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Difficulty: MediumPharmacological Therapies

A practical nurse is preparing to administer scheduled morning medications to a client diagnosed with heart failure. The medication administration record includes a prescription for oral digoxin. Upon reviewing the client's electronic health record, the nurse notes a morning serum potassium level of 2.9 mEq/L. Based on these findings, which of the following actions should the practical nurse take first?

  1. A
    Administer the scheduled digoxin and document the abnormal potassium level in the client's medical record.
  2. B
    Recalculate the digoxin dosage based on the client's current weight to compensate for the electrolyte imbalance.
  3. Withhold the dose of digoxin and promptly notify the registered nurse about the laboratory result.Answer
  4. D
    Independently initiate an intravenous potassium replacement infusion before giving the oral digoxin.

Answer

The practical nurse should withhold the dose of digoxin and promptly notify the registered nurse about the critical laboratory result.
The normal serum potassium range is 3.5 to 5.0 mEq/L. A level of 2.9 mEq/L indicates severe hypokalemia. Because hypokalemia strongly predisposes a client to digoxin toxicity, the safest and most appropriate action for the practical nurse is to withhold the dose and escalate the critical finding to the registered nurse or healthcare provider for further evaluation.

Step-by-Step Solution

1
Evaluate the client's laboratory results against normal reference ranges.
The serum potassium level is 2.9 mEq/L, which is significantly below the normal range of 3.5 to 5.0 mEq/L (hypokalemia).
Identifying abnormal laboratory values is an essential pre-administration safety check.
2
Correlate the abnormal laboratory finding with the prescribed medication.
Hypokalemia is identified as a major risk factor that precipitates digoxin toxicity, even if the digoxin level itself is within a normal range.
Understanding drug-lab interactions is necessary to prevent severe adverse pharmacological events, such as life-threatening cardiac arrhythmias.
3
Determine the appropriate nursing intervention within the practical nurse scope of practice.
The safest and legally correct action is to withhold the contraindicated medication and immediately report the finding to the supervising RN or healthcare provider.
A practical nurse must advocate for client safety by not administering harmful medications and by escalating critical findings to higher-level providers for medical intervention.

Key Concept

Pharmacological Therapies: Digoxin Administration and Electrolyte Monitoring
Estimated Time:1m 0s
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Topics

Pharmacological Therapies

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