im Wrong? PLZ tell me

Man, I can see what exactly you are saying. But I can also see why your instructor's answer is more correct in a sense as well. I k

For example, for the first problem both you and the instructor are correct - equally. from http://www.nlm.nih.gov/medlineplus/e...cle/000165.htm
digoxin toxicity Symptoms

• Confusion
• Irregular pulse
• Loss of appetite
• Nausea, vomiting, diarrhea
• Palpitations
• Visual changes (unusual)
  • Blind spots in vision
  • Blurred vision
  • Changes in color perception
  • Halos or rings of light around objects
  • Seeing lights or bright spots

for the second problem, yes inotropic - being positive agent as well as negative agent. But in this problem we are specificially referring to the digoxin - that doesn't specifically decrease the heart rate, but rather decrease the electrical impulses. Digoxin does increase/strengthen the contraction. it says halos of light around object, and yours around light?

My suggestion is to talk with your instructor and go thruough each answer one by one. That way you will get a chance to see from your instructor's view point and give your rationale behind why your chosen answers are correct or more correct.

The problem with multiple choice questions is that there are often two right answers but one is more right. In the first two examples you gave, as you now know, you picked the less right responses - it's annoying but learning from that will certainly help you in the future.

The third question is a little less clear. I've looked after many patients whose MI did not affect their observations but who sustained significant myocardial damage - the key is symptoms rather than signs, and I'm far more likely to treat ischemic pain with a report of intense pain/tightness/shortness of breath than a change in vitals. Frankly, by the time you see an alteration there the patient's already sustained a butt load of damage. I'm far more likely to use the vitals to make sure the anginine I'm giving isn't compromising the BP (thereby reducing blood flow to the already labourng heart) than to check how effective my pain plan is.

On an unrelated but relevant note - please consider using less formating in your posts - the size changes, bolding etc made it harder to read and I ended up skipping everything after "my conclusion."

#2.

I was taught Dig had a inotropic (force) and chornotropic (time) action.

My drug book says it too.

"... resulting in increased cardiac output (positive inotropic effect); increases force of contraction; decreases heart rate (negative chronotropic effect)"

(Skidmore-Roth, Linda. Mosby's 2010 Nursing Drug Reference, 23rd Edition. Mosby, 062009.).
<vbk:9780323066518>


The anwser would have been decreases heart rate if the keyword was CHRONOTROPIC instead of INOTROPIC.

This is my pharm book if you want more legit sources ....

Digitalis preparations like digoxin have three effects on heart muscle: (1) a positive inotropic action (increases myocardial contraction stroke volume), (2) a negative chronotropic action (decreases heart rate), and (3) a negative dromotropic action (decreases conduction of the heart cells).

(Kee, Joyce Lefever. Pharmacology: A Nursing Process Approach, 6th Edition. Saunders Book Company, 102008. 55.5).
<vbk:9781416046639#outline(55.5)>

I'm sorry, there's a very small chance you're going to get credit on question #2.

I'm going to emphasize what I posted again since you're still going to fight for it.

Digoxin has a dual action of INOTROPIC and CHRONOTROPIC.

Test taking wise, you're teacher is just going to point out the keyword INOTROPIC. This deals with FORCE, NOT HEART RATE, therefore the answer being Strengthen Heart Contraction. I cannot break it down any further. This question is not multi-dimensional nor requires further analysis. It is BASIC DEFINITION.

We understand Digoxin decreases heart rate, but that's because it's also has a CHRONOTROPIC property.

Since you love citing Wikipedia I will too.

http://en.wikipedia.org/wiki/Inotrope
http://en.wikipedia.org/wiki/Chronotrope

You know what? After reading your post. Here's another basic explanation why #1 is wrong.

You're teacher purposely threw you off. Here's why.

You're anwser was ...

"Halos around LIGHTS"

The correct anwser if she wrote it correctly (but she didn't on purpose) would be

"Halos of light around OBJECTS"

You know why she didn't write it correctly? If she did then that question would be bogus and the question would have to be dropped since two anwser are correct. The anwser you choose is NOT CORRECT based on the fact that ...

The Halos form around OBJECTS not LIGHT.

Here's my citations ...

"visual illusions (white, green, yellow halos around objects)"

(Kee, Joyce Lefever. Pharmacology: A Nursing Process Approach, 6th Edition. Saunders Book Company, 102008. 55.5.2.3).
<vbk:9781416046639#outline(55.5.2.3)>

and wiki proves you wrong also

http://en.wikipedia.org/wiki/Digoxin_toxicity --> says around OBJECTS.

I can't be bothered with question #3 at this point I'm thinking you're on a bias when you wrote that since it's coming from memory. At the beginning I thought your teacher was out to get you guys, but the questions #1 and #2 are fair ..

Good luck to you

I didn't read your whole post (your liberal use of colors, font sizes, etc was very hard on the eyes) but...

As to question number 2, it's not even a matter of "better or worse" answer... it's a simple definition: "The nurse defines inotropic as..." The fact that it was dig had no bearing on the question.

Inotropic = strength
Chronotropic = rate