A patient is being treated for heart failure. Labs: Sodium 146 meq/L, Potassium 4.2 mmol/L, Hemoglobin 10.5 gm/dL, White Blood Cells 12.2, digoxin level 0.8 ng/mL
VS: BP 118/66, apical heart rate 68, O2 96% on 2L nasal cannula, temperature 98.4°F
What will the nurse do with the digoxin order?
Recheck heart rate in one hour
Give the digoxin as ordered
Call prescriber and ask for chest x-ray
Hold the digoxin and call the MD
The Correct Answer is B
Choice A reason: This choice is incorrect because there is no need to recheck the heart rate in one hour before giving the digoxin. The client's apical heart rate is within the normal range (60 to 100 beats per minute) and does not indicate bradycardia (slow heart rate), which is a sign of digoxin toxicity. The nurse should check the apical heart rate for one full minute before giving the digoxin and withhold the dose if the heart rate is below 60 beats per minute.
Choice B reason: This choice is correct because the client's digoxin level is within the therapeutic range (0.5 to 2.0 ng/mL) and does not indicate digoxin toxicity or underdosing. The client's vital signs and labs are also stable and do not indicate any adverse effects of digoxin. Digoxin is a cardiac glycoside that improves the contractility and efficiency of the heart and helps to control the heart rate and rhythm in clients with heart failure. The nurse should give the digoxin as ordered and monitor the client's response and digoxin level.
Choice C reason: This choice is incorrect because there is no indication for a chest x-ray for this client. A chest x-ray is a diagnostic test that can show the size and shape of the heart and lungs and detect any abnormalities, such as fluid accumulation, infection, or tumors. The client's symptoms and labs do not suggest any pulmonary complications or worsening of heart failure that would require a chest x-ray. The nurse should follow the provider's orders and protocols for chest x-ray indications.
Choice D reason: This choice is incorrect because there is no reason to hold the digoxin and call the MD for this client. The client's digoxin level is not too high or too low and does not require dose adjustment or discontinuation. The client's vital signs and labs are also normal and do not indicate any signs of digoxin toxicity or adverse effects. Holding the digoxin could cause the client's heart failure to worsen or cause arrhythmias. The nurse should only hold the digoxin and call the MD if the client has signs of digoxin toxicity, such as nausea, vomiting, visual disturbances, confusion, or bradycardia. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["0.1"]
Explanation
To calculate the dose of darbepoetin that the nurse should administer, we can follow these steps:
Convert the client's weight from pounds to kilograms:
198 lb ÷ 2.2 = 89.82 kg (rounded to two decimal places)
Calculate the dose of darbepoetin:
0.45 mcg/kg × 89.82 kg = 40.41 mcg
Determine the volume of darbepoetin needed using the available concentration:
40.41 mcg ÷ 300 mcg/mL = 0.1347 mL
Rounding to the nearest tenth, the nurse should administer 0.1 mL of darbepoetin subcutaneously once weekly.
Correct Answer is B
Explanation
Choice A reason: This choice is incorrect because glargine is not a drug that needs to be assessed before a CT scan with contrast. Glargine is a long-acting insulin that lowers blood sugar levels in people with diabetes. It is injected once a day, usually at bedtime, and works for 24 hours. The nurse should monitor the client's blood sugar levels and adjust the dose of glargine as needed, but it does not interfere with the CT scan or the contrast dye.
Choice B reason: This choice is correct because metformin is a drug that needs to be assessed before a CT scan with contrast. Metformin is an oral medication that lowers blood sugar levels in people with diabetes. It works by reducing the amount of glucose produced by the liver and increasing the sensitivity of the cells to insulin. However, metformin can cause a rare but serious condition called lactic acidosis, which is a buildup of lactic acid in the blood that can cause symptoms such as nausea, vomiting, abdominal pain, muscle weakness, and breathing problems. The risk of lactic acidosis is increased when metformin is combined with contrast dye, which can affect the kidney function and the clearance of metformin from the body. The nurse should check the client's kidney function and the dose and timing of metformin before the CT scan. The nurse should also instruct the client to stop taking metformin before and after the CT scan, as directed by the provider.
Choice C reason: This choice is incorrect because famotidine is not a drug that needs to be assessed before a CT scan with contrast. Famotidine is an antacid that reduces the amount of acid in the stomach. It is used to treat conditions such as gastroesophageal reflux disease (GERD), ulcers, and gastritis. It does not affect the blood sugar levels or the kidney function, and it does not interact with the contrast dye. The nurse should administer famotidine as prescribed and monitor the client's gastrointestinal symptoms, but it does not require any special precautions before the CT scan.
Choice D reason: This choice is incorrect because glucagon is not a drug that needs to be assessed before a CT scan with contrast. Glucagon is a hormone that raises blood sugar levels in people with diabetes. It is used as an emergency treatment for severe hypoglycemia (low blood sugar), when the person is unconscious or unable to swallow. It is injected into a muscle or under the skin, and it works by stimulating the liver to release glucose into the blood. The nurse should have glucagon available in case of hypoglycemia, but it does not affect the CT scan or the contrast dye.
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