The nurse is caring for an adult client who is taking digoxin. Which laboratory value should be reported to the healthcare provider immediately?

Reference Range:
Sodium [Adult 136 to 145 mEq/L (136 to 145 mmol/L)]
Digoxin level (0.8 to 2.0 ng/mL (0.6 to 13 nmol/L)]
Potassium (K+) [Adult: 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L)]
Creatinine [0.5 to 1.1 mg/dL (44 to 97 μmol/L)]

Digoxin level of 1.1 ng/mL (1.4 nmol/L).

Creatinine level of 0.8 mg/dL (70.72 μmol/L).

Potassium level of 3.2 mEq/L (3.2 mmol/L).

Sodium level of 135 mEq/L (135 mmol/L).

Answer and Explanation

The Correct Answer is C

A. Digoxin level of 1.1 ng/mL (1.4 nmol/L):
A digoxin level of 1.1 ng/mL is within the therapeutic range (0.8 to 2.0 ng/mL). While it is important to monitor digoxin levels, this value does not indicate an immediate concern.

B. Creatinine level of 0.8 mg/dL (70.72 μmol/L):
A creatinine level of 0.8 mg/dL is within the normal range (0.5 to 1.1 mg/dL) and does not indicate any renal impairment or immediate issue.

C. Potassium level of 3.2 mEq/L (3.2 mmol/L):
A potassium level of 3.2 mEq/L is below the normal range (3.5 to 5.0 mEq/L). Hypokalemia can increase the risk of digoxin toxicity and arrhythmias, making this an urgent issue that should be reported to the healthcare provider immediately.

D. Sodium level of 135 mEq/L (135 mmol/L):
A sodium level of 135 mEq/L is slightly below the normal range (136 to 145 mEq/L), but it is not as critical as a significantly abnormal potassium level in the context of digoxin use. While it should be monitored, it is less urgent compared to the potassium level.

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Correct Answer is C

Explanation

A) Diarrhea: Diarrhea is a common side effect of many medications, including those used for nausea and vomiting. While it can be uncomfortable and may require management, it is generally less severe compared to neurological symptoms. Persistent diarrhea should be monitored and managed, but it does not typically indicate a serious underlying issue with metoclopramide.

B) Unusual irritability: Irritability can occur as a side effect of many medications and might be a sign of a mild central nervous system effect or a response to the stress of illness. While it is important to assess and address any changes in mood, unusual irritability is generally less urgent compared to neurological symptoms that could suggest more serious adverse effects.

C) Involuntary movements: Involuntary movements, such as tremors or muscle spasms, are significant concerns when a patient is on metoclopramide. These symptoms can indicate extrapyramidal side effects, which include tardive dyskinesia or other severe movement disorders. These conditions can be serious and potentially irreversible if not addressed promptly, making it crucial to report such symptoms immediately to the healthcare provider for further evaluation and intervention.

D) Nausea: Nausea is the primary symptom that metoclopramide is intended to treat, so its presence is expected and does not usually signal an adverse reaction to the medication. If nausea persists despite treatment, it might suggest the need for dose adjustment or an alternative treatment, but it is not an urgent adverse effect that requires immediate reporting compared to neurological symptoms.

A. Request a prescription to change the route of administration and use the available heparin. B. Advise the pharmacy of the need to deliver a vial of heparin to the nursing unit immediately. C. Calculate and administer the equivalent dose of the available low molecular weight heparin. D. Dilute the available heparin in 250 mL of normal saline solution prior to IV administration.

Correct Answer is B

Explanation

A. Request a prescription to change the route of administration and use the available heparin:
Low molecular weight heparin (LMWH) and unfractionated heparin (UFH) are not interchangeable. LMWH is usually administered subcutaneously, whereas UFH is administered intravenously for acute situations. Changing the route of administration without a new prescription would not be appropriate.

B. Advise the pharmacy of the need to deliver a vial of heparin to the nursing unit immediately:
Since the prescription is for intravenous heparin and the available syringes are of LMWH (which is not suitable for IV use), it is essential to contact the pharmacy to provide the correct formulation. Immediate action ensures that the client receives the correct medication promptly.

C. Calculate and administer the equivalent dose of the available low molecular weight heparin:
Calculating and administering LMWH instead of UFH is inappropriate because they are different types of heparin with different indications, dosing regimens, and routes of administration. Using LMWH for an IV prescription could result in ineffective treatment or complications.

D. Dilute the available heparin in 250 mL of normal saline solution prior to IV administration:
LMWH should not be diluted or used in place of UFH for IV administration. This action is incorrect because the available medication is not suitable for the prescribed route and dose. The proper medication needs to be obtained from the pharmacy.

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