Quiz: Digoxin Toxicity
Mrs. Fredrich tells you she is feeling a lot better. Prior to Mrs. Fredrich's discharge, her most recent digoxin level registered at 1.1 ng/mL. The health care provider wrote an order for her to receive 0.25 mg of digoxin through her IV line. The medication that is available for the nurse is 250 mcg/mL. Calculate how much medication you should give. Please limit your answer to a numeral. Record your answer rounding to the nearest whole number
.25mg Rationale The answer may be calculated using the following formula: First, convert mcg to mg by moving the decimal point 3 places to the left: 250 mcg equals = 0.25 mg Desired dose times × Quantity on hand equals = Dose Dose on hand 0.25 mg times × 1 mL equals = 1 mL 0.25 mg
Mrs. Fredrich is resting quietly in bed. When you ask how she is feeling, she says she is homesick and looks out the window. You sense her longing and decide to focus your activity on things to help promote her discharge. Mrs. Fredrich's intake and output must be calculated before she can leave. Her chart indicates: Time Intake Output Description 0730 375 mL Clear pale yellow urine 0800 8 oz Orange juice 0900 10 oz Decaf coffee 1030 400 mL Clear pale yellow urine 1200 16 oz Water 1400 400 mL Clear pale yellow urine Calculate her intake in mL. Please limit your answer to a numeral. Record your answer rounding to the nearest whole number
1020 mL Rationale There are 30 milliliters in each ounce. Mrs. Fredrich has ingested a total of 34 ounces during the 8 hour shift. Mrs. Fredrich has ingested 1020 milliliters. 34 ounces times × 30 mL equals = 1020 mL 1 ounce
ou speak with the health care provider about Mrs. Fredrich's nausea, and you receive the following order: prochlorperazine (Compazine) 5 mg IV every 4 hours as needed for nausea. The vial of prochloraperaine that you have available is 10 mg/2 mL. Calculate the dose to determine how much medication to give to the client. Please limit your answer to a numeral. Record your answer rounding to the nearest whole number
10mg The answer may be calculated using the following formula: Desired Dose times × Quantity on Hand equals = Dose Dose on Hand 5mg times × 2 mL equals = 1 mL 10mg
The activity on your unit has picked up and your attention has been temporarily diverted to another client. You are speaking with the health care provider about that client, who is not doing well. Regarding Mrs. Fredrich's care, which task would be LEAST appropriate to delegate to unlicensed assistive personnel?
Assessing intake and output. Rationale Unlicensed assistive personnel may calculate and report, but they may not perform an assessment. You could ask another nurse to perform the assessment if you are unable to do so. The nursing assistant may help Mrs. Fredrich brush her teeth, assist Mrs. Fredrich to ambulate in the hallway, and document how much Mrs. Fredrich voided.
Mrs. Fredrich has a variety of medications ordered for administration this morning. You have examined the medical administration record and determine that she needs to be given potassium chloride, furosemide, omeprazole, and digoxin at 9:00 a.m. this morning. Her digoxin level is 2.3 ng/ml, pulse is 55, blood pressure is 100/70, and her potassium level is 3.0 mEq/L. Considering the results of Mrs. Fredrich's labs, which of these medications would you probably withhold?
Digoxin 0.125 mcg tablet PO Rationale The labs indicate that her digoxin level is 2.3 ng/mL and her symptoms are consistent with digoxin toxicity. You should hold the digoxin. Mrs. Fredrich's heart rate is below 60 beats per minute, so even if she wasn't experiencing digoxin toxicity, you would still hold the dose. Mrs. Fredrich should receive the potassium chloride because her potassium level is below normal. She can have the furosemide because there is nothing to indicate that she is dehydrated or not tolerating the furosemide well. You should give the omeprazole to help reduce stomach acidity.
You sit down and talk to Mrs. Fredrich to inform her of the latest test results. "Mrs. Fredrich, your results show that you are experiencing clinical manifestations consistent with digoxin toxicity." Mrs. Fredrich responds, "Really" I don't understand how that could be." Which statement indicates that Mrs. Fredrich requires further teaching about self-administration of digoxin?
"As long as my heart rate is over 40 bmp, I still take my digoxin." Rationale Mrs. Fredrich should take a radial pulse for 1 full minute and if the pulse is below 60 beats/min (not 40 beats/min), then she should not take the dose. Taking digoxin with food can inhibit absorption. Over-the-counter medications should be avoided because many interact with digoxin. Mrs. Fredrich needs approval from the health care provider before she stops taking digoxin.
You are preparing Mrs. Fredrich for discharge. Which of the following statements indicates that she understands your discharge instructions?
"I talked to my daughter, and she's going to pick up some bananas, oranges, and salad greens for me to eat." Rationale Low levels of potassium can increase a client's risk for developing digoxin toxicity. Mrs. Fredrich should be encouraged to eat potassium-rich foods. It is fine for Mrs. Fredrich to take a radial or carotid pulse; she does not need a stethoscope. When clients feel bad it may not necessarily be related to low levels of potassium. Mrs. Fredrich should take her pulse at the same time each day and write that number on the calendar.
Mrs. Fredrich is speaking with you about how she's feeling. Which statements by Mrs. Fredrich are most likely related to the development of digoxin toxicity? Select all that apply.
"I wish the doctor would order something for this diarrhea." This is the correct answer. "I have been so tired and weak recently." Your answer is correct. "My vision seems blurry." Symptoms of digoxin toxicity include anorexia, nausea, vomiting, diarrhea, blurred or "yellow" vision, unusual tiredness, and weakness. Feeling cold and sore muscles are not associated with digoxin toxicity.
You have been assigned to care for Viola Fredrich, a newly admitted client on the telemetry unit. Mrs. Fredrich has just been brought up from the emergency department. She is 77 years old and was diagnosed with heart failure nine years ago. At home, she takes 40 mg of furosemide (Lasix), omeprazole (Prilosec) 20 mg, and 0.25 mg of digoxin (Lanoxin) every morning. When you enter the room, Mrs. Fredrich is lying in her hospital bed with the covers pulled all of the way up to her neck. She states, "Please let me rest. I couldn't sleep at all last night with my upset belly and diarrhea." With tears in her eyes, she turns away from you and quietly asks for an emesis basin. She has normal saline infusing through an intravenous line (IV) at 50 mL/hr. The IV has been placed in her right forearm. Her vital signs are: T 97.8 degrees °F, P 54 bpm, R 20/min, BP 126/82 mmHg. The significant results from the labs drawn in the Emergency Department are: potassium 3.1 mEq/L and digoxin level 2.3 ng/mL. Mrs. Fredrich is wearing oxygen at 2 L/min per nasal cannula. Her oxygen saturation level is 94%. A cardiac monitor is in place that is used to continuously monitor her heart rhythm. Mrs. Fredrich is lying in bed in semi-Fowler position. She is twisting her blanket nervously in her hands. She tells you, "I was talking to my daughter, and she says I should talk to the doctor about not taking the digoxin. It caused me to have to come to the hospital, and I don't feel comfortable taking it anymore." You calmly explain, "Mrs. Fredrich, I definitely understand your daughter's concerns. While all medications have side effects, it is important to weigh the risks with the benefits with any medication you may be taking." As you continue your discussion with Mrs. Fredrich, what is your best response?
"You need the digoxin to help your heart pump more effectively." Rationale Digoxin is used to help the heart pump more effectively by increasing the contractility and contraction force. Digoxin would help the client avoid retaining fluid by helping her heart pump more effectively and increasing her cardiac output through isotropic action. Digoxin decreases sympathetic nervous system activation and the renin-angiotensin-aldosterone system (RAAS), which results in a decreased blood pressure. Digoxin decreases the conduction through the AV node and lowers the heart rate.
Mrs. Fredrich states, "I can't eat anymore of my breakfast. I don't have an appetite." Mrs. Fredrich had blood drawn early this morning. The results of labs are back, and her potassium level is 2.8 mEq/L. Mrs. Fredrich asks, "Could you explain what's going on?" What is your best response?
"You've been vomiting a lot, and that's one of the ways we lose potassium." Rationale Hypokalemia can occur due to vomiting and the use of furosemide (Lasix). Mrs. Fredrich has been vomiting and she takes furosemide (Lasix) every day. Salt substitute often contains potassium, so increased ingestion of salt substitute would most like result in hyperkalemia. A failing liver would promote the development of hypokalemia. The use of furosemide (Lasix) is associated with an increased risk of developing hypokalemia. Not taking enough furosemide (Lasix) possibly would have decreased her risk for developing hypokalemia.
