During a morning medication pass on a medical-surgical unit, a client with heart failure i… — NCLEX-PN

During a morning medication pass on a medical-surgical unit, a client with heart failure is scheduled to receive oral digoxin $0.25\text{ mg}$ and oral furosemide $40\text{ mg}$ . The client reports experiencing new-onset nausea and states, 'I have not had any appetite since yesterday.' The morning laboratory report indicates a serum potassium level of $2.9\text{ mEq/L}$ , and the current apical pulse is 62 beats per minute. Which action should the practical nurse take?

Withhold both the digoxin and furosemide, and immediately notify the registered nurse of the client's symptoms and laboratory value.Answer
B
Administer the digoxin since the apical pulse is above 60 beats per minute, but withhold the furosemide to prevent further potassium loss.
C
Administer a prescribed as-needed antiemetic to relieve the nausea before proceeding with the administration of both cardiac medications.
D
Accept direction from the charge nurse to administer a stat intravenous push dose of potassium chloride to correct the electrolyte deficit.

Answer

The correct action is to withhold both medications and immediately report the findings to the registered nurse.

The client is exhibiting early signs of digoxin toxicity (nausea, anorexia) combined with a critically low potassium level of

2.9\text{ mEq/L}

. Hypokalemia sensitizes the myocardium to digoxin, significantly increasing the risk of life-threatening dysrhythmias. Furthermore, furosemide is a potassium-wasting diuretic that would worsen the hypokalemia. The appropriate action within the practical nurse's scope is to withhold both medications and immediately notify the registered nurse so the healthcare provider can be alerted.

Step-by-Step Solution

Evaluate the morning laboratory results and vital signs.

The potassium level is critically low at

2.9\text{ mEq/L}

(normal is

3.5

5.0\text{ mEq/L}

), and the apical pulse is 62 beats per minute.

Identifying abnormal baseline data is the first step in pre-administration safety checks.

Analyze the client's reported symptoms.

The client is experiencing new-onset nausea and a complete loss of appetite.

Gastrointestinal symptoms are often the earliest clinical indicators of digoxin toxicity.

Correlate the prescribed medications with the clinical findings.

Furosemide depletes potassium, and hypokalemia directly increases the risk of digoxin toxicity. Administering either drug would cause further harm.

Understanding pharmacokinetic interactions is essential for safe medication administration.

Determine the appropriate nursing intervention within the practical nurse scope of practice.

The medications must be withheld and the registered nurse immediately notified.

The practical nurse must hold medications that pose an immediate risk and report critical findings to the supervising nurse for medical escalation.

Key Concept

Recognizing Digoxin Toxicity and Hypokalemia within the Practical Nurse Scope of Practice

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