A patient is taking digoxin (Lanoxin) and quinidine to treat sustained ventricular tachycardia
Before giving medications, the nurse reviews the patient's electrocardiogram (ECG) and notes a QRS complex that has widened by 50% from the baseline ECG. What will the nurse do?
a. Administer the medications as ordered, because this indicates improvement.
b. Contact the provider to discuss reducing the digoxin dose.
c. Contact the provider to request an increase in the quinidine dose.
d. Withhold the quinidine and contact the provider to report the ECG finding.
ANS: D
Quinidine widens the QRS complex by slowing depolarization of the ventricles. As cardiotoxicity develops as a result of quinidine toxicity, the QRS complex widens excessively. Any widening of the QRS complex of 50% or more warrants notifying the provider, so the nurse should withhold the medication and contact the provider. Widening of the QRS complex by more than 50% of baseline indicates cardiotoxicity. Quinidine can double digoxin levels, so it is not likely that the digoxin dose would need to be increased, and an increase in the QRS complex does not indicate a need for more digoxin. The quinidine dose should not be increased, because the findings indicate cardiotoxicity from the quinidine.
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