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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B"]
Explanation
This is a mnemonic to remember the common suffix of drugs that block the beta receptors in the heart and blood vessels, which can lower blood pressure, heart rate, and reduce chest pain. For example, metoprolol, atenolol, and propranolol are beta blockers.
Choice A is wrong because calcium channel blockers do not end in DIPINE.
Calcium channel blockers are drugs that block the entry of calcium into the cells of the heart and blood vessels, which can relax the blood vessels and lower blood pressure.
Some calcium channel blockers end in DIPINE, such as amlodipine and nifedipine, but not all of them.
For example, verapamil and diltiazem are also calcium channel blockers.
Choice C is wrong because ACE inhibitors do not end in ZoSIN.
ACE inhibitors are drugs that inhibit the enzyme angiotensin-converting enzyme (ACE), which can lower blood pressure and prevent heart failure.
ACE inhibitors usually end in PRIL, such as lisinopril, enalapril, and captopril.
Choice D is wrong because angiotensin II receptor blockers do not end in STATIN.
Angiotensin II receptor blockers are drugs that block the action of angiotensin II, a hormone that constricts blood vessels and raises blood pressure.
Angiotensin II receptor blockers usually end in SARTAN, such as losartan, valsartan, and irbesartan.
The normal range for blood pressure is less than 120/80 mmHg.
The normal range for heart rate is 60 to 100 beats per minute.
Correct Answer is B
Explanation
Diuretics are drugs that increase the amount of urine and salt (sodium) excreted by the kidneys. They are used to treat high blood pressure, heart failure, and edema (fluid retention). However, some diuretics can cause low levels of potassium in the blood (hypokalemia), which can lead to muscle weakness, cramps, and arrhythmias. To prevent this, a combination of diuretics acting on different parts of the kidney (such as a loop diuretic and a thiazide diuretic) may be prescribed.This way, the potassium-sparing effect of one diuretic can balance the potassium-wasting effect of the other, while still achieving a net sodium loss.
Choice A is wrong because they are not a part of the initial diuretic therapy.Combination diuretic therapy is usually reserved for patients who are resistant to or intolerant of monotherapy.
Choice C is wrong because little follow up is not needed after the initial treatment.Patients on combination diuretic therapy require close monitoring of their blood pressure, electrolytes, renal function, and weight to avoid adverse effects such as dehydration, hyponatremia, hypotension, and worsening renal function.
Choice D is wrong because they do not increase the risk of hypokalemia.As explained above, combination diuretic therapy aims to reduce the risk of hypokalemia by using a potassium-sparing diuretic along with a potassium-wasting diuretic.
Normal ranges for serum potassium are 3.5 to 5.0 mmol/L and for serum sodium are 135 to 145 mmol/L.
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