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.