This is an NCLEX hotspot practice question. This question provides a scenario about administering the drug called Digoxin (Lanoxin), and the nurse must determine what area on the chest must be assessed before administering this drug.
This question is one of the many questions we will be practicing in our new series called “Weekly NCLEX Question”.
So, every week be sure to tune into our YouTube Channel for the NCLEX Question of the Week.
NCLEX Hotspot Question on Digoxin
A 55-year-old male patient is ordered by the physician to take Digoxin (Lanoxin) 0.25 mg by mouth daily. Prior to administering this medication, you will assess what area on the diagram?
First let’s ask ourselves, “What is Digoxin?”:
It is a cardiac medication that is part of the cardiac glycoside family.
How does it work? It is an interesting drug in that it has a POSITIVE inotropic effect and NEGATIVE chronotropic effect on the heart.
Positive inotropic effect = each heart contraction is stronger
Negative chronotropic effect = each heart beat is slower
End result = the heart pumps more efficiently at a slower rate…hence decreasing the workload on the heart.
Nurse’s Role BEFORE administering Digoxin: You must listen to the apical pulse with your stethoscope for 1 full minute to make sure the pulse is at least 60 bpm or greater in adults.
Where is the apical pulse?
First, let’s back track a little bit and think about assessing heart sounds because the apical pulse is located at the same location as the MITRAL VALVE assessment point, which is the apex of the heart. The apex of the heart is where the point of maximal impulse is located…hence the best area to determine the apical pulse.
When assessing heart sounds the nurse is assessing the closure of the 4 heart valves in the heart, which are the Aortic, Pulmonic, Tricuspid, and Mitral valve. Therefore, the nurse will listen to 4 areas on the chest, and these areas can be found at certain landmark locations.
To help me remember the order of how I will assess the valves, I like to remember this mnemonic:
“All Patients Take Medicine”
All = Aorta
Patients = Pulmonic
Take = Tricuspid
Medicine = Mitral
Landmarks for assessing heart sounds:
Aortic: found right of the sternal border in the 2nd intercostal space REPRESENTS S2 “dub”
Pulmonic: found left of the sternal border in the 2nd intercostal space REPRESENTS S2 “dub”
Tricuspid: found left of the sternal border in the 4th intercostal space REPRESENTS S1 “lub”
Mitral: found midclavicular in the 5th intercostal space REPRESENTS S1 “lub” *Apical Pulse location
Answer to this question:
The nurse will assess the apical pulse, which will be found at the 5th intercostal space at the midclavicular line:
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