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Difficulty: EasyReduction of Risk Potential

A client diagnosed with heart failure is scheduled to receive an oral dose of digoxin. During the pre-administration data collection, which of the following findings should prompt the practical nurse to withhold the medication and notify the registered nurse? Select all that apply.

  1. An apical heart rate of 54 beats per minuteAnswer
  2. A serum potassium level of 3.0 mEq/LAnswer
  3. The client reports a new onset of nausea and blurred visionAnswer
  4. D
    Trace bilateral pedal edema
  5. E
    A serum sodium level of 141 mEq/L
  6. F
    A respiratory rate of 18 breaths per minute

Answer

The practical nurse should withhold the digoxin for an apical pulse less than 60 beats per minute (54 beats per minute), a low potassium level (3.0 mEq/L), and signs of toxicity (nausea and blurred vision).
Digoxin is a cardiac glycoside that slows the heart rate and strengthens cardiac contractility. Because of its narrow therapeutic index, the nurse must ensure the apical pulse is 60 beats per minute or greater, the potassium level is within the normal range (3.5 to 5.0 mEq/L), and the client is free from toxicity symptoms (like gastrointestinal upset or visual changes) before safely administering the dose.

Step-by-Step Solution

1
Evaluate the client's apical heart rate against safe administration parameters.
The apical rate is 54 beats per minute, which is below the safe threshold of 60 beats per minute for an adult.
Digoxin slows down the heart rate; administering it to a bradycardic client can cause severe and life-threatening dysrhythmias.
2
Analyze the client's laboratory values, specifically focusing on the potassium level.
The potassium level is 3.0 mEq/L, indicating hypokalemia.
Low potassium levels increase the binding of digoxin to cardiac muscle cells, significantly heightening the risk for toxicity even when normal doses are given.
3
Assess the client for subjective symptoms indicating medication toxicity.
The client reports experiencing nausea and blurred vision.
These are classic early subjective indicators of digoxin toxicity and require immediate clinical intervention.

Key Concept

Reduction of Risk Potential: Preventing Digoxin Toxicity
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Topics

Reduction of Risk Potential

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