Pharmacology Digoxin #3

Question

A patient with a diagnosis of congestive heart failure is receiving digoxin 0.25 mg daily. The nurse determines that the medication is achieving the desired goal because of which findings?

Answers

  1. Increased heart rate.
    • Rationale:

      This answer is not correct because digoxin decreases the heart rate, not increases. Bradycardia is a side effect associated with digoxin therapy. The apical heart rate is assessed for a full 60 seconds to determine an accurate heart rate. If the heart rate is <60 bpm, digoxin should be held until the health care provider is contacted.

  2. Increased blood pressure.
    • Rationale:

      This answer is not correct because digoxin does not affect blood pressure. It does not increase or decrease blood pressure. In fact, digoxin is prescribed to patients with atrial fibrillation who have lower blood pressure because it does not affect the blood pressure.

  3. Increased urine output.
    • Rationale:

      This answer is correct because digoxin increases myocardial contraction force, increases cardiac output, thus increasing kidney perfusion and output. The increase in urine helps to decrease excess fluid associated which decreases the workload on the heart that occurs during heart failure. This is the overall goal of digoxin therapy.

  4. Decreased myocardial contractility.
    • Rationale:

      This answer is not correct because digoxin’s action is to increase (not decrease) myocardial contractility. In doing so, cardiac output increases and kidney perfusion and output occurs. The increase in urine helps to decrease excess fluid associated which decreases the workload on the heart that occurs during heart failure. This is the overall goal of digoxin therapy.

Overview

Digoxin is in the medication class of cardiac glycosides and often used to treat heart failure and atrial fibrillation.

Explanation

The correct answer is C because lanoxin increases myocardial contraction force, increases cardiac output, thus increased kidney perfusion and output. The increase in urine helps to decrease excess fluid. Selection A is incorrect since lanoxin decreases the heart rate to make the heart more effective. Selection B is incorrect since it is not the primary goal. Blood pressure may actually decrease. Selection D is incorrect because lanoxin increases myocardial contractibility.

Learning Outcomes

Digoxin is a cardiac glycoside medication and the desired goal of the medication is to increase myocardial contraction force for patients with heart failure, increase cardiac output, thus increasing kidney perfusion and output. The increase in urine helps to decrease excess fluid associated which decreases the workload on the heart that occurs during heart failure. The blood pressure is not affected during digoxin therapy but the heart rate can be significantly decreased. The apical heart rate is assessed for a full 60 seconds to determine an accurate heart rate. If the heart rate is <60 bpm, digoxin should be held until the health care provider is contacted. Digoxin blood levels are also drawn and monitored to help reduce the risk of digoxin toxicity. Toxicity signs and symptoms include bradycardia, visual disturbances, and anorexia and should be taught to the patient so early intervention can occur if toxicity occurs.

Test Taking Tip

Digoxin’s therapeutic blood level is 0.5-2.0 ng/mL. Toxicity symptoms, including bradycardia, visual disturbances, anorexia, can occur as the patient’s blood levels rise above 2.0-2.5 ng/mL.

Video Rationale