A senior nurse is providing instructions to a newly hired nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The senior nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia?

A) Assess for dislodgement and use forceps to retrieve the dislodged pellets and place in the lead container:
The priority action when a patient is receiving brachytherapy for uterine cancer is to assess for potential dislodgement of the radioactive implant. If the radiation source has been displaced, it must be handled carefully to prevent radiation exposure to the nurse, other patients, and staff. The nurse should use forceps to carefully retrieve the dislodged pellets and place them in a lead container to prevent contamination.

B) Assess the patient's knowledge of the treatment plan and her willingness to participate:
While it is important to assess the patient's understanding of the treatment plan and her willingness to participate, this is not the immediate priority in this situation. The nurse’s first priority is to address the potential risk of radiation exposure due to the dislodgement of the implant.

C) Assess the UAP's knowledge and explain the rationale for strict bed rest:
Although it is important for the nurse to ensure that all team members, including UAPs, understand the rationale for strict bed rest during brachytherapy, this action is not the most immediate priority in this scenario. The potential dislodgement of the radiation implant requires urgent assessment and intervention.

D) Notify the physician about the potential dislodgment of the radiation implant:
Notifying the physician about the dislodgement is an important step, but it is not the first action the nurse should take. The immediate priority is to assess and secure the radiation implant using appropriate protocols. Once the dislodged pellets have been safely contained in the lead container, the nurse should then notify the physician for further guidance on the next steps in treatment or care.

A) Hydration with IV fluids:
IV hydration may be ordered to improve kidney function and help facilitate the excretion of excess digoxin from the body. Digoxin toxicity is often related to impaired renal clearance, so improving hydration can promote renal perfusion and enhance the elimination of the drug. This is a common supportive measure to help in managing digoxin toxicity.

B) Nothing as the digoxin level is within normal ranges:
This is incorrect because the patient's digoxin level is 4 ng/ml, which is significantly above the normal therapeutic range of 0.8–2.0 ng/ml. A level of 4 ng/ml is toxic, and immediate action is required. Symptoms like severe bradycardia, nausea, and vomiting are indicative of digoxin toxicity, and they necessitate prompt intervention.

C) Hold the Digoxin:
In the case of digoxin toxicity, it is crucial to hold the digoxin. Digoxin should be discontinued immediately if toxicity is suspected, as continuing the medication could worsen symptoms like bradycardia and increase the risk of potentially life-threatening arrhythmias. This step is essential to prevent further complications.

D) Digibind:
Digibind (Digoxin immune fab) is a digoxin-specific antibody used in cases of severe digoxin toxicity or overdose. It binds to the digoxin molecules and helps to neutralize its effects. Given the elevated level of digoxin (4 ng/ml) and the presence of symptoms like severe bradycardia, nausea, and vomiting, Digibind is likely to be ordered to reverse the effects of the toxicity.

E) Narcan:
Narcan (naloxone) is used to reverse opioid overdoses, not digoxin toxicity. There is no indication for the use of Narcan in this scenario, as digoxin toxicity does not involve opioid overdose. This intervention would be inappropriate and irrelevant to the management of digoxin toxicity.