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 B
Explanation
Diuretics are drugs that increase the excretion of water and sodium by the kidneys, reducing blood volume and blood pressure.Diuretics lower blood pressure by dilating peripheral arterioles and decreasing blood volume by increasing the excretion of sodium and water.
Choice A is wrong because angiotensin-converting enzyme (ACE) inhibitors do not increase the excretion of water and sodium by the kidneys.ACE inhibitors block the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor and stimulator of aldosterone secretion.By reducing angiotensin II levels, ACE inhibitors lower blood pressure by dilating blood vessels and decreasing sodium and water retention.
Choice C is wrong because adrenergic drugs do not increase the excretion of water and sodium by the kidneys. Adrenergic drugs act on the sympathetic nervous system, which regulates heart rate, blood pressure, and other functions. Depending on the type and location of adrenergic receptors, adrenergic drugs can have different effects on blood pressure. Some adrenergic drugs can increase blood pressure by stimulating alpha receptors, which cause vasoconstriction.Other adrenergic drugs can decrease blood pressure by stimulating beta receptors, which cause vasodilation and decreased cardiac output.
Choice D is wrong because direct acting vasodilators do not increase the excretion of water and sodium by the kidneys. Direct acting vasodilators are drugs that relax the smooth muscle of blood vessels, causing them to widen and lower blood pressure.Direct acting vasodilators do not affect the renin-angiotensin-aldosterone system or the sympathetic nervous system, which regulate sodium and water balance.
Correct Answer is C
Explanation
Angiotensin II receptor blockers (ARBs) block the binding of angiotensin II to its receptors on blood vessels and adrenal glands, preventing its vasoconstrictive and aldosterone-stimulating effects
Choice A is wrong because beta blockers do not block angiotensin II receptors, but rather beta-adrenergic receptors, which are involved in the sympathetic nervous system.Beta blockers reduce heart rate and blood pressure by inhibiting the effects of adrenaline and noradrenaline
Choice B is wrong because calcium channel blockers do not block angiotensin II receptors, but rather calcium channels, which are involved in the contraction of smooth muscle cells.Calcium channel blockers relax blood vessels and lower blood pressure by reducing the influx of calcium into the cells
Choice D is wrong because direct acting vasodilators do not block angiotensin II receptors, but rather act directly on the smooth muscle cells of blood vessels, causing them to relax and dilate.Direct acting vasodilators lower blood pressure by decreasing peripheral resistance
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