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 72-year-old female patient with congestive heart failure is
prescribed digoxin. She has a history of chronic kidney disease
with an estimated glomerular filtration rate (eGFR) of 35
mL/min/1.73m². Her serum digoxin level is reported as 2.4
ng/mL (therapeutic range: 0.8-2.0 ng/mL).
Question Stem:
The nurse anticipates which intervention based on this digoxin
level?
Answer Options:
A. Administer the next scheduled dose as ordered
B. Hold the next dose and notify the healthcare provider
C. Increase the dose to achieve therapeutic effectiveness
D. Administer digoxin immune Fab (Digibind) immediately
Correct Answer: B. Hold the next dose and notify the
healthcare provider
Detailed Rationale:
The serum digoxin level of 2.4 ng/mL is above the therapeutic
,range (0.8-2.0 ng/mL), indicating digoxin toxicity. In a patient
with chronic kidney disease (eGFR 35 mL/min/1.73m²), digoxin
clearance is significantly reduced because approximately 60-
80% of digoxin is excreted unchanged by the kidneys. This
patient is at increased risk for digoxin toxicity due to reduced
renal function, and the elevated serum level confirms toxicity.
The first step is to hold the next dose and notify the healthcare
provider to assess for signs of toxicity and adjust the dosage.
Digoxin immune Fab is reserved for severe, life-threatening
digoxin toxicity with dysrhythmias or hyperkalemia, not for
asymptomatic elevated levels.
Incorrect Option Analysis:
A. Administer the next scheduled dose as ordered
• Why It Is Incorrect: This would further increase the already
toxic serum digoxin level
• Common Clinical Misconception: The misconception that
"ordered doses must always be given regardless of lab
values"
• Potential Medication Safety Risk: Administration could
precipitate severe digoxin toxicity, including life-
threatening dysrhythmias
, • Appropriate Nursing Consideration: Always verify serum
drug levels before administering medications with narrow
therapeutic indices
C. Increase the dose to achieve therapeutic effectiveness
• Why It Is Incorrect: The dose should be decreased, not
increased
• Common Clinical Misconception: Confusing
subtherapeutic levels with toxic levels
• Potential Medication Safety Risk: Could rapidly worsen
toxicity
• Appropriate Nursing Consideration: Know the therapeutic
range for all narrow-therapeutic-index medications
D. Administer digoxin immune Fab (Digibind) immediately
• Why It Is Incorrect: This is a reserved therapy for life-
threatening toxicity
• Common Clinical Misconception: Overestimating the
severity of toxicity
• Potential Medication Safety Risk: Unnecessary
administration of a costly and resource-intensive antidote
• Appropriate Nursing Consideration: Reserve digoxin
immune Fab for severe toxicity with cardiac dysrhythmias
or serum potassium >5.0 mEq/L
Care
12th Edition
• Author(s)Jacqueline Rosenjack
Burchum; Laura D. Rosenthal
,TEST BANK
Question 1
Type: MCQ
Clinical Scenario:
A 72-year-old female patient with congestive heart failure is
prescribed digoxin. She has a history of chronic kidney disease
with an estimated glomerular filtration rate (eGFR) of 35
mL/min/1.73m². Her serum digoxin level is reported as 2.4
ng/mL (therapeutic range: 0.8-2.0 ng/mL).
Question Stem:
The nurse anticipates which intervention based on this digoxin
level?
Answer Options:
A. Administer the next scheduled dose as ordered
B. Hold the next dose and notify the healthcare provider
C. Increase the dose to achieve therapeutic effectiveness
D. Administer digoxin immune Fab (Digibind) immediately
Correct Answer: B. Hold the next dose and notify the
healthcare provider
Detailed Rationale:
The serum digoxin level of 2.4 ng/mL is above the therapeutic
,range (0.8-2.0 ng/mL), indicating digoxin toxicity. In a patient
with chronic kidney disease (eGFR 35 mL/min/1.73m²), digoxin
clearance is significantly reduced because approximately 60-
80% of digoxin is excreted unchanged by the kidneys. This
patient is at increased risk for digoxin toxicity due to reduced
renal function, and the elevated serum level confirms toxicity.
The first step is to hold the next dose and notify the healthcare
provider to assess for signs of toxicity and adjust the dosage.
Digoxin immune Fab is reserved for severe, life-threatening
digoxin toxicity with dysrhythmias or hyperkalemia, not for
asymptomatic elevated levels.
Incorrect Option Analysis:
A. Administer the next scheduled dose as ordered
• Why It Is Incorrect: This would further increase the already
toxic serum digoxin level
• Common Clinical Misconception: The misconception that
"ordered doses must always be given regardless of lab
values"
• Potential Medication Safety Risk: Administration could
precipitate severe digoxin toxicity, including life-
threatening dysrhythmias
, • Appropriate Nursing Consideration: Always verify serum
drug levels before administering medications with narrow
therapeutic indices
C. Increase the dose to achieve therapeutic effectiveness
• Why It Is Incorrect: The dose should be decreased, not
increased
• Common Clinical Misconception: Confusing
subtherapeutic levels with toxic levels
• Potential Medication Safety Risk: Could rapidly worsen
toxicity
• Appropriate Nursing Consideration: Know the therapeutic
range for all narrow-therapeutic-index medications
D. Administer digoxin immune Fab (Digibind) immediately
• Why It Is Incorrect: This is a reserved therapy for life-
threatening toxicity
• Common Clinical Misconception: Overestimating the
severity of toxicity
• Potential Medication Safety Risk: Unnecessary
administration of a costly and resource-intensive antidote
• Appropriate Nursing Consideration: Reserve digoxin
immune Fab for severe toxicity with cardiac dysrhythmias
or serum potassium >5.0 mEq/L
