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Difficulty: MediumPharmacological Therapies

The nursing team is providing care for a client diagnosed with heart failure who is prescribed oral digoxin and a potassium-wasting diuretic. Which interventions are appropriate for the practical nurse (PN) to perform regarding this client's pharmacological management? Select all that apply.

  1. Auscultate the client's apical pulse for a full 6060 seconds prior to administering the digoxin.Answer
  2. B
    Proceed with administering the morning digoxin dose after reviewing a serum digoxin level of 3.23.2 ng/mL.
  3. Withhold the diuretic and notify the registered nurse immediately when the morning metabolic panel reveals a potassium level of 2.52.5 mEq/L.Answer
  4. D
    Administer a supplemental dose of intravenous push (IVP) furosemide as delegated by the unit charge nurse.
  5. E
    Verify the client's identity by checking the room and bed number on the door since the client is sleeping and wearing a damaged ID band.
  6. Ask the client to state their full name and date of birth while verifying the information against the medication administration record.Answer

Answer

The appropriate actions are auscultating the apical pulse for 60 seconds, withholding the diuretic for a critically low potassium level of 2.5 mEq/L, and actively verifying the client's name and date of birth.
Safe pharmacological management for a client on digoxin and diuretics requires strict adherence to safety protocols. This includes verifying patient identity using two valid identifiers (name and date of birth), assessing the apical pulse for a full minute to detect bradycardia, and recognizing that critical laboratory values, such as severe hypokalemia (which exacerbates digoxin toxicity), require immediate escalation and the withholding of the diuretic.

Step-by-Step Solution

1
Analyze the prescribed medications and identify required safety parameters.
Digoxin requires assessing the apical pulse for one minute and monitoring for toxicity. Potassium-wasting diuretics require monitoring serum potassium to prevent hypokalemia, which worsens digoxin toxicity.
Understanding the pharmacokinetics and interactions of the drugs ensures safe administration.
2
Evaluate the clinical data provided in the options against established norms.
A digoxin level of 3.2 ng/mL is toxic (normal is typically 0.5-2.0 ng/mL). A potassium level of 2.5 mEq/L is hypokalemic (normal is typically 3.5-5.0 mEq/L).
Nurses must recognize critical laboratory values to safely withhold medications and alert the care team.
3
Assess the procedural interventions against the practical nurse (PN) scope of practice and the medication rights.
Intravenous push (IVP) administration is out of scope. Room numbers are invalid identifiers. Direct questioning of name and date of birth aligns with strict medication administration rights.
Maintaining practice boundaries and adhering to universal safety protocols prevents adverse events.

Key Concept

Pharmacological Therapies, Safe Medication Administration, and PN Scope of Practice
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Topics

Pharmacological Therapies

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