Confusing Question

[TinaPatch]

68. A 72-year-old client has an order for digoxin (Lanoxin) 25 mg PO daily. The nurse reviews the following information: apical pulse 68/min, respirations 16/min, plasma digoxin level 2 ng/ml.Based on this assessment, which of the following nursing actions is appropriate?

1. Give the medication on time.

2. Withhold the medication; notify the physician.

3. Administer epinephrine 1:1,000 stat.

4. Check the client's blood pressure.

Strategy: Answers are a mix of assessments and implementations. Is the assessment

appropriate? No. Determine the outcome of the implementations.

(1) medication should be withheld

(2) correct-therapeutic plasma level of digoxin is 0.5-2.0 ng/ml

(3) not a correct action

(4) assessment, does not address the issue of the elevated blood level of digoxin

Can someone please explain to me why 2 is the right answer. I thought it was 1. Digoxin is still within the therapeutic level 0.5 - 2. and pulse is within the normal range to. I would understand it if the level is greater than 2, then I will hold it & call MD. Thanks.

[jennifer_app]

Simply because if the medication was given, digoxin level would definitely go beyond the therapeutic level of 2.0 and would be in range of toxicity. Therefore to prevent that from happening, you should withhold it.

[NJ2013]

in addition to the above comment. Remember that Digoxin has a very narrow range, and any elevation could affect the patient.

[SherluckyRN]

So definitely call MD and see what the next step would be. Sometimes in som cases it would still be given when the benefit outweighs the risk but the nclex is searching for the topic answer. One size fits all

[PayitForwardHolistic]

https://allnurses.com/nclex-discussion-forum/kaplan-trainer-5-a-663869.html

Found this question in an older post... I think the following user summed it up pretty well

Just did that same question!! I actually got a question in a Qbank wrong today and ended up getting this question right b/c of it. It was about Lithium being at the level of 1.5 mEq, what should you do...(notify doc). Just remember when drugs are at their max therapeutic levels you should question the dosage b/c giving more of the drug will result in higher levels in the body...now I see why they say to read each and every rationale!

Good luck and just keep answering questions. Kaplan is kicking my butt, I have 2 trainers left and about 30% of the Qbank to complete.