The nurse is preparing a patient’s daily dose of digoxin (Lanoxin), an inotropic drug. The adult patient has an apical pulse of 48/min.
What should the nurse do next?
Withhold the dose and notify the health care provider.
Notify the health care provider and monitor the patient’s vital signs.
Recheck the pulse, making sure to count for 1 full minute.
Administer the dose.
The Correct Answer is A
Digoxin is a medication that can help the heart pump more blood and slow down the heart rate in certain conditions, such as heart failure and atrial fibrillation. However, digoxin has a narrow therapeutic range, which means that too much or too little of it can be harmful. The therapeutic range of digoxin levels in the blood is 0.5-2 ng/mL, and the toxic level is >2.4 ng/mL. Digoxin should be held if the resting apical pulse of an infant is <90 bpm, an older child is <70 bpm, or an adult is <60 bpm. A pulse of 48/min in an adult is too low and could indicate digoxin toxicity, which can cause life-threatening arrhythmias. Therefore, the nurse should withhold the dose and notify the health care provider immediately.
Choice B is wrong because notifying the health care provider and monitoring the patient’s vital signs are not enough.
The nurse should also withhold the dose to prevent further exposure to digoxin.
Choice C is wrong because rechecking the pulse, making sure to count for 1 full minute, is not necessary. The nurse should already have counted the pulse for 1 full minute before administering digoxin, as per standard procedure.
Choice D is wrong because administering the dose could worsen the patient’s condition and increase the risk of digoxin toxicity and arrhythmias.
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Related Questions
Correct Answer is B
Explanation
Hypokalemia is a condition where the blood potassium level is too low, which can cause muscle weakness, arrhythmias, and other problems. Diuretics are drugs that increase urine output and help remove excess fluid from the body. Some diuretics, such as loop diuretics, also cause potassium loss in the urine.To prevent hypokalemia, a combination of diuretics may be prescribed, such as a loop diuretic with a potassium-sparing diuretic or a thiazide diuretic. These combinations help balance the potassium level while still removing sodium and water.
Choice A is wrong because they are not a part of the initial diuretic therapy.Combination diuretic therapy is usually reserved for patients who have resistant edema or hypertension that does not respond to monotherapy.
Choice C is wrong because they do not boost the blood-pressure-lowering effect of other medications.Diuretics can lower blood pressure by reducing blood volume and relaxing blood vessels, but they are not used to enhance the effect of other antihypertensive drugs.
Choice D is wrong because they do not have fewer side effects when used in a drug combination.Combination diuretic therapy can increase the risk of electrolyte imbalances, such as hyponatremia, hypokalemia, hypomagnesemia, and metabolic alkalosis.It can also cause hypotension, dehydration, and worsening renal function.Therefore, combination diuretic therapy should be used with caution and close monitoring.
Normal ranges for blood potassium level are 3.5 to 5.0 mmol/L or 3.5 to 5.0 mEq/L.Normal ranges for blood sodium level are 135 to 145 mmol/L or 135 to 145 mEq/L.
Normal ranges for blood pressure are less than 120/80 mm Hg for normal, 120-129/less than 80 mm Hg for elevated, 130-139/80-89 mm Hg for stage 1 hypertension, and 140 or higher/90 or higher mm Hg for stage 2 hypertension.
Correct Answer is C
Explanation
Positive inotropy and negative chronotropy.Digoxin is a cardiac glycoside that increases the force of the heart contractions (positive inotropy) and slows down the heart rate (negative chronotropy).
Choice A is wrong because positive chronotropy means increasing the heart rate, which is the opposite of what digoxin does.
Choice B is wrong because negative inotropy means decreasing the force of the heart contractions, which is also the opposite of what digoxin does.
Choice D is wrong because positive chronotropy means increasing the heart rate, which is not what digoxin does.
Digoxin is used to treat heart failure and atrial fibrillation, a type of irregular heartbeat.It has a narrow therapeutic window, meaning that the dose must be carefully adjusted to avoid toxicity or ineffectiveness.
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