A patient is taking digoxin Lanoxin and quinidine to treat ...

[beccaep]

A patient is taking digoxin Lanoxin and quinidine to treat sustained ventricular tachycardia.
 
  Before giving medications, the nurse reviews the patient's electrocardiogram (ECG) and notes a QRS complex that has widened by 50 from the baseline ECG. What will the nurse do? a. Administer the medications as ordered, because this indicates improvement.
  b. Contact the provider to discuss reducing the digoxin dose.
  c. Contact the provider to request an increase in the quinidine dose.
  d. Withhold the quinidine and contact the provider to report the ECG finding.

Question 2

A -year-old child who has been receiving high-dose systemic glucocorticoids for several months comes to a clinic for school immunizations, which usually include the DTaP vaccine; varicella virus vaccine Varivax; the measles, mumps, and rubella
 
  virus (MMR) vaccine; and the inacti-vated poliovirus vaccine (IPV). The clinic nurse will expect to administer which vaccines to this child? a. All four school immunizations
  b. DTaP and IPV only
  c. DTaP, OPV, and Varivax only
  d. DTaP and IPV, along with immunoglobu-lins

[pangili4]

Answer to Question 1

D
Quinidine widens the QRS complex by slowing depolarization of the ventricles. As cardiotoxic-ity develops as a result of quinidine toxicity, the QRS complex widens excessively. Any widen-ing of the QRS complex of 50 or more warrants notifying the provider, so the nurse should withhold the medication and contact the provider. Widening of the QRS complex by more than 50 of baseline indicates cardiotoxicity. Quinidine can double digoxin levels, so it is not likely that the digoxin dose would need to be increased, and an increase in the QRS complex does not indicate a need for more digoxin. The quinidine dose should not be increased, because the find-ings indicate cardiotoxicity from the quinidine.

Answer to Question 2

B
Children who are immunocompromised should not receive live virus vaccines, including the MMR vaccine and Varivax. Children taking high-dose systemic glucocorticoids are immuno-compromised and should not receive the vaccine until therapy is stopped and normal glucocorti-coid production returns. The oral polio vaccine (OPV) contains live virus and is contraindicated. Immunoglobulins are not indicated unless children are exposed to the diseases themselves.

[beccaep]

Gracias!

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