Kaplan Trainer 5 - Question 68 (Digoxin)

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So if a patient has a plasma level of 2.0 we should withhold the medication??? I figured if the therapeutic level is 0.5 to 2.0, then 2.0 is still therapeutic, especially since it's a maintenance dose. If the dose is withheld, wouldn't the level drop?? Please share your opinion, but I think this question is poorly written.

  • order for digoxin (Lanoxin) 25 mg PO daily
  • apical pulse 68/min
  • respirations 16/min
  • plasma digoxin level 2 ng/ml

  • which of the nursing action is appropriate?

  1. 1. Give the medication on time.
  2. 2. Withhold the medication; notify the physician.
  3. 3. Administer epinephrine 1:1,000 stat.
  4. 4. Check the client's blood pressure.

(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

If you give more Digoxin, the serum will get higher than 2.0 ng/ml.

but if you withhold it, is there a possibility that it would fall below the therapeutic range? it's a maintenance dose... so shouldn't it 'maintain' the level at 2.0 given the schedule and half-life?

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.

Remember, keeping your patient safe in the HERE AND NOW! Giving the drug at that moment will increase the level and then you have put your patient in a potential predicament.

If you withhold the dose, yeah the serum level may drop a little bit (I doubt it would go below the therapeutic range, but even if it did, it's not toxic).

If you give the med, the serum WILL go above 2 ng/ml.

Google Digoxin Toxicity. It's bad stuff.

thanks for the replies... hopefully I get something like this on my actual NCLEX so I can kick NCLEXs @SS!! :p

LOL! You definitely won't forget it! How soon are you testing?

19 days, 20 hours, 9 minutes and counting

Also remember--Dig Toxicity = Diarrhea and seeing halos (my Kaplan instructor said it like 1800 times) :lol2:

now i pray for a Dig question.... BRING IT ON!! hahaha

I remember when my test was that far away, OMG, it's so close now. I'm just ready to get the experience behind me already, eek!

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