Nokea
After teaching a client about his prescribed cardiotonic drug therapy, the nurse determines that additional teaching is needed when the client states which of the following?
- A. I will take the drug at the same time each day.'
- B. I can crush the tablet and mix it with food.'
- C. I should call if my pulse rate is below 80 beats per minute.'
- D. I need to notify my doctor if I have blurred vision.'
Correct Answer: C
Rationale: The client should call the primary health care provider if his pulse rate is below 60 beats per minute or above 100 beats per minute. The client should take the drug at the same time each day, crush the tablet and mix with food, and notify the primary health care provider if blurred vision occurs.
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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.
To help control the nausea and anorexia that may occur as an adverse reaction during digoxin therapy, the nurse should recommend which of the following? Select all that apply.
- A. Eating frequent smaller meals
- B. Restricting fluids at mealtime
- C. Maintaining good oral hygiene
- D. Eating more protein
- E. Avoiding fluid intake 1 hour before and after meals
Correct Answer: A,B,C,E
Rationale: If the nausea or anorexia is not a result of toxicity but an adverse reaction to the drug, use nursing measures to help control the reactions. Offer frequent small meals rather than three large meals. Restricting fluids at meals and avoiding fluids 1 hour before and after meals help to control nausea. Helping the patient to maintain good oral hygiene by brushing teeth or rinsing the mouth after ingesting food will also help with nausea.
A nurse would administer the prescribed digoxin (Lanoxin) cautiously for a client with which electrolyte imbalances? Select all that apply.
- A. Hypokalemia
- B. Hypermagnesemia
- C. Hypocalcemia
- D. Hyperkalemia
- E. Hypomagnesemia
Correct Answer: A,C,E
Rationale: The cardiotonic drugs are given cautiously to clients with electrolyte imbalances (especially hypokalemia, hypocalcemia, and hypomagnesemia).
A nurse checks the serum digoxin level of a client and finds it to be increased. Which of the following would the nurse identify as possibly associated with this increase?
- A. Colestipol (Colestid)
- B. Verapamil (Calan)
- C. Clarithromycin (Biaxin)
- D. Calcium carbonate (Maalox)
- E. Spironolactone (Aldactone)
Correct Answer: B,C,E
Rationale: Increased serum digoxin levels can occur with verapamil, clarithromycin, and spironolactone. Antacids, such as calcium carbonate, and colestipol cause a decrease in serum digoxin levels.
A client receives his prescribed daily digoxin at 9 a.m. today. The nurse would expect to obtain a serum drug level at which time?
- A. 12 noon today
- B. 4 p.m. today
- C. 9 p.m. tonight
- D. 12 midnight
Correct Answer: B
Rationale: Blood for plasma level measurements should be drawn immediately before the next dose or 6 to 8 hours after the last dose regardless of route. For this client, that would be between 3 p.m. and 5 p.m. today or immediately before his dose tomorrow.