Nokea
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.
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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.
A nurse is monitoring a client who is prescribed milrinone for heart failure. The nurse determines that the client is experiencing an adverse reaction based on assessment of which of the following?
- A. Edema
- B. Hypotension
- C. Bradycardia
- D. Cyanosis
Correct Answer: B
Rationale: When caring for clients taking milrinone, the development of hypotension indicates an adverse reaction. Edema and cyanosis need to be assessed by the nurse as part of the preadministration assessment. Edema, bradycardia, and cyanosis are not adverse reactions associated with milrinone.
A nurse is preparing to administer a prescribed cardiotonic to a client. The nurse understands that the drug is being administered to achieve which of the following? Select all that apply.
- A. Improved myocardial contractility
- B. Increased myocardial efficiency
- C. Increased blood pressure
- D. Increased peripheral edema
- E. Improved profusion to all body tissues
Correct Answer: A,B,E
Rationale: Cardiotonics are drugs used to increase the efficiency and improve the contraction of the heart muscle, which leads to improved blood flow to all tissues of the body.
A nurse is required to care for a child, age 4 years, who is being digitalized. Which of the following changes in the pulse rate indicates that the nurse should withhold the drug?
- A. Pulse rate less than 70 beats per minute
- B. Pulse rate less than 80 beats per minute
- C. Pulse rate less than 90 beats per minute
- D. Pulse rate more than 100 beats per minute
Correct Answer: A
Rationale: In a child, a pulse rate less than 70 beats per minute indicates toxicity. The nurse should withhold the drug when the pulse rate is less than 70 beats per minute and notify the health care provider. A pulse rate less than 60 or more than 100 beats per minute indicates toxicity in adults. A pulse rate less than 90 beats per minute indicates toxicity in infants.
A client comes to the clinic for a visit. The client has been taking digoxin for several months. While interviewing the client, the nurse suspects the client is experiencing digoxin toxicity based on which of the following? Select all that apply.
- A. Anorexia
- B. Weakness
- C. Inability to relax
- D. Photosensitivity
- E. Disorientation
Correct Answer: A,B,E
Rationale: Signs of digitalis toxicity include anorexia, weakness, lethargy, blurred vision, and disorientation. An inability to relax and photosensitivity are not associated with digitalis toxicity.