Pharmacology and the Nursing
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,QUESTION 1
Item Type: MCQ
Clinical Scenario
A 72-year-old patient with heart failure and chronic kidney
disease (eGFR 35 mL/min/1.73m²) is prescribed digoxin 0.125
mg orally daily. The patient has been taking this medication for
3 weeks and reports mild nausea, visual disturbances with
yellow halos around lights, and fatigue.
Question Stem
Which nursing action is most appropriate based on the patient's
presentation?
Answer Options
A. Administer the digoxin as prescribed and document the
findings
B. Hold the digoxin dose and assess apical pulse for 1 full
minute
C. Administer the digoxin and notify the provider of the
patient's symptoms
D. Hold the digoxin dose and obtain a serum digoxin level
Correct Answer
D. Hold the digoxin dose and obtain a serum digoxin level
,Comprehensive Rationale
This patient is exhibiting classic signs of digoxin toxicity: nausea,
visual disturbances (yellow halos), and fatigue. In older adults
with renal impairment, digoxin has a prolonged half-life
(normally 36-48 hours, extended to 4-5 days in renal failure)
because 50-70% is excreted unchanged by the kidneys. The
patient's eGFR of 35 mL/min indicates significant renal
impairment, leading to drug accumulation and increased risk of
toxicity. The therapeutic serum digoxin range is 0.8-2.0 ng/mL,
with toxicity occurring at levels >2.0 ng/mL. This patient's
symptoms warrant immediate assessment of digoxin levels.
Digoxin toxicity can progress to life-threatening cardiac
dysrhythmias including bradycardia, heart block, and ventricular
tachycardia. The nurse must hold the medication until serum
levels are obtained to prevent further drug accumulation.
Assessment of the apical pulse is important but secondary to
determining digoxin levels in a symptomatic patient.
Administration would compound the toxicity risk.
Distractor Analysis
A. Administer the digoxin as prescribed and document the
findings
• Why Incorrect: Administering the medication without
investigating symptoms of toxicity places the patient at risk
for severe cardiac complications
, • Common Clinical Misconception: The provider's
prescription must be followed without question
• Potential Medication Safety Risk: Continuing to administer
digoxin could lead to fatal cardiac dysrhythmias
• Appropriate Nursing Action: The nurse should hold the
medication and investigate the cause of symptoms
B. Hold the digoxin dose and assess apical pulse for 1 full
minute
• Why Incorrect: While assessing pulse is important and
should be done, this action alone is insufficient as the
patient is already symptomatic with multiple signs of
toxicity
• Common Clinical Misconception: Apical pulse assessment
is the only assessment needed before digoxin
administration
• Potential Medication Safety Risk: Delaying laboratory
investigation while the patient has clear signs of toxicity
• Appropriate Nursing Action: The nurse should hold the
dose, assess pulse, and obtain a serum digoxin level
C. Administer the digoxin and notify the provider of symptoms
• Why Incorrect: Administering the medication before
provider notification could worsen toxicity
Process
10th Edition
• Author(s)Linda Lane Lilley;
Shelly Rainforth Collins; Julie
S. Snyder
TEST BANK
,QUESTION 1
Item Type: MCQ
Clinical Scenario
A 72-year-old patient with heart failure and chronic kidney
disease (eGFR 35 mL/min/1.73m²) is prescribed digoxin 0.125
mg orally daily. The patient has been taking this medication for
3 weeks and reports mild nausea, visual disturbances with
yellow halos around lights, and fatigue.
Question Stem
Which nursing action is most appropriate based on the patient's
presentation?
Answer Options
A. Administer the digoxin as prescribed and document the
findings
B. Hold the digoxin dose and assess apical pulse for 1 full
minute
C. Administer the digoxin and notify the provider of the
patient's symptoms
D. Hold the digoxin dose and obtain a serum digoxin level
Correct Answer
D. Hold the digoxin dose and obtain a serum digoxin level
,Comprehensive Rationale
This patient is exhibiting classic signs of digoxin toxicity: nausea,
visual disturbances (yellow halos), and fatigue. In older adults
with renal impairment, digoxin has a prolonged half-life
(normally 36-48 hours, extended to 4-5 days in renal failure)
because 50-70% is excreted unchanged by the kidneys. The
patient's eGFR of 35 mL/min indicates significant renal
impairment, leading to drug accumulation and increased risk of
toxicity. The therapeutic serum digoxin range is 0.8-2.0 ng/mL,
with toxicity occurring at levels >2.0 ng/mL. This patient's
symptoms warrant immediate assessment of digoxin levels.
Digoxin toxicity can progress to life-threatening cardiac
dysrhythmias including bradycardia, heart block, and ventricular
tachycardia. The nurse must hold the medication until serum
levels are obtained to prevent further drug accumulation.
Assessment of the apical pulse is important but secondary to
determining digoxin levels in a symptomatic patient.
Administration would compound the toxicity risk.
Distractor Analysis
A. Administer the digoxin as prescribed and document the
findings
• Why Incorrect: Administering the medication without
investigating symptoms of toxicity places the patient at risk
for severe cardiac complications
, • Common Clinical Misconception: The provider's
prescription must be followed without question
• Potential Medication Safety Risk: Continuing to administer
digoxin could lead to fatal cardiac dysrhythmias
• Appropriate Nursing Action: The nurse should hold the
medication and investigate the cause of symptoms
B. Hold the digoxin dose and assess apical pulse for 1 full
minute
• Why Incorrect: While assessing pulse is important and
should be done, this action alone is insufficient as the
patient is already symptomatic with multiple signs of
toxicity
• Common Clinical Misconception: Apical pulse assessment
is the only assessment needed before digoxin
administration
• Potential Medication Safety Risk: Delaying laboratory
investigation while the patient has clear signs of toxicity
• Appropriate Nursing Action: The nurse should hold the
dose, assess pulse, and obtain a serum digoxin level
C. Administer the digoxin and notify the provider of symptoms
• Why Incorrect: Administering the medication before
provider notification could worsen toxicity
