since Bell's Palsy can impair the ability to close the eyelid fully, this can lead to dryness and potential corneal damage on the affected side. Artificial tears or lubricating eye drops should be used regularly to moisturize the eye and prevent complications such as corneal ulcers or abrasions.

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A patient taking Digoxin is experiencing severe bradycardia, nausea and vomiting. A lab draw shows that their Digoxin level is 4 ng/mi (0.8-2.0 ng/ml). What management does the nurse anticipate the physician to order? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

The nurse is preparing discharge teaching for a client with Bell's Palsy. Which of the following is most important to include in the teaching? [Select all that apply)

Correct Answer is ["B","C","E"]

Explanation

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