Author Question: A primary care NP sees a patient who is being treated for heart failure with digoxin, a loop ... (Read 37 times)

mydiamond · **on:** Jul 24, 2018

A primary care NP sees a patient who is being treated for heart failure with digoxin, a loop diuretic, and an ACE inhibitor. The patient reports having nausea. The NP notes a heart rate of 60 beats per minute and a blood pressure of 100/60 mm Hg.

The NP should: a. decrease the dose of the diuretic to prevent further dehydration.
b. obtain a serum potassium level to assess for hyperkalemia.
c. hold the ACE inhibitor until the patient's blood pressure stabilizes.
d. obtain a digoxin level before the patient takes the next dose of digoxin.

Question 2

The primary care NP sees a patient covered by Medicaid, writes a prescription for a medication, and is informed by the pharmacist that the medication is off-formulary. The NP should:

a. inform the patient that an out-of-pocket expense will be necessary.
b. write the prescription for a generic drug if it meets the patient's needs.
c. call the patient's insurance provider to advocate for this particular drug.
d. contact the pharmaceutical company to see if medication samples are available.

brittiany.barnes · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

D
To monitor for toxicity, the health care provider must be alert to early signs of toxicity and must obtain a serum level. Nausea is an early sign of toxicity.

Answer to Question 2

B
Medicaid often stipulates which medications are or are not covered. Unless the particular drug is absolutely necessary, the NP should substitute with an acceptable generic drug. Insisting that the patient pay out of pocket may mean that the prescription is not filled. If the drug is necessary, the NP may advocate for its use by contacting the third-party payer. Asking for drug samples is not a long-term solution for the problem.