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Difficulty: MediumPharmacological and Parenteral Therapies

An 7878-year-old client with a history of heart failure is receiving a continuous intravenous (IV) infusion of furosemide and is scheduled for an intermittent IV push dose of digoxin. During the morning assessment, the client reports nausea, anorexia, and seeing "yellow halos" around the lights in the room. The nurse assesses an irregular apical heart rate of 52 beats/min52 \text{ beats/min}. Based on these findings, which of the following is the priority nursing action?

  1. Withhold the scheduled dose of intravenous digoxin, obtain a serum potassium level, and notify the healthcare provider.Answer
  2. B
    Explain to the client that mild visual changes are a normal, age-related finding and document the assessment.
  3. C
    Delegate the unlicensed assistive personnel (UAP) to reassess the client's apical pulse in 15 minutes15 \text{ minutes} while preparing the medication.
  4. D
    Administer the digoxin via intravenous push concurrently with the furosemide infusion to ensure continuous diuresis.

Answer

Withhold the scheduled dose of intravenous digoxin, obtain a serum potassium level, and notify the healthcare provider.
The correct action prioritizes client safety by immediately recognizing life-threatening medication toxicity. Digoxin has a very narrow therapeutic index, and toxicity manifests with gastrointestinal (nausea, anorexia), neurological (visual halos), and cardiac (bradycardia, dysrhythmias) symptoms. Because furosemide causes rapid potassium depletion, this client is at extreme risk for hypokalemia-induced digoxin toxicity. Withholding the drug, assessing the potassium level, and notifying the provider are the essential priority actions.

Step-by-Step Solution

1
Analyze the client's assessment findings and vital signs.
The client presents with bradycardia (52 beats/min52 \text{ beats/min}), nausea, anorexia, and yellow visual halos.
These specific manifestations are classic systemic and neurological indicators of digoxin toxicity.
2
Identify contributing pharmacological factors from the medication record.
The client is receiving a continuous infusion of furosemide.
Furosemide is a loop diuretic that causes potassium excretion. Hypokalemia strongly precipitates and exacerbates digoxin toxicity.
3
Determine the highest priority nursing intervention.
The nurse must prioritize withholding the digoxin dose and notifying the provider to obtain a serum potassium and digoxin level.
Administering further doses would worsen the toxicity and potentially cause life-threatening cardiac dysrhythmias.

Key Concept

Digoxin Toxicity and Pharmacological Interactions
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Topics

Pharmacological and Parenteral Therapies

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