Lehne's Pharmacology for Nursing
Care
12th Edition
• Author(s)Jacqueline Rosenjack
Burchum; Laura D. Rosenthal
,TEST BANK
QUESTION 1
Type: MCQ
Clinical Scenario
A 68-year-old patient with chronic heart failure is prescribed
digoxin. The patient has a history of chronic kidney disease with
a glomerular filtration rate (GFR) of 35 mL/min/1.73m². The
nurse notes that the patient's serum digoxin level is 2.5 ng/mL
(therapeutic range: 0.8-2.0 ng/mL).
Question Stem
Based on the pharmacokinetic principles affecting this patient,
which nursing action is the priority?
Answer Options
A. Administer the next scheduled dose of digoxin as ordered
B. Hold the digoxin and notify the healthcare provider
C. Increase the patient's fluid intake to enhance renal excretion
D. Administer digoxin immune Fab (Digibind) immediately
Correct Answer
B. Hold the digoxin and notify the healthcare provider
,Detailed Rationale
The patient is exhibiting signs of digoxin toxicity with a serum
level of 2.5 ng/mL, which exceeds the therapeutic range. This
patient is at increased risk for toxicity due to two factors: (1)
advanced age (68 years) leading to decreased renal function
and reduced drug clearance, and (2) chronic kidney disease
with a GFR of 35 mL/min/1.73m², which significantly impairs
the renal excretion of digoxin. Digoxin has a narrow therapeutic
index, meaning the margin between therapeutic and toxic
doses is small. The pharmacokinetic principle of elimination is
impaired in this patient, leading to drug accumulation and
toxicity. Holding the dose and notifying the provider allows for
appropriate dose adjustment based on the patient's renal
function and serum drug levels.
Incorrect Option Analysis
A. Administer the next scheduled dose of digoxin as ordered
• Why Incorrect: Administering the next dose would further
increase the serum digoxin level, potentially precipitating
life-threatening cardiac dysrhythmias.
• Common Misconception: Following orders without critical
thinking about current patient status and lab values.
• Medication Safety Risk: Severe cardiac toxicity, including
ventricular dysrhythmias and asystole.
, • Nursing Consideration: Always assess serum drug levels
and patient status before administering medications with
narrow therapeutic indices.
C. Increase the patient's fluid intake to enhance renal
excretion
• Why Incorrect: Increasing fluid intake in a patient with
heart failure could precipitate fluid overload and
worsening heart failure symptoms.
• Common Misconception: Believing that increasing fluid
intake universally enhances drug excretion without
considering fluid status.
• Medication Safety Risk: Fluid overload, pulmonary edema,
and exacerbation of heart failure.
• Nursing Consideration: Assess fluid balance and renal
function when managing medications excreted by the
kidneys.
D. Administer digoxin immune Fab (Digibind) immediately
• Why Incorrect: Digoxin immune Fab is indicated for severe,
life-threatening digoxin toxicity, typically when serum
levels are significantly higher or when the patient is
experiencing life-threatening dysrhythmias.
• Common Misconception: Treating all elevated levels as
emergencies requiring immediate reversal.
Care
12th Edition
• Author(s)Jacqueline Rosenjack
Burchum; Laura D. Rosenthal
,TEST BANK
QUESTION 1
Type: MCQ
Clinical Scenario
A 68-year-old patient with chronic heart failure is prescribed
digoxin. The patient has a history of chronic kidney disease with
a glomerular filtration rate (GFR) of 35 mL/min/1.73m². The
nurse notes that the patient's serum digoxin level is 2.5 ng/mL
(therapeutic range: 0.8-2.0 ng/mL).
Question Stem
Based on the pharmacokinetic principles affecting this patient,
which nursing action is the priority?
Answer Options
A. Administer the next scheduled dose of digoxin as ordered
B. Hold the digoxin and notify the healthcare provider
C. Increase the patient's fluid intake to enhance renal excretion
D. Administer digoxin immune Fab (Digibind) immediately
Correct Answer
B. Hold the digoxin and notify the healthcare provider
,Detailed Rationale
The patient is exhibiting signs of digoxin toxicity with a serum
level of 2.5 ng/mL, which exceeds the therapeutic range. This
patient is at increased risk for toxicity due to two factors: (1)
advanced age (68 years) leading to decreased renal function
and reduced drug clearance, and (2) chronic kidney disease
with a GFR of 35 mL/min/1.73m², which significantly impairs
the renal excretion of digoxin. Digoxin has a narrow therapeutic
index, meaning the margin between therapeutic and toxic
doses is small. The pharmacokinetic principle of elimination is
impaired in this patient, leading to drug accumulation and
toxicity. Holding the dose and notifying the provider allows for
appropriate dose adjustment based on the patient's renal
function and serum drug levels.
Incorrect Option Analysis
A. Administer the next scheduled dose of digoxin as ordered
• Why Incorrect: Administering the next dose would further
increase the serum digoxin level, potentially precipitating
life-threatening cardiac dysrhythmias.
• Common Misconception: Following orders without critical
thinking about current patient status and lab values.
• Medication Safety Risk: Severe cardiac toxicity, including
ventricular dysrhythmias and asystole.
, • Nursing Consideration: Always assess serum drug levels
and patient status before administering medications with
narrow therapeutic indices.
C. Increase the patient's fluid intake to enhance renal
excretion
• Why Incorrect: Increasing fluid intake in a patient with
heart failure could precipitate fluid overload and
worsening heart failure symptoms.
• Common Misconception: Believing that increasing fluid
intake universally enhances drug excretion without
considering fluid status.
• Medication Safety Risk: Fluid overload, pulmonary edema,
and exacerbation of heart failure.
• Nursing Consideration: Assess fluid balance and renal
function when managing medications excreted by the
kidneys.
D. Administer digoxin immune Fab (Digibind) immediately
• Why Incorrect: Digoxin immune Fab is indicated for severe,
life-threatening digoxin toxicity, typically when serum
levels are significantly higher or when the patient is
experiencing life-threatening dysrhythmias.
• Common Misconception: Treating all elevated levels as
emergencies requiring immediate reversal.
