The nurse is preparing a patient’s daily dose of digoxin (Lanoxin), an inotropic drug. The adult patient has an apical pulse of 48/min.
What should the nurse do next?
Withhold the dose and notify the health care provider.
Notify the health care provider and monitor the patient’s vital signs.
Recheck the pulse, making sure to count for 1 full minute.
Administer the dose.
The Correct Answer is A
Digoxin is a medication that can help the heart pump more blood and slow down the heart rate in certain conditions, such as heart failure and atrial fibrillation. However, digoxin has a narrow therapeutic range, which means that too much or too little of it can be harmful. The therapeutic range of digoxin levels in the blood is 0.5-2 ng/mL, and the toxic level is >2.4 ng/mL. Digoxin should be held if the resting apical pulse of an infant is <90 bpm, an older child is <70 bpm, or an adult is <60 bpm. A pulse of 48/min in an adult is too low and could indicate digoxin toxicity, which can cause life-threatening arrhythmias. Therefore, the nurse should withhold the dose and notify the health care provider immediately.
Choice B is wrong because notifying the health care provider and monitoring the patient’s vital signs are not enough.
The nurse should also withhold the dose to prevent further exposure to digoxin.
Choice C is wrong because rechecking the pulse, making sure to count for 1 full minute, is not necessary. The nurse should already have counted the pulse for 1 full minute before administering digoxin, as per standard procedure.
Choice D is wrong because administering the dose could worsen the patient’s condition and increase the risk of digoxin toxicity and arrhythmias.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
This is because enoxaparin is administered subcutaneously, which means under the skin, and the needle should be inserted fully into the skin to ensure proper delivery of the drug.
Choice A is wrong because aspirating (pulling back on the plunger) after inserting the needle is not recommended for subcutaneous injections of enoxaparin, as it may increase the risk of bleeding or bruising.
Choice B is wrong because administering the injection in the client’s thigh is not the preferred site for enoxaparin.The preferred site is the abdomen, at least 2 inches away from the navel, as it has more fatty tissue and less blood vessels than other areas.
Choice D is wrong because expelling the air bubble from the prefilled syringe is not necessary for enoxaparin.The air bubble helps to ensure that the entire dose of enoxaparin is injected and prevents blood from entering the syringe.
Normal ranges for enoxaparin dosage depend on the indication and the patient’s weight, but for prophylaxis of deep vein thrombosis after hip arthroplasty, the usual dose is 40 mg once a day for 3 weeks.
The prefilled syringe of enoxaparin 40 mg/0.4 ml contains the correct dose for this indication.
Correct Answer is B
Explanation
Diuretics are medicines that help the kidneys get rid of excess water and salt, which can ease the symptoms of heart failure, such as breathlessness and swelling.However, diuretics may also lower the blood pressure by reducing the blood volume and the cardiac output. This can cause symptoms such as dizziness, fatigue, or fainting.Hypotension is defined as a systolic blood pressure lower than 90 mmHg or a diastolic blood pressure lower than 60 mmHg.
Choice A is wrong because fluid retention is the opposite of what diuretics do. Diuretics increase the urine output and decrease the fluid accumulation in the body.
Choice C is wrong because hyperglycemia is not a common side effect of diuretics. Hyperglycemia is a condition where the blood sugar level is too high.Diuretics may affect the blood sugar level in some cases, but usually not significantly.
Choice D is wrong because diarrhea is not a typical side effect of diuretics.
Diarrhea is a condition where the stool is loose and watery.Diuretics may cause some gastrointestinal discomfort, such as nausea or cramps, but not diarrhea.
Normal ranges for blood pressure are 120/80 mmHg for systolic/diastolic in healthy adults, and 140/90 mmHg or higher for hypertension.Normal ranges for blood sugar are 70-100 mg/dL for fasting glucose, and less than 140 mg/dL for postprandial glucose.
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