During morning medication rounds, a practical nurse (PN) assesses a client with heart fail… — NCLEX-PN

During morning medication rounds, a practical nurse (PN) assesses a client with heart failure prior to administering a scheduled dose of oral digoxin. The client's current apical pulse is $56 \text{ beats/min}$ , and the most recent laboratory report reveals a serum potassium level of $3.1 \text{ mEq/L}$ . Based on these findings, which action should the PN take?

A
Administer half of the prescribed medication dose to prevent further lowering of the client's heart rate.
B
Administer the medication as prescribed and ensure the client receives a potassium-rich snack with breakfast.
C
Reassess the client's apical pulse in one hour and administer the scheduled dose if the heart rate is greater than $60 \text{ beats/min}$ .
Withhold the digoxin dose and promptly report the clinical findings to the supervising registered nurse.Answer

Answer

The practical nurse should withhold the digoxin dose and promptly report the clinical findings to the supervising registered nurse.

The correct action is to withhold the medication and report to the registered nurse. Digoxin is a cardiac glycoside that slows the heart rate, and it must be withheld if an adult client's apical pulse is less than

60 \text{ beats/min}

. Additionally, a serum potassium level of

3.1 \text{ mEq/L}

indicates hypokalemia (normal range is

3.5

5.0 \text{ mEq/L}

). Hypokalemia significantly increases the client's risk for developing dangerous digoxin toxicity, making it a critical finding that warrants withholding the drug and immediately notifying the supervising nurse.

Step-by-Step Solution

Evaluate the client's apical pulse against standard administration parameters for digoxin.

The apical pulse is

56 \text{ beats/min}

, which is below the standard threshold of

60 \text{ beats/min}

for adults.

Digoxin slows the heart rate. Administering it to a bradycardic client can cause severe dysrhythmias.

Analyze the client's laboratory values in relation to the prescribed medication.

The serum potassium is

3.1 \text{ mEq/L}

, indicating hypokalemia (normal is

3.5

5.0 \text{ mEq/L}

Hypokalemia increases the sensitivity of the cardiac muscle to digoxin, significantly raising the risk of digoxin toxicity even at normal blood levels of the drug.

Determine the safest clinical action within the PN scope of practice.

The medication must be withheld due to both the low heart rate and the critical lab value, and the findings must be reported.

The PN must ensure client safety by withholding contraindicated medications and communicating abnormal assessment data to the RN or provider for further orders.

Key Concept

Digoxin Toxicity Risk Factors and Safe Administration

Question

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