A client with heart disease is taking digoxin (Lanoxin) and ...

[APUS57]

A client with heart disease is taking digoxin (Lanoxin) and complains of having no appetite, diarrhea, and blurry vision. The nurse notes that the client's serum potassium (K) level is 3.0 ng/mL.
 
  Based on analysis of the data, what might the nurse anticipate assessing when reviewing the digoxin level results? 1. Digoxin level lower than 0.5 ng/mL
  2. Digoxin level higher than 2 ng/mL
  3. Digoxin level of 1.8 ng/mL
  4. Digoxin level of 0 ng/mL because of diarrhea

Question 2

The client had a 1000-mL bag of 5 dextrose in 0.9 sodium chloride hung at 15:00. The nurse, making rounds at 15:45, finds the client is complaining of a pounding headache, is dyspneic with chills, is apprehensive, and has an increased pulse rate.
 
  The intravenous (IV) bag has 400 mL remaining. The nurse should take which of the following actions first? 1. Shut off the infusion.
  2. Sit the client up in bed.
  3. Remove the angiocatheter and IV.
  4. Place the client in Trendelenburg's position.

[gcook]

Answer to Question 1

2

Rationale: When the client is taking digoxin, digoxin toxicity is a concern. The therapeutic digoxin level is 0.5 to 2 ng/mL. Anorexia, diarrhea, and visual disturbances are symptoms of digoxin toxicity. In addition, a low serum potassium level potentiates the risk for digoxin toxicity. This client's potassium level is low at 3.0 ng/mL. The client's complaints are indicative of digoxin toxicity. Therefore the only correct option is digoxin level higher than 2 ng/mL.

Answer to Question 2

1

Rationale: The client's symptoms are compatible with speed shock (fluid volume overload). This may be verified by noting that 600 mL has infused in the course of 45 minutes. The first action of the nurse from the options presented is to shut off the infusion. The nurse may elevate the head of bed to aid the client's breathing. Placing the client in Trendelenburg's position is not an appropriate action and will increase the dyspnea. The nurse also notifies the physician. The angiocatheter does not need to be removed. It may continue to be needed when the complication has been managed.

[APUS57]

Excellent

[mohan]

TYSM