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A patient is prescribed digoxin 0.25 mg orally. Available tablets are 0.125 mg each. How many tablets should the nurse administer?
Using the Desired-Available formula for drug dosage calculation:
\[ \text{Tablets} = \frac{\text{Desired dose}}{\text{Available dose per tablet}} = \frac{0.25 \text{ mg}}{0.125 \text{ mg per tablet}} = 2 \text{ tablets} \]
Critical nursing points for Digoxin:
- Assess apical pulse for 1 full minute before administering
- Withhold and notify physician if pulse < 60 bpm (adults) or < 100 bpm (infants)
- Therapeutic range: \( 0.5\text{–}2.0 \text{ ng/mL} \)
- Toxicity signs: bradycardia, nausea/vomiting, visual disturbances (yellow-green halos), arrhythmias
- Hypokalemia increases digoxin toxicity risk
Which item results in a credit entry in the statement of profit or loss?
Option A is correct.
When the allowance is reduced, the previously charged expense is released: Debit allowance account; Credit statement of profit or loss โ effectively increasing profit.
Options B, C, D all result in debit entries (expenses) that reduce profit.
The Somogyi Effect (post-hypoglycemic hyperglycemia):
- Nocturnal hypoglycemia occurs (often unnoticed during sleep)
- Counter-regulatory hormones (glucagon, cortisol, epinephrine, GH) are released
- Causes rebound morning hyperglycemia
Differentiation from Dawn Phenomenon:
| Feature | Somogyi Effect | Dawn Phenomenon |
|---|---|---|
| Cause | Rebound from nocturnal hypoglycemia | Growth hormone/cortisol surge at 3โ8 AM |
| 3 AM glucose | Low (<60 mg/dL) | Normal or slightly elevated |
| Morning glucose | High | High |
| Management | Reduce evening insulin dose | Increase evening insulin or change timing |
Checking 3 AM blood glucose helps distinguish these two conditions โ important for Charge Nurse assessment.
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