Unclassified Antidysrhythmic Drugs

Which statement(s) would indicate that the patient understands how to take digoxin?

1. "I will take my pulse and make sure it is greater than 60 bpm prior to taking my digoxin." 2. "I will talk with my health care provider prior to starting any other medications." 3. "I will keep these medications away from children."

Which factors are important for the nurse check prior to administering digoxin?

1. Electrolytes 2. Weight gain 3. Apical pulse

Which medications can increase the digoxin level by as much as 50%?

1. Verapamil 2. Quinidine 3. Amiodarone

A patient with supraventricular tachycardia (SVT) is being monitored in the emergency department. After rapid IV administration of adenosine, the cardiac monitor indicates asystole. What is the priority nursing intervention?

Continue to monitor the patient.

Adenosine decreases heart rate by which mechanism?

Decreasing automaticity in the SA node and slowing conduction through the AV node.

A patient with a history of severe heart failure is currently taking metoprolol for his fast heart rate. When the provider prescribes digoxin, the patient asks how this will help. How should the nurse respond?

"Digoxin will help your heart beat stronger and also slow down your heartbeat."

A patient with heart failure has been given a prescription for digoxin, Lasix, and potassium supplements. The patient wants to know why he only has to take the Lasix and potassium supplements if his weight increases greater than 3 pounds in 24 hours. How should the nurse respond?

"Lasix can cause a decrease in serum potassium. Potassium supplements prevent your potassium levels from getting low enough to cause problems with your other medications."

A 2-year-old boy is seen in the emergency department 15 minutes after ingesting his grandfather's digoxin medication. The child is running around the treatment room. A new nurse is overheard by the charge nurse saying, "They are overreacting bringing the child to the emergency department because the child is obviously fine." How could the charge nurse explain the inaccuracy of this statement to the new nurse?

"PO digoxin's onset of action is 1-2 hours with the peak plasma concentration in 2-8 hours. Complications from digoxin toxicity are not likely to start to show for 1-4 hours. Let's get him treated now."

A patient asks if there are dietary restrictions when taking digoxin. Which is an appropriate response from the nurse?

"Yes, you should avoid licorice, or meals with increased bran fiber."

Which instructions would be important for the nurse to explain to the patient and family of a patient taking digoxin?

1. Take medication as instructed and do not miss doses. 2. Keep medication in childproof containers. 3. Call provider if heartbeat is irregular or below 60 bpm.

A digoxin peak level is to be drawn after the first IV dose. When should the nurse draw the patient's blood sample?

2-3 hours after the initial dose

A spouse caring for her 75-year-old husband asks when she should question giving her husband his digoxin medication. Which heart rate would the nurse verbalize?

54 bpm

A patient in the emergency department was given one 6 mg IV push dose of adenosine for PSVT. The cardiac monitor shows the heart rate slowing for 2-3 beats and then returning to the high rate. What should the nurse anticipate?

A higher dose of adenosine 12 mg IV push will be given

Which medication should the nurse anticipate being ordered for a patient with SVT?

Adenosine

Which instruction will the nurse give a patient regarding digoxin toxicity?

Bradycardia (low heart rate) is one of the first signs of digoxin toxicity.

A patient taking digoxin becomes lethargic, confused, and complains of people appearing yellow. What should the nurse suspect?

Digoxin toxicity

Digoxin is scheduled for 0900. The patient's electrolyte levels are within normal range and the apical pulse is 54 bpm. What action should the nurse take?

Hold the medication and call the health care provider

How should adenosine be administered?

IV push quickly over 1-2 seconds

What type of drug interaction could occur if digoxin is prescribed for a patient taking a beta blocker, a calcium channel blocker, and a thiazide diuretic?

Increased effect of digoxin

A patient is hospitalized due to severe heart failure. Three hours after the first dose of IV digoxin, the patient becomes confused. What other signs and symptoms should be assessed for digoxin toxicity?

Low blood pressure, nausea and vomiting

What strategy can be used to build up an effective serum level in a patient taking digoxin?

Prepare to administer a loading dose

What does the nurse tell Mr. Torres about adenosine administration?

Side effects should resolve very quickly.

A 40-year-old woman has a new prescription for digoxin, and states that she loves licorice and finds that Saint John's wort really helps ease her depression. What teaching for this patient may need to be reviewed?

Signs and symptoms of digoxin toxicity

Prior to receiving the first dose of adenosine, which teaching point should the nurse include?

Some patients feel some chest pressure

For which cardiac arrhythmia would adenosine be given?

Supraventricular tachycardia