Nokea
A nurse caring for a client with atrial fibrillation who is started on digoxin therapy is required to monitor plasma drug levels. The nurse would report which level to the primary health care provider?
- A. 1.6 ng/ml
- B. 1.8 ng/ml
- C. 2.0 ng/ml
- D. 2.2 ng/ml
Correct Answer: D
Rationale: A plasma digoxin level of more than 2 ng/mL would require the nurse to report to the primary health care provider; therefore, plasma digitalis levels of 2.2 ng/mL indicate digoxin toxicity. The therapeutic levels range from 0.5 to 2 ng/mL.
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When reviewing the medical record of a client who is prescribed a cardiotonic, which condition would lead the nurse to contact the primary health care provider because the drug is contraindicated for use? Select all that apply.
- A. Digitalis toxicity
- B. Hypertension
- C. Cardiac tamponade
- D. Hypotension
- E. Ventricular tachycardia
Correct Answer: A,C,E
Rationale: The cardiotonics are contraindicated in the presence of digitalis toxicity and in clients with known drug hypersensitivity, ventricular tachycardia, cardiac tamponade, restrictive cardiomyopathy, or AV block.
After teaching a group of nursing students about digoxin, the instructor determines that the teaching was successful when the students identify which of the following as true regarding the monitoring of plasma digoxin levels? Select all that apply.
- A. Levels should be drawn immediately after the dose.
- B. Levels should be drawn immediately before the next dose.
- C. Levels should be drawn 6 to 8 hours after the last dose.
- D. Levels of greater than 2 ng/ml are considered toxic.
- E. Levels are considered therapeutic between 0.5 and 1.5 ng/ml.
Correct Answer: B,C,D
Rationale: Digoxin blood plasma level measurements should be drawn immediately before the next dose or 6 to 8 hours after the last dose regardless of route. Therapeutic digoxin levels are between 0.8 and 2 ng/ml. Plasma digoxin levels greater than 2 ng/ml are considered toxic and are reported to the physician.
A nursing instructor is conducting a class on heart failure and the events that occur. The instructor describes which of the following as a result of increases in neurohormonal activity that occur with heart failure? Select all that apply.
- A. Decreased secretion of catecholamines
- B. Remodeling of the cardiac muscle cells
- C. Hypertrophy of the heart
- D. Increased need for oxygen
- E. Cardiac necrosis
Correct Answer: B,C,D,E
Rationale: Increased catecholamines lead to increases in neurohormonal activity that cause remodeling of the cardiac muscle cells, leading to hypertrophy of the heart, increased need for oxygen, and cardiac necrosis, which worsen the heart failure.
Before administering a cardiotonic drug to a client, which of the following would be most important for the nurse to assess? Select all that apply.
- A. Apical-radial pulse rate
- B. Respiratory rate
- C. Urinalysis
- D. Weight measurement
- E. Blood pressure
Correct Answer: A,B,D,E
Rationale: Preadministration physical assessment should include assessment of the apical-radial pulse rate, respiratory rate, weight, and blood pressure to establish a baseline for comparison. Assessing the client's urine is not required.
Before administering a cardiotonic drug, the nurse would expect which of the following laboratory tests to be completed? Select all that apply.
- A. Liver function tests
- B. Renal function tests
- C. Complete blood count
- D. Electrolyte levels
- E. Blood glucose
Correct Answer: A,B,C,D
Rationale: Liver function tests, renal function tests, complete blood count with the addition of serum electrolytes, and an electrocardiogram complete the lab workup prior to initiating therapy with a cardiotonic drug. It is not necessary to obtain serum blood glucose, but it might appear with other lab work that has been gathered.