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A patient about to receive a morning dose of digoxin has an apical pulse of 50 beats/min. What will the nurse do next?
- A. Administer the dose.
- B. Administer the dose, and notify the prescriber.
- C. Check the radial pulse for 1 full minute.
- D. Withhold the dose, and notify the prescriber.
Correct Answer: D
Rationale: Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/min or lower or is higher than 100 beats/min. The other options are incorrect.
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In assessing a patient before administration of a cardiac glycoside, the nurse knows that which lab result can increase the toxicity of the drug?
- A. Potassium level 2.8 mEq/L
- B. Potassium level 4.9 mEq/L
- C. Sodium level 140 mEq/L
- D. Calcium level 10 mg/dL
Correct Answer: A
Rationale: Hypokalemia increases the chance of digitalis toxicity. The other levels listed are incorrect.
A patient has been placed on a milrinone infusion as part of the therapy for end-stage heart failure. What adverse effect of this drug will the nurse watch for when assessing this patient during the infusion?
- A. Hypertension
- B. Hyperkalemia
- C. Nausea and vomiting
- D. Cardiac dysrhythmias
Correct Answer: D
Rationale: The primary adverse effects seen with milrinone are cardiac dysrhythmias, mainly ventricular. It may also cause hypotension, hypokalemia, and other effects, but not nausea and vomiting.
When a patient is experiencing digoxin toxicity, which clinical situation would necessitate the use of digoxin immune Fab?
- A. The patient reports seeing colorful halos around lights.
- B. The patient's serum potassium level is above 5 mEq/L.
- C. The patient is experiencing nausea and anorexia.
- D. The patient is experiencing severe sinus bradycardia that does not respond to cardiac pacing.
- E. The patient has received an overdose of greater than 10 mg of digoxin.
- F. The patient reports fatigue and headaches.
Correct Answer: B,D,E
Rationale: Clinical situations that would require the use of digoxin immune Fab in a patient with digoxin toxicity include serum potassium level above 5 mEq/L, severe sinus bradycardia that does not respond to cardiac pacing, or an overdose of more than 10 mg of digoxin. Seeing colorful halos around lights, nausea, anorexia, fatigue, and headaches are potential adverse effects of digoxin therapy but are not necessarily reasons for digoxin immune Fab treatment.
A patient is taking digoxin and a loop diuretic daily. When the nurse enters the room with the morning medications, the patient states, -I am seeing a funny yellow color around the lights. What is the nurse's next action?
- A. Assess the patient for symptoms of digoxin toxicity.
- B. Withhold the next dose of the diuretic.
- C. Administer the digoxin and diuretic together as ordered.
- D. Document this finding, and reassess in 1 hour.
Correct Answer: A
Rationale: Seeing colors around lights is one potential indication of developing digoxin toxicity. If a patient indicates these visual problems, the nurse needs to assess for other signs and symptoms of digoxin toxicity including bradycardia, headache, dizziness, confusion, nausea, and blurred vision, and then notify the prescriber. Administering the drug or withholding the diuretic are incorrect options.
A patient in the intensive care unit is on a dobutamine infusion and is to receive furosemide 40 mg IV now. What is the nurse's best action to administer the furosemide?
- A. Infuse the drug into the same intravenous line as the milrinone.
- B. Stop the milrinone, flush the line, and then administer the furosemide.
- C. Administer the furosemide in a separate intravenous line.
- D. Notify the prescriber that the furosemide cannot be given at this time.
Correct Answer: C
Rationale: Furosemide must not be injected into an intravenous line with milrinone because it will precipitate immediately. The infusion must not be stopped because of the patient's condition. A separate line will be needed. The other options are incorrect.