Digoxin

2. Decrease in the amount of infant formula taken or a refusal to take it. 3. Pulse rate greater than 140 bpm or less than 100 bpm. 4. Signs that the infant is not following moving objects. 5. Sudden vomiting or sudden drowsiness.

A 3-month-old infant is being discharged on digoxin (Lanoxin). The nurse should instruct the parents to report which of the following? Select all that apply. 1. Signs of constipation or painful straining. 2. Decrease in the amount of infant formula taken or a refusal to take it. 3. Pulse rate greater than 140 bpm or less than 100 bpm. 4. Signs that the infant is not following moving objects. 5. Sudden vomiting or sudden drowsiness.

3. Rheumatic fever.

A 70-year-old female is scheduled to undergo mitral valve replacement for severe mitral stenosis and mitral regurgitation. Although the diagnosis was made during childhood, she did not have symptoms until 4 years ago. Recently, she noticed increased symptoms, despite daily doses of digoxin and furosemide. During the initial interview with the client, the nurse would most likely learn that the client's childhood health history included: 1. Chickenpox. 2. Poliomyelitis. 3. Rheumatic fever. 4. Meningitis.

1. Check the last serum electrolyte results for the child.

A child with heart disease starts on oral digoxin (Lanoxin). When preparing to administer the medication, which of the following should the nurse do first? 1. Check the last serum electrolyte results for the child. 2. Verify the dosage with a licensed practical nurse who is working that day. 3. Ask the mother if she is willing to administer the medication. 4. Teach the mother how to measure the child's heart rate.

2. Digoxin toxicity.

A client has a history of heart failure and has been taking several medications, including furosemide (Lasix), digoxin (Lanoxin) and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first degree atrioventricular block. The nurse should assess the client for signs of which condition? 1. Hyperkalemia. 2. Digoxin toxicity. 3. Fluid deficit. 4. Pulmonary edema.

4. Discontinue the furosemide and notify the physician. The nurse should recognize the ringing in the ears, or tinnitus, as a sign of ototoxicity probably caused by the furosemide.

A client has been hospitalized with heart failure. He is receiving digoxin (Lanoxin) and furosemide (Lasix) intravenously. He tells the nurse that he hears a continuous ringing in his ears and that he has never had this problem before. What is the appropriate action for the nurse to take at this time? 1. Obtain a digoxin level to check for toxicity. 2. Note the observation in the chart and plan to reassess in 2 hours. 3. Ask the client if he has been taking aspirin in addition to his other medications. 4. Discontinue the furosemide and notify the physician.

3. Visual disturbances.

A client has been prescribed digoxin (Lanoxin). Which of the following symptoms should the nurse tell the client to report as a potential indication of digoxin toxicity? 1. Urticaria. 2. Shortness of breath. 3. Visual disturbances. 4. Hypertension.

2. Withhold the digoxin.

A client is receiving digoxin (Lanoxin). His pulse range is normally 70 to 76 bpm. After assessing the apical pulse for 1 minute and finding it to be 60 bpm, the nurse should first: 1. Call the physician for orders. 2. Withhold the digoxin. 3. Administer the digoxin. 4. Notify the charge nurse.

1. Serum potassium level within normal limits. Digoxin administered for rapid apical pulse. Digoxin, a cardiac glycoside, slows and strengthens the heart. It is used for rate control in clients with atrial fibrillation.

A client is to receive a scheduled dose of digoxin (Lanoxin®). A nurse determines that the client's apical pulse is irregular at 92 beats per minute and that the client's serum potassium level is 3.9 mEq/L. Which documentation by the nurse reflects the most appropriate action based on this information? 1. Serum potassium level within normal limits. Digoxin administered for rapid apical pulse. 2. Digoxin withheld because the client's heart rate is irregular. 3. Digoxin withheld to prevent toxicity due to the low serum potassium level. 4. Physician notified to report the irregular heart rate and low serum potassium level.

4. 2.2 ng/mL (2.8 nmol/L) The optimal therapeutic range for digoxin is 0.5 to 2.0 ng/mL (0.63 to 2.56 nmol/L). If the client is experiencing symptoms such as anorexia and is experiencing hypokalemia as evidenced by a low potassium level, digoxin toxicity is a concern. Therefore, option 4 is correct because it is outside of the therapeutic level and elevated.

A client who is receiving digoxin daily has a serum potassium level of 3 mEq/L (3 mmol/L) and reports anorexia. The health care provider prescribes a serum digoxin level to be done. The nurse checks the results and should recognize which level that is outside of the therapeutic range? 1. 0.5 ng/mL (0.63 nmol/L) 2. 0.8 ng/mL (1.02 nmol/L) 3. 0.9 ng/mL (1.14 nmol/L) 4. 2.2 ng/mL (2.8 nmol/L)

3. Decreased cardiac arrhythmias.

A client with heart failure is receiving digoxin intravenously. The nurse should determine the effectiveness of the drug by assessing which of the following? 1. Dilated coronary arteries. 2. Increased myocardial contractility. 3. Decreased cardiac arrhythmias. 4. Decreased electrical conductivity in the heart.

1. A return demonstration of palpating the radial pulse.

A loading dose of digoxin (Lanoxin) is given to a client newly diagnosed with atrial fibrillation. The nurse begins instructing the client about the medication and the importance of monitoring his heart rate. An expected outcome of the education program will be: 1. A return demonstration of palpating the radial pulse. 2. A return demonstration of how to take the medication. 3. Verbalization of why the client has atrial fibrillation. 4. Verbalization of the need for the medication.

1. Serum potassium levels The serum potassium level is the most important result when preparing to administer digoxin. Hypokalemia increases the risk of digoxin toxicity and life-threatening dysrhythmias.

A nurse is caring for a pediatric client who has congestive heart failure (CHF). The client is receiving digoxin therapy. Which laboratory test result is most important to evaluate when preparing to administer digoxin? 1. Serum potassium levels 2. Serum magnesium levels 3. Serum sodium levels 4. Serum chloride levels

3. 28.8 mcg

A pediatric client with ventricular septal defect repair is placed on a maintenance dosage of digoxin. The dosage is 8 mcg/kg/day, and the client's weight is 7.2 kg. The pediatrician prescribes the digoxin to be given twice daily. The nurse prepares how many mcg of digoxin to administer to the child at each dose? 1. 12.6 mcg 2. 21.4 mcg 3. 28.8 mcg 4. 32.2 mcg

1. Digoxin enables the heart to pump more effectively with a slower and more regular rhythm. Digoxin's effect is to slow the rate of the electrical conduction through the heart and increase the strength of the heart's contraction.

An 18-month-old with a congenital heart defect is to receive digoxin twice a day. The nurse should instruct the parents about which of the following? 1. Digoxin enables the heart to pump more effectively with a slower and more regular rhythm. 2. Signs of toxicity include loss of appetite, vomiting, increased pulse, and visual disturbances. 3. Digoxin is absorbed better if taken with meals. 4. If the child vomits within 15 minutes of administration, the dosage should be repeated.

3. Digoxin toxicity.

An 80-year-old client is admitted with nausea and vomiting. He has a history of heart failure and is being treated with digoxin (Lanoxin). He tells the nurse he has been nauseated for a week and began vomiting 2 days ago. Laboratory values indicate that he has hypokalemia. Because of these clinical findings, the nurse should assess the client carefully for signs of which of the following conditions? 1. Chronic renal failure. 2. Exacerbation of heart failure. 3. Digoxin toxicity. 4. Metabolic acidosis.

3. Withhold the medication and immediately notify the prescriber because these are signs of toxicity. The nurse should hold the medication and immediately notify the prescriber because these are signs of digoxin toxicity.

Before administering oral digoxin (Lanoxin®) to a pediatric client, a nurse notes that the child has bradycardia and mild vomiting. Which is the nurse's most appropriate action? 1. Explain to the parent that bradycardia is an expected effect of the digoxin. 2. Administer the medication, document the observations, and reevaluate after the next dose. 3. Withhold the medication and immediately notify the prescriber because these are signs of toxicity. 4. Administer an oral beta-blocker medication.

1. Give the medication at regular intervals. 4. Notify the primary care provider of poor feeding or vomiting. 6. Notify the primary care provider if more than 2 consecutive doses are missed. 7. Keep medication in a safe place, preferably a locked cabinet.

Discharge teaching for a 3-month-old infant with a cardiac defect who is to receive digoxin (Lanoxin) should include which of the following? Select all that apply. 1. Give the medication at regular intervals. 2. Mix the medication with a small volume of breast milk or formula. 3. Repeat the dose one time if the child vomits immediately after administration. 4. Notify the primary care provider of poor feeding or vomiting. 5. Make up any missed doses as soon as realized. 6. Notify the primary care provider if more than 2 consecutive doses are missed. 7. Keep medication in a safe place, preferably a locked cabinet. 8. Induce vomiting if there is an accidental overdose.

4. Serum magnesium level

Prior to administering a client's daily dose of digoxin to treat heart failure, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL (2.45 mmol/L); serum magnesium, 1.0 mEq/L (0.4 mmol/L); serum potassium, 4.1 mEq/L (4.1 mmol/L); serum creatinine, 0.9 mg/dL (79.5 mcmol/L). Which result should alert the nurse that the client is at risk for digoxin toxicity? 1. Serum calcium level 2. Serum potassium level 3. Serum creatinine level 4. Serum magnesium level

2. Diarrhea 4. Blurred vision 5. Nausea and vomiting

The nurse is monitoring a client with heart failure who is taking digoxin. Which findings are characteristic of digoxin toxicity? Select all that apply. 1. Tremors 2. Diarrhea 3. Irritability 4. Blurred vision 5. Nausea and vomiting

2. Increased risk for digoxin toxicity The older client is at risk for medication toxicity because of decreased lean body mass and an age-associated decreased glomerular filtration rate. This age-related change is not specifically associated with decreased absorption, decreased therapeutic effect, or increased risk for side effects.

The nurse is providing medication instructions to an older client who is taking digoxin daily. The nurse explains to the client that decreased lean body mass and decreased glomerular filtration rate, which are age-related body changes, could place the client at risk for which complication with medication therapy? 1. Decreased absorption of digoxin 2. Increased risk for digoxin toxicity 3. Decreased therapeutic effect of digoxin 4. Increased risk for side effects related to digoxin

4. Hypokalemia.

The nurse monitors the serum electrolyte levels of a client who is taking digoxin (Lanoxin). Which of the following electrolyte imbalances is a common cause of digoxin toxicity? 1. Hyponatremia. 2. Hypomagnesemia. 3. Hypocalcemia. 4. Hypokalemia.

4. "If my child vomits after medication administration, I will repeat the dose." Digoxin is a cardiac glycoside. The parents need to be instructed that if the child vomits after digoxin is administered, they are not to repeat the dose. Options 1, 2, and 3 are accurate instructions regarding the administration of this medication. In addition, the parents should be instructed that if a dose is missed and is not identified until 4 hours later, the dose should not be administered.

The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? 1. "I will not mix the medication with food." 2. "If more than 1 dose is missed, I will call the pediatrician." 3. "I will take my child's pulse before administering the medication." 4. "If my child vomits after medication administration, I will repeat the dose."

4. Low potassium level

The nurse should be especially alert for signs and symptoms of digoxin toxicity if serum levels indicate that the client has a: 1. Low sodium level. 2. High glucose level. 3. High calcium level. 4. Low potassium level

3. Visual disturbances such as seeing yellow spots.

The nurse should teach the client that signs of digoxin toxicity include which of the following? 1. Rash over the chest and back. 2. Increased appetite. 3. Visual disturbances such as seeing yellow spots. 4. Elevated blood pressure.