he nurse is preparing to administer digoxin (Lanoxin) to a client experiencing atrial fibrillation. Which of the following electrolyte imbalances would the nurse assess to reduce the incidence of toxicity with digoxin (Lanoxin)?
hypokalemia
hyperkalemia
hypocalcemia
hypernatremia
The Correct Answer is A
A) Hypokalemia: Hypokalemia, or low potassium levels, significantly increases the risk of digoxin toxicity. Since digoxin competes with potassium for binding at the sodium-potassium ATPase site in the heart, low potassium levels can lead to increased digoxin effects and toxicity. Therefore, it is crucial to monitor potassium levels and correct any deficiencies before administering digoxin.
B) Hyperkalemia: While hyperkalemia is a serious concern and can also affect digoxin therapy, it usually results in decreased effectiveness of digoxin rather than increasing toxicity. Elevated potassium levels can diminish the drug's positive inotropic effect.
C) Hypocalcemia: Although calcium levels can influence cardiac function, hypocalcemia is not directly related to digoxin toxicity. Monitoring calcium is important for overall cardiac health, but it is not the primary focus when assessing the risk for digoxin toxicity.
D) Hypernatremia: Elevated sodium levels do not have a direct impact on the efficacy or toxicity of digoxin. While sodium levels are essential to monitor for overall health, they are not critical in the context of digoxin administration and toxicity risk.
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Correct Answer is C
Explanation
A) Migraine headache: While migraines can be uncomfortable and distressing, they are not a known serious side effect of atorvastatin. Clients may experience headaches, but this symptom does not typically require immediate reporting unless accompanied by other concerning signs.
B) Bradycardia: Bradycardia, or a slow heart rate, is not a common side effect of atorvastatin. While monitoring heart rate is important, bradycardia alone does not necessitate immediate reporting unless it leads to significant symptoms or complications.
C) Dark-red urine: Dark-red urine is a concerning finding that could indicate serious conditions, such as hematuria or rhabdomyolysis, particularly when associated with statin use. This symptom requires immediate reporting to the healthcare provider, as it may signify potential muscle breakdown or kidney issues, which are serious complications of atorvastatin therapy.
D) Elevated HDL cholesterol: Increased levels of HDL (high-density lipoprotein) cholesterol are generally considered beneficial and a positive outcome of treatment. Therefore, this finding would not necessitate immediate reporting to the healthcare provider.
Correct Answer is D
Explanation
A. "Depending on the level of your PT/INR, the clot will begin to dissolve.": This response is misleading, as heparin's effect is not primarily monitored by PT/INR; rather, heparin is monitored by activated partial thromboplastin time (aPTT). Moreover, heparin does not directly dissolve clots; it prevents further clot formation.
B. "After the first dose, the clot will begin to dissolve.": This statement inaccurately suggests that heparin has an immediate effect on dissolving existing clots. While heparin acts quickly to inhibit further clotting, it does not lead to the dissolution of clots after the first dose.
C. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level.": This is not accurate for heparin, which has an immediate effect on coagulation. While the therapeutic effects can be optimized over several days, heparin begins to work right away to prevent further clotting.
D. "Heparin does not dissolve clots. It stops new clots from forming.": This response accurately describes the mechanism of action of heparin. Heparin prevents the extension of existing clots and the formation of new clots, but it does not actively dissolve clots. This clarification is essential for the client’s understanding of their treatment and expectations regarding DVT management.