A patient is being treated for heart failure. Labs: Sodium 146 meq/L, Potassium 4.2 mmol/L, Hemoglobin 10.5 gm/dL, White Blood Cells 12.2, digoxin level 0.8 ng/mL

VS: BP 118/66, apical heart rate 68, O2 96% on 2L nasal cannula, temperature 98.4°F

What will the nurse do with the digoxin order?

Choice A reason: This choice is incorrect because there is no need to recheck the heart rate in one hour before giving the digoxin. The client's apical heart rate is within the normal range (60 to 100 beats per minute) and does not indicate bradycardia (slow heart rate), which is a sign of digoxin toxicity. The nurse should check the apical heart rate for one full minute before giving the digoxin and withhold the dose if the heart rate is below 60 beats per minute.

Choice B reason: This choice is correct because the client's digoxin level is within the therapeutic range (0.5 to 2.0 ng/mL) and does not indicate digoxin toxicity or underdosing. The client's vital signs and labs are also stable and do not indicate any adverse effects of digoxin. Digoxin is a cardiac glycoside that improves the contractility and efficiency of the heart and helps to control the heart rate and rhythm in clients with heart failure. The nurse should give the digoxin as ordered and monitor the client's response and digoxin level.

Choice C reason: This choice is incorrect because there is no indication for a chest x-ray for this client. A chest x-ray is a diagnostic test that can show the size and shape of the heart and lungs and detect any abnormalities, such as fluid accumulation, infection, or tumors. The client's symptoms and labs do not suggest any pulmonary complications or worsening of heart failure that would require a chest x-ray. The nurse should follow the provider's orders and protocols for chest x-ray indications.

Choice D reason: This choice is incorrect because there is no reason to hold the digoxin and call the MD for this client. The client's digoxin level is not too high or too low and does not require dose adjustment or discontinuation. The client's vital signs and labs are also normal and do not indicate any signs of digoxin toxicity or adverse effects. Holding the digoxin could cause the client's heart failure to worsen or cause arrhythmias. The nurse should only hold the digoxin and call the MD if the client has signs of digoxin toxicity, such as nausea, vomiting, visual disturbances, confusion, or bradycardia. .

Choice A reason: This choice is correct because captopril is an angiotensin-converting enzyme (ACE) inhibitor that can cause fetal harm or death if used during pregnancy. Captopril can affect the development of the baby's kidneys, lungs, skull, and blood vessels. The nurse should advise the patient to use effective contraception while taking captopril and to inform the provider as soon as possible if she becomes pregnant or plans to become pregnant. The provider may switch the patient to a safer medication for blood pressure control during pregnancy.

Choice B reason: This choice is incorrect because facial swelling is a serious side effect of captopril that may indicate angioedema, a life-threatening allergic reaction that causes swelling of the face, lips, tongue, throat, or airway. The nurse should instruct the patient to stop taking captopril and seek emergency medical attention if she develops facial swelling or any signs of difficulty breathing, such as wheezing, stridor, or cyanosis. Reducing the dose of captopril will not prevent or treat angioedema.

Choice C reason: This choice is incorrect because captopril can be taken with or without food, depending on the patient's preference and tolerance. Food may decrease the absorption of captopril, but this effect is not clinically significant for most patients. The nurse should advise the patient to take captopril at the same time each day, preferably one hour before meals, to maintain consistent blood levels and effects.

Choice D reason: This choice is incorrect because captopril is unlikely to cause anaphylaxis, a severe and potentially fatal allergic reaction that involves multiple organ systems. Anaphylaxis can cause symptoms such as hives, itching, flushing, swelling, nausea, vomiting, diarrhea, abdominal pain, low blood pressure, fast heart rate, and shock. The nurse should instruct the patient to carry an epi pen only if she has a history of anaphylaxis or a severe allergy to another substance. .