Family Nurse Practitioner Exam

For an elderly woman on digoxin displaying new onset atrial fibrillation, what is considered the most appropriate intervention?

1. Order an electrolyte panel and a digoxin level

2. Order a serum thyroid-stimulating hormone (TSH), digoxin level, and an electrolyte panel

3. Order a serum digoxin level and decrease her digoxin dose by half while waiting for results

4. Discontinue the digoxin and order another 12-lead EKG

The correct answer is: Order a serum thyroid-stimulating hormone (TSH), digoxin level, and an electrolyte panel

The most appropriate intervention for the elderly woman on digoxin who is displaying new onset atrial fibrillation is to order a serum thyroid-stimulating hormone (TSH), a digoxin level, and an electrolyte panel. In this scenario, it is critical to assess multiple factors that could be contributing to the new onset atrial fibrillation. The TSH test helps evaluate thyroid function, as thyroid disorders, particularly hyperthyroidism, can precipitate atrial fibrillation. The digoxin level is essential to determine whether the patient is within the therapeutic range or potentially has digoxin toxicity, which could also lead to arrhythmias. Finally, an electrolyte panel is important because abnormalities in potassium, magnesium, or calcium levels can significantly affect heart rhythm and lead to atrial fibrillation. By ordering all three tests, a comprehensive evaluation can be performed to address potential causes of the atrial fibrillation and guide the appropriate management of the patient's conditions. This approach considers the complexity of an elderly woman on digoxin, where multiple comorbidities are likely at play. It ensures that any necessary interventions, such as adjustments in medication or further treatment for underlying issues, can be based on accurate and relevant information.