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/ency/article/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.

in referance to my question 2: i thank you for your comment but it offered no insight to contradict-disproove why i chose my answer.

however- yesterday came my moment of clarity-i finally figured out what my issue & probelm was. my answer was right-pathophysiologicly as well as the systematical flow of the drugs actions on the heart.b]

im greatful to be thinking as hard as i do but all in all. i was thinking too much.

i was focusing on the literal actions so much i bypassed the intentions of what the question is asking...im telling a patient the actions of that medicine. i can not explian in grave details to a person who has no medical education. if i told them my answer "decreases heart rate-id have to go into the full tells on how it ends with final purpose that results in muscle contraction. the "strengthens heart contraction" choice basically sums it up very simply.

hmm glancing at the signs & symptoms under visual- i guess loss of appetite would be the right choice because "unusual" is placed after "visual changes"...... where as "loss of appetite" is a definate.

ironic how it took alot of agitation. lack of rationale (explanation) on the test's correct answers...

only i was able to disprove myself.

question 3 still boggles me.... but i will let it go for the sake of retaining my sanity.

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.).

<9780323066518>

<9781416046639>

http://en.wikipedia.org/wiki/Digoxin"inhibition of the Na+/K+ pump leads to increased intracellular Na+ levels, which in turn slows down the extrusion of Ca2+ by the sodium-calcium exchanger that relies on the high Na+ gradient. This effect causes an increase in the length of Phase 4 and Phase 0 of the cardiac action potential, which when combined with the effects of digoxin on the parasympathetic nervous system, leads to a decrease in heart rate" -as cited from http://en.wikipedia.org/wiki/Digoxin Under "Mechanism of Action" section.

Basicaly; digoxin DOES slow Heart Rate now in order for the blood to build up in L-Ventricle to create a stronger beat at the end that packs a better punch.

Naturally I decided to dig deeper...

After a few minutes of collected research on the effect of this drug and its theraputic purpose "stronger muscle contractions".. Without calcium channel block aide, digoxin only increase contractility minimally.

:cheers:

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).

<9781416046639>

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

I withdrew completely from the LPN program and my Tech college. I am accepted into the undergraduate pre-med doctorial program at our University college.

I took into consideration the comments my Instructors said to me, two of them were "*myname* your thinking too much and too deep" (my original is example) and "*myname*, you know what your problem is..your thinking like a Doctor in a nursing class"

Since I wanna be a Dr in the end. Made sense.

I've looked at #3, and I believe that what they are going for is that when you do a VITAL ASSESSMENT, you are searching for not only the pain level, but all possible CAUSES. We are being taught that part of your assessment of vitals INCLUDES a pain scale assessment.

In the Digoxin question, they are asking specifically what inotropic means, not the whole effect of the drug.

It makes sense that you would overthink those. You just mentioned that you were aiming for Doctor, and I feel that could be quite suitable for you since doctors are more sternly clinical in their thought. Nurses must go a step further and be abstract about the way they think. Not so much "Educate about all of the possible toxicity symptoms" but more of "What education is *most* beneficial to my client?"

I hope that makes sense or that I'm not speaking out of turn. I wish you the best, and congrats on Med School!

In your response to my #3 Question, that is the best answer that makes sense. Yes-patients response to rate pain is obviously important. The vital answer im assuming covers all aspects needed to compose a "pain management program", the pain scale which is included along with vital numbers that determine the fluctuation & how hard the pain is throwing the body's systems off wack which may dissrupt upcoming testing.

I would not have been so angered if only the "right" answers were explained in full rationale.

Thanks for the input. I just decided to jump straight into Dr now because apparently my instructors made it clear that-yes, critical thinking is needed, but your thinking further & deeper than a nurse would.

best way to put it is a baseball metaphore- Im up at bat. The entire field is Nursing & Patients. I hit the ball over the fence (homeRun). Where the ball went is great but does no good if the patient cant reach it (understand things).

As for the Digoxin -Inotropic Question- It is true it is stateing its an Inotropic. Yes it does not say whether its Positive or Negative Inotropic because that is irrelevant info because All in all, both my answer & theirs are right. Both are the Inotropic actions. Digoxin simply can not work without decreaseing the HR to what ever extent the doseage is. Do you concur?

(Im not worried or furious with these questions any longer but I do enjoy the debate of these)

Some info on study done of Digoxin in detail..

http://nels.nii.ac.jp/els/110002580761.pdf?id=ART0002842807&type=pdf&lang=en&host=cinii&order_no=&ppv_type=0&lang_sw=&no=1257304996&cp=

I would not have been so angered if only the "right" answers were explained in full rationale.

Beleive me, I understand. The expectations aren't always laid out. I'm having the same problem at my school. :)

Thanks for the input. I just decided to jump straight into Dr now because apparently my instructors made it clear that-yes, critical thinking is needed, but your thinking further & deeper than a nurse would.

I think your thought processes are just highly factual and scientific. Which is not a bad thing! But you have to be able to judge what's really being asked. If a patient starts asking what they will do with their dog while they are in surgery, they may actually be asking "Am I going to be ok".

best way to put it is a baseball metaphore- Im up at bat. The entire field is Nursing & Patients. I hit the ball over the fence (homeRun). Where the ball went is great but does no good if the patient cant reach it (understand things).

that's a great metaphor! I might share that with a few people I know. :)

As for the Digoxin -Inotropic Question- It is true it is stateing its an Inotropic. Yes it does not say whether its Positive or Negative Inotropic because that is irrelevant info because All in all, both my answer & theirs are right. Both are the Inotropic actions. Digoxin simply can not work without decreaseing the HR to what ever extent the doseage is. Do you concur?

it is true that Dig slows heart rate and strengthens contractions. But is that what the question was asking? The question was asking "what is its INOTROPIC action"

And Im glad you are still willing to discuss this. Because I can guarantee you that med school will do the same thing.

(Im not worried or furious with these questions any longer but I do enjoy the debate of these)

Wonderful! Because an unexpected outcome of this discussion is that I am reinforcing some knowledge that I'm currently gaining. We had been talking about Dig in class, but this discussion has helped me to remember it's properties better. I learn by talking. :)