Final-Digoxin EAQ

A patient's serum digoxin level is noted to be 0.5 ng/mL. Which action by the nurse is appropriate? 1 Notify the provider. 2 Administer an antidote. 3 Hold the ordered dose of digoxin. 4 Administer the ordered dose of digoxin.

4 Therapeutic serum digoxin levels are 0.5 to 0.8 ng/mL. The patient should receive the next dose to keep the level in therapeutic range. Because the dose is in the therapeutic range, it would not be appropriate to hold the dose, administer an antidote, or notify the provider.

The nurse is preparing to administer an oral dose of digoxin [Lanoxin]. The apical pulse rate is 64. Which nursing action is most appropriate? 1 Give the medication. 2 Obtain a serum digoxin level. 3 Notify the healthcare provider. 4 Assess for signs of digoxin toxicity.

1 Determine heart rate and rhythm prior to administration. If heart rate is less than 60 beats/min or if a change in rhythm is detected, withhold digoxin and notify the healthcare provider.

The nurse assesses a patient's pulse before administering digoxin and notes a rate of 55 beats/min. What is the priority intervention by the nurse? 1 Withhold the dose. 2 Administer the drug. 3 Check potassium level before giving. 4 Reduce the dose to half the prescribed dose.

1 If heart rate is less than 60 beats/min or if a change in rhythm is detected, digoxin should be withheld and the prescriber notified. Checking potassium level before giving is not a priority as the drug should not be administered with this pulse rate. Administering the drug to a patient in such a condition would reduce the patient's heart rate, causing bradycardia. Administering the drug by reducing the dose to half would worsen the condition by causing bradycardia, and the nurse should not administer a drug to a patient without the prescription of a provider.

Which assessment is most important for the nurse to obtain prior to administering digoxin to a patient with heart failure? 1 Pulse 2 Blood pressure 3 Respiratory rate 4 Weight in kilograms

1 It is crucial to measure the patient's pulse before administering digoxin because digoxin causes a decrease in heart rate. In fact, if the heart rate is below 60, digoxin cannot be given. Respiratory rate is not a priority before administration of digoxin because it does not cause respiratory depression. Blood pressure is not as important as pulse because digoxin increases the strength of cardiac contractions. Weight in kilograms is not necessary before administering digoxin.

The nurse is caring for a patient prescribed digoxin [Lanoxin] for heart failure. Which finding would require immediate attention by the nurse? 1 Vomiting and diarrhea 2 Heart rate of 68 beats/min 3 Digoxin level of 0.7 ng/mL 4 Potassium level of 3.7 mEq/L

1 Vomiting and diarrhea can lead to hypokalemia, which increases the risk of digoxin toxicity. These symptoms, along with nausea, fatigue, and visual disturbances, also may precede digoxin toxicity and warrant further attention. A heart rate of 68 beats/min, potassium level of 3.7 mEq/L, and digoxin level of 0.7 ng/mL (0.5 to 0.8 being the optimal range) are within the normal range.

The nurse is preparing to administer a daily dose of digoxin [Lanoxin]. What is the priority nursing intervention? 1 Check blood pressure. 2 Palpate the pedal pulses. 3 Assess for Homans' sign. 4 Analyze heart rate and rhythm.

4 Before giving digoxin [Lanoxin], the nurse should assess heart rate and rhythm. The dosage will be held and the prescriber notified if the heart rate is below 60 beats/min or if the cardiac rhythm has changed. Digoxin [Lanoxin] can cause bradycardia and electrical changes in the heart.

A patient is prescribed digoxin to treat heart failure. Which biochemical parameter should be assessed by the nurse to ensure safe drug administration? 1 Liver enzyme concentration 2 Blood glucose concentration 3 Serum calcium concentration 4 Serum potassium concentration

4 Hypokalemia, usually diuretic induced, is the most frequent underlying cause of dysrhythmias. The nurse should monitor serum potassium concentrations. Because potassium competes with digoxin, when potassium levels are low, binding of digoxin to Na+, K+-ATPase (sodium, potassium-ATPase) increases. This increase can produce excessive inhibition of Na+, K+ -ATPase with resultant toxicity. Digoxin does not have any effect on liver enzymes, blood glucose, or serum calcium. Therefore, assessment of these parameters is not necessary before administering digoxin.

The nurse reviews a patient's laboratory values and observes a digoxin level of 2.5 ng/mL and a potassium level of 5.9 mEq/L. Upon physical assessment, the patient begins to experience changes in heart rate and rhythm (dysrhythmias). Which drug should the nurse be prepared to administer? 1 Digoxin 2 Quinidine 3 Potassium supplements 4 Digoxin immune Fab antibody fragments

4 When digoxin overdose is especially severe (normal range is 0.5-0.8 ng/mL), digoxin levels can be lowered using digoxin immune Fab antibody fragments. Potassium supplements are helpful when hypokalemia is present, not hyperkalemia. Giving digoxin would make the situation worse. Although the patient has dysrhythmias, quinidine should not be used as it causes plasma levels of digoxin to rise. Rather, phenytoin and lidocaine are most effective.

Which patient symptoms should alert the nurse to be concerned about digoxin [Lanoxin] toxicity? Select all that apply. A Fatigue B Vomiting C Constipation D Blurred vision E Muscle weakness

A B D Fatigue, vomiting, and blurred vision are common noncardiac symptoms that can provide advance warning of digoxin toxicity. Muscle weakness is an early sign of hypokalemia. Constipation is not a symptom of digoxin toxicity.

The nurse is monitoring a patient with suspected digoxin toxicity. Which assessment findings would be consistent with digoxin toxicity? Select all that apply. A Diarrhea B Anorexia C Vomiting D Dry cough E Visual disturbances

B C E Anorexia, vomiting, visual disturbances (blurred or yellow vision or appearance of halos around dark objects), fatigue, and nausea frequently foreshadow more serious toxicity (dysrhythmias) and should be reported immediately. Dry cough is a common side effect associated with angiotensin-converting enzyme inhibitors. Digoxin rarely causes diarrhea.