A client is being treated for heart failure. Labs: Sodium 146, Potassium 2.9, Hemoglobin 10.5, White Blood Cells 12.2 VS: BP 118/66, apical heart rate 68, O2 96% on 2L nasal cannula, temperature 98.4F
What will the nurse do with the digoxin order?
Recheck heart rate in one hour.
Hold the digoxin and call the MD.
Call prescriber and ask for chest x-ray.
Give the digoxin as ordered.
The Correct Answer is B
Choice A reason: This statement is false. The nurse should not delay the administration of digoxin based on the heart rate alone, unless it is below 60 beats per minute. The nurse should also consider the serum potassium level, which is low in this case and increases the risk of digoxin toxicity.
Choice B reason: This statement is true. The nurse should hold the digoxin and call the MD, as the client has a low potassium level, which can potentiate the effects of digoxin and cause arrhythmias, nausea, vomiting, or visual disturbances. The MD may order a serum digoxin level, potassium supplementation, or a dose adjustment.
Choice C reason: This statement is false. The nurse does not need to call the prescriber and ask for a chest x-ray, as this is not relevant to the digoxin order. A chest x-ray may be indicated to assess the severity of heart failure, but it does not affect the decision to administer digoxin.
Choice D reason: This statement is false. The nurse should not give the digoxin as ordered, as the client has a low potassium level, which can increase the risk of digoxin toxicity. The nurse should hold the digoxin and call the MD for further instructions..
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C"]
Explanation
Choice A reason: This statement is true. Atenolol is a beta blocker, which is a type of medication that blocks the effects of adrenaline on the beta receptors in the heart and blood vessels. This lowers the blood pressure and heart rate, and prevents angina and heart attacks.
Choice B reason: This statement is true. Labetalol is a beta blocker, which is a type of medication that blocks the effects of adrenaline on both the alpha and beta receptors in the heart and blood vessels. This lowers the blood pressure and heart rate, and prevents hypertension and preeclampsia.
Choice C reason: This statement is true. Metoprolol is a beta blocker, which is a type of medication that blocks the effects of adrenaline on the beta receptors in the heart and blood vessels. This lowers the blood pressure and heart rate, and prevents angina, heart failure, and arrhythmias.
Choice D reason: This statement is false. Captopril is not a beta blocker, but an angiotensin-converting enzyme (ACE) inhibitor, which is a type of medication that blocks the conversion of angiotensin I to angiotensin II, a hormone that constricts the blood vessels and raises the blood pressure. This lowers the blood pressure and prevents hypertension, heart failure, and kidney damage.
Choice E reason: This statement is false. Ramipril is not a beta blocker, but an angiotensin-converting enzyme (ACE) inhibitor, which is a type of medication that blocks the conversion of angiotensin I to angiotensin II, a hormone that constricts the blood vessels and raises the blood pressure. This lowers the blood pressure and prevents hypertension, heart failure, and stroke.
Correct Answer is A
Explanation
Choice A reason: This statement is true. The nurse should include this information with calcium channel blockers, which are a type of medication that relax the blood vessels and lower the blood pressure. Grapefruit juice can interfere with the metabolism of calcium channel blockers and increase their levels in the blood. This can cause serious side effects, such as low blood pressure, slow heart rate, or liver damage.
Choice B reason: This statement is false. The nurse should not include this information with calcium channel blockers, as checking the apical heart rate is not necessary before taking this medication. Calcium channel blockers can lower the heart rate, but not to a dangerous level. However, the nurse should monitor the client's vital signs regularly and report any abnormal findings.
Choice C reason: This statement is false. The nurse should not include this information with calcium channel blockers, as these medications are not used to reduce cholesterol. Calcium channel blockers have no effect on the cholesterol levels in the blood. However, the nurse should advise the client to follow a healthy diet and lifestyle to prevent cardiovascular diseases.
Choice D reason: This statement is false. The nurse should not include this information with calcium channel blockers, as these medications do not cause increased blood pressure. Calcium channel blockers lower the blood pressure by relaxing the blood vessels. However, the nurse should inform the client that some calcium channel blockers can cause headaches, flushing, or swelling of the ankles, which are mild and temporary side effects.
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