A patient has been taking furosemide (Lasix) for 6 months. A ...

[tiara099]

A patient has been taking furosemide (Lasix) for 6 months. A prescriber has just started the patient on digoxin (Lanoxin). Which of the following assessment data should most concern the nurse prior to the administration of digoxin?
 
  a. Crackles and respirations of 22/minutes
  b. Digoxin level of 0.5 mg/dL
  c. Blood pressure of 140/90
  d. Apical pulse rate of 56/minute

Question 2

A nurse is discussing the mechanism of action of spironolactone (Aldactone) with a group of nurses.
 
  The nurse states that spironolactone has been demonstrated to prolong survival as well as improve heart failure symptoms by which of the following actions?
  a. Decreasing the excretion of sodium
  b. Blocking receptors for aldosterone
  c. Redistributing edema
  d. Increasing the excretion of potassium

[kswal303]

Answer to Question 1

ANS: D
With low potassium levels (ie, below 3.5 mEq/L), which can occur secondary to furosemide administration, the risk of digoxin-induced toxicity is greatly increased. The apical pulse must be monitored, and digoxin should not be administered to a patient with a pulse below 60/minutes.
Crackles and respirations of 22/minute would be indications for furosemide and digoxin therapy and therefore not a concern for the nurse related to administration.
A digoxin level of 0.5 mg/dL is considered therapeutic, therefore digoxin should be continued with no concern.
A blood pressure of 140/90 would not be affected by digoxin and may actually be helped by furosemide, which would reduce volume and thus help reduce blood pressure.

Answer to Question 2

ANS: B
Spironolactone (Aldactone) blocks the action of aldosterone in the distal nephron and benefits patients with severe heart failure. Aldosterone acts to promote sodium uptake in exchange for potassium secretion; it therefore increases the excretion of sodium, promoting diuresis.
Spironolactone increases, rather than decreases, the excretion of sodium.
Spironolactone does not redistribute edema; rather, it is used to help reduce edema.
Spironolactone spares potassium removal rather than increasing its excretion.

[tiara099]

TYSM

[cam1229]

Thanks for the timely response, appreciate it