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. 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.
(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
OMG I just did QT 5 yesterday and had the same confusion on holding that Dig!! I actually have a post-it on the side of my computer as a reminder to figure out when to hold. I, too, figured it was within the safe range and thought you would administer the Dig. Still confusing to me because if the blood level comes up within range, where do you draw the line on what number to hold the Dig?
Regarding the toxicity - our instructors always told us that you are much more likely to see the GI effects before any halos or green vision.
With a half life of 36 hours it is easier to see why holding it and checking with MD is a responsible response. While not in the question it is also important to know the potassium level. What is kidney function? If excreted via kidney and there are changes then the maintenance dose may need to be modified.
Good to know the answers to the questions but remember the whole, not just that specific question. It could be presented in a different way.
rockstar is absolutely correct. it may very well be that the physician will say to give it anyway, if the patient has been on a stable dose forever, has always been at this level on this dose, and has no other/new reason to worry about dig toxicity, but you don't know that so it's up to the md to choose the medical plan of care from here.
the number one objective of nclex questions is to determine whether your nursing plan of care is putting patient safety first. the question is not poorly-written, it's exactly reflective of a real patient care scenario. the correct answer is the only one that meets that criterion.
hi Jabalos, i also got that question wrong was thinking exactly what u were thinking. When are u taking your exam? My account expires tonight and u have a whole weekend still before i do my exam. I am scared this will be my 3rd time. I am very scared
Hey guys.... We just went over F&E in lecture and we were taught that when K is low you have to watch for pt taking Dig because the serum level of the drug will rise causing dig toxicity... Conquer NCLEX!!! We are all rooting for you!
jabalos
35 Posts
"far away" ahhahahaha, i feel like i'm running out of time.