The nurse is caring for a patient with chronic heart failure who has been prescribed digoxin (Lanoxin). The patient’s apical pulse rate is 58 beats/min. What should the nurse do next?
Administer the medication as ordered.
Hold the medication and notify the provider.
Check the patient’s serum digoxin level.
Give an additional dose of digoxin.
The Correct Answer is B
Digoxin (Lanoxin) is a cardiac glycoside that is used to improve the contractility of the heart and slow down the heart rate in patients with chronic heart failure. However, digoxin has a narrow therapeutic range and can cause toxicity if the dose is too high or if the patient has low potassium levels. A normal serum digoxin level is 0.5 to 2 ng/mL and a normal serum potassium level is 3.5 to 5 mEq/L. A low heart rate (less than 60 beats/min) is a sign of digoxin toxicity and the nurse should withhold the medication and report it to the provider. The nurse should also check the patient’s serum digoxin and potassium levels to determine if they are within normal limits.
Choice A is wrong because administering the medication as ordered could worsen the patient’s condition and increase the risk of digoxin toxicity.
Choice C is wrong because checking the patient’s serum digoxin level is not enough to prevent digoxin toxicity. The nurse should also check the patient’s serum potassium level and heart rate before giving digoxin.
Choice D is wrong because giving an additional dose of digoxin could cause a fatal overdose and lead to cardiac arrest. The nurse should never give more than the prescribed dose of digoxin without consulting the provider.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Digoxin (Lanoxin) is a cardiac glycoside that is used to treat atrial fibrillation and heart failure.
It works by increasing the force of cardiac contraction and slowing down the heart rate.
However, digoxin can also cause toxicity, which can lead to life-threatening arrhythmias.
One of the risk factors for digoxin toxicity is hypokalemia, or low serum potassium level.
Potassium is an electrolyte that is essential for normal cardiac function and conduction.When the serum potassium level is low, digoxin binds more strongly to the cardiac cells and increases its effects, which can result in bradycardia, heart block, or ventricular tachycardia.
Therefore, the nurse should monitor the serum potassium level to evaluate the therapeutic effectiveness and safety of digoxin therapy.
Choice B) Serum sodium level is wrong because sodium is not directly related to digoxin action or toxicity.
Sodium is another electrolyte that is important for fluid balance and blood pressure regulation.However, sodium does not affect the binding of digoxin to the cardiac cells or its effects on the heart rate and contractility.
Therefore, the nurse does not need to monitor the serum sodium level to evaluate digoxin therapy.
Choice C) Serum magnesium level is wrong because magnesium is not directly related to digoxin action or toxicity.
Magnesium is another electrolyte that is involved in many enzymatic reactions and neuromuscular function.However, magnesium does not affect the binding of digoxin to the cardiac cells or its effects on the heart rate and contractility.
Therefore, the nurse does not need to monitor the serum magnesium level to evaluate digoxin therapy.
Choice D) Serum calcium level is wrong because calcium is not directly related to digoxin action or toxicity.
Calcium is another electrolyte that is essential for bone health and muscle contraction.However, calcium does not affect the binding of digoxin to the cardiac cells or its effects on the heart rate and contractility.
Therefore, the nurse does not need to monitor the serum calcium level to evaluate digoxin therapy.
The normal range for serum potassium level is 3.5-5.0 mEq
Correct Answer is ["A","B","C","D"]
Explanation
Nifedipine is a calcium channel blocker that lowers blood pressure by relaxing the blood vessels and reducing the workload of the heart.
The following instructions should be included in the teaching:
• Avoid drinking alcohol while taking this medication.Alcohol can increase the risk of side effects such as dizziness, flushing, headache, and low blood pressure.
• Monitor your blood pressure and pulse regularly.This will help to evaluate the effectiveness of the medication and detect any abnormal changes.Normal blood pressure for adults is less than 130/80 mm Hg and normal pulse rate is 60 to 100 beats per minute.
• Report any swelling in your ankles or feet to your provider.This can be a sign of fluid retention or heart failure, which are possible complications of nifedipine.
• Do not stop taking this medication abruptly.This can cause a rebound increase in blood pressure and chest pain.The dose should be tapered gradually under the supervision of the provider.
Choice E is wrong because chewing or crushing the sustained-release tablet can cause too much of the drug to be released at once, which can lead to overdose or severe side effects.
The tablet should be swallowed whole with a glass of water.
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