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Difficulty: MediumPharmacological Therapies

A practical nurse (PN) is preparing to administer scheduled oral digoxin to an adult client diagnosed with heart failure. Which of the following actions should the PN take to ensure safe medication administration? (Select all that apply.)

  1. Auscultate the client's apical pulse for a full 6060 seconds before giving the medication.Answer
  2. Verify the client's identity by checking two distinct identifiers against the medication administration record.Answer
  3. Withhold the dose and notify the registered nurse if the client's morning serum potassium level is 2.92.9 mEq/L.Answer
  4. D
    Administer a newly prescribed dose of the medication via intravenous (IV) push for acute symptom relief.
  5. E
    Bypass the electronic barcode medication scanning system if the nurse has been caring for the client for several consecutive days.

Answer

The appropriate actions are: auscultating the apical pulse for a full 60 seconds, verifying the client's identity using two distinct identifiers, and withholding the dose while reporting a critically low potassium level.
Safe administration of digoxin requires comprehensive monitoring and strict adherence to established protocols. Auscultating the apical pulse for one full minute is necessary because digoxin slows the heart rate. Verifying two distinct patient identifiers ensures the right client receives the medication, maintaining a fundamental medication right. Additionally, hypokalemia (such as a potassium level of 2.9 mEq/L) significantly increases the risk of digoxin toxicity, meaning the practical nurse must withhold the medication and immediately escalate this critical laboratory value to the registered nurse.

Step-by-Step Solution

1
Identify the medication class and primary nursing considerations for digoxin.
Digoxin is a cardiac glycoside that requires strict heart rate monitoring and is highly sensitive to electrolyte imbalances.
Understanding the drug profile dictates the necessary pre-administration clinical assessments.
2
Evaluate the client's vital sign monitoring requirements.
An apical pulse must be auscultated for 60 seconds; the medication should typically be withheld if the heart rate is less than 60 beats per minute.
Digoxin slows the heart rate and can cause severe bradycardia, making accurate pulse measurement critical.
3
Assess laboratory values relevant to digoxin therapy.
A potassium level of 2.9 mEq/L indicates hypokalemia, which must be immediately reported because it significantly increases the risk of digoxin toxicity.
Electrolyte imbalances directly impact the safety of administering this specific medication.
4
Apply the practical nurse scope of practice and general medication safety rules to the remaining choices.
IV push administration is outside the practical nurse scope, and barcode scanning with dual identifiers is mandatory for all patients in all circumstances.
Ensuring legal and institutional safety compliance prevents life-threatening administration errors.

Key Concept

Safe digoxin administration, hypokalemia implications, and practical nurse scope of practice
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Topics

Pharmacological Therapies

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