In which situation would the nurse hold digoxin?
A.
When the lab reports a digoxin level 1.2 ng/mL
B.
When the client complains of seeing yellow-green halos
C.
When the client is edematous
D.
When the client is pacing and very thirsty
The Correct Answer and Explanation is:
The correct answer is B. When the client complains of seeing yellow-green halos.
Explanation:
Digoxin is a cardiac glycoside commonly used to treat conditions like heart failure and atrial fibrillation. It increases the force of heart contractions and helps to control heart rate. However, digoxin has a narrow therapeutic window, meaning the difference between a therapeutic dose and a toxic dose is small. Therefore, nurses must be vigilant for signs of toxicity.
One of the hallmark signs of digoxin toxicity is the presence of visual disturbances, such as seeing yellow-green halos around objects. This occurs due to the drug’s effects on the central nervous system and its impact on visual perception. If a patient reports seeing halos, it indicates potential digoxin toxicity, and the nurse should hold the medication and notify the healthcare provider for further assessment.
Let’s examine the other options:
A. When the lab reports a digoxin level 1.2 ng/mL: This level is typically considered within the therapeutic range (0.5 to 2.0 ng/mL) for most patients, particularly those on digoxin therapy for heart failure or atrial fibrillation. Therefore, this would not be a reason to hold the medication.
C. When the client is edematous: While edema can be a sign of heart failure, it does not indicate that digoxin should be held. In fact, digoxin may help improve the client’s condition by enhancing cardiac output.
D. When the client is pacing and very thirsty: These symptoms could suggest a variety of issues, such as dehydration or anxiety, but they do not specifically indicate digoxin toxicity. Therefore, holding digoxin in this scenario would not be appropriate without further assessment.
In summary, a report of visual disturbances, particularly seeing yellow-green halos, is a critical sign of digoxin toxicity and necessitates immediate action from the nurse, including holding the medication and contacting the healthcare provider.