Review the dofetilide initiation record and determine the correct dose decision.
Trend
Choose your responses, then check the answer.
Explanation
The female Cockcroft-Gault clearance is approximately 45 mL/min, which supports 250 mcg BID. A post-dose QTc above 500 msec requires discontinuation rather than another dose.
Quick answer The starting dose matches the renal band, but the later QTc requires discontinuing dofetilide and notifying the authorized clinician.
Why this is correct For a woman, Cockcroft-Gault includes the 0.85 factor: (140-68) times 70 divided by (72 times 1.3), then times 0.85, or about 46 mL/min. The 40-to-60 band uses 250 mcg BID. After a subsequent dose, QTc greater than 500 msec requires discontinuation.
Easy analogy or mental picture The renal calculation chooses the starting lane; the QT monitor can still close the road.
Memory hook CrCl sets the first dose; QTc decides whether the trip continues.
NCLEX decision rule Use the labeled sequence: baseline QT, calculated clearance, renal dose, continuous ECG, and post-dose QT checks.
Why the other choices are wrong A correct starting dose does not authorize continued therapy after a stop-threshold QTc.