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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Digoxin is a cardiac glycoside that increases the force of heart contractions (positive inotropy) and decreases the heart rate (negative chronotropy) by inhibiting the sodium-potassium ATPase pump in the cardiac cell membranes and affecting the autonomic tone.This helps to improve the symptoms of heart failure and to control the ventricular rate in atrial fibrillation.
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 heart contractions, which is also the opposite of what digoxin does.
Choice D is wrong because positive inotropy and positive chronotropy would both increase the workload of the heart, which is not desirable in heart failure or atrial fibrillation.
Normal ranges for digoxin are 0.5 to 2 ng/mL for heart failure and 0.8 to 2 ng/mL for atrial fibrillation.Digoxin has a narrow therapeutic window and can cause serious side effects if overdosed or underdosed.
Correct Answer is C
Explanation
Digibind is the trade name forantidigoxin, which is an antibody made up of anti-digoxin immunoglobulin fragments.It is thespecific antidoteto digoxin toxicity, which can occur even when the serum digoxin concentration is within the therapeutic range.Digoxin toxicity causes anorexia, nausea, vomiting, neurological symptoms and arrhythmias.
Choice A, Protamine sulfate, is wrong because it is the antidote for heparin overdose, not digoxin toxicity.
Protamine sulfate reverses the anticoagulant effect of heparin by binding to it and forming a stable complex.
Choice B, Acetylcysteine, is wrong because it is the antidote for acetaminophen overdose, not digoxin toxicity.
Acetylcysteine replenishes glutathione, which is depleted by acetaminophen metabolites that cause hepatotoxicity.
Choice D, Vitamin K, is wrong because it is the antidote for warfarin overdose, not digoxin toxicity.
Vitamin K restores the synthesis of clotting factors that are inhibited by warfarin.
Normal ranges for serum digoxin concentration are 0.6 to 1.2 nanomol/L (0.5 to 0.9 nanograms/mL) for heart failure and unknown for atrial fibrillation without heart failure.
Normal ranges for serum potassium level are 3.5 to 5.0 mmol/L and for serum magnesium level are 0.7 to 1.0 mmol/L.
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