A practical nurse (PN) is reviewing the electronic health record for a client with heart f… — NCLEX-PN

A practical nurse (PN) is reviewing the electronic health record for a client with heart failure who is prescribed digoxin $0.25\text{ mg}$ PO and furosemide $40\text{ mg}$ PO daily. Morning assessment data reveals an apical pulse of $54\text{ beats/min}$ and a serum potassium level of $2.8\text{ mEq/L}$ . Which action should the PN take?

Withhold both medications and immediately escalate the assessment findings to the registered nurse (RN).Answer
B
Administer the furosemide to promote diuresis, but withhold the digoxin because the apical pulse is below $60\text{ beats/min}$ .
C
Administer the digoxin after verifying the client using their name and room number, but withhold the furosemide.
D
Obtain the intravenous (IV) formulations of both medications and administer them via IV push to ensure rapid absorption.

Answer

The PN must withhold both the digoxin and the furosemide and immediately escalate the assessment findings to the registered nurse (RN).

The correct action is to withhold both medications. Digoxin requires an apical pulse of at least

60\text{ beats/min}

for safe administration; the client's pulse is

54\text{ beats/min}

. Furosemide is a loop diuretic that wastes potassium; administering it to a client with a critically low potassium level of

2.8\text{ mEq/L}

would dangerously worsen the hypokalemia. Furthermore, hypokalemia increases the risk of digoxin toxicity. The PN must withhold the doses and report these critical findings to the RN immediately.

Step-by-Step Solution

Evaluate the client's vital signs against medication administration parameters.

The apical pulse is

54\text{ beats/min}

, which is below the standard

60\text{ beats/min}

threshold for administering digoxin.

Digoxin has a negative chronotropic effect (slows heart rate). Giving it during bradycardia can lead to severe cardiac compromise.

Analyze the laboratory results in the context of the prescribed medications.

The serum potassium is

2.8\text{ mEq/L}

(normal is

3.5

5.0\text{ mEq/L}

). Furosemide is a loop diuretic that causes potassium loss.

Administering furosemide will exacerbate the severe hypokalemia, which can trigger fatal dysrhythmias.

Synthesize the interaction between the laboratory findings and digoxin.

Hypokalemia increases myocardial sensitivity to digoxin.

Even at normal dosage levels, low potassium increases the risk of digoxin toxicity.

Determine the appropriate nursing intervention within the PN scope of practice.

The PN must withhold both contraindicated medications and escalate the critical findings to the RN or provider.

Operating safely within the PN scope requires recognizing abnormal data, withholding harmful interventions, and communicating with the supervising RN.

Key Concept

Pharmacological safety involves synthesizing vital signs, laboratory data, and drug interactions to recognize critical administration contraindications.

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