EKG

2. Morphine Morphine is an opioid. Opioids decrease intestinal peristalsis, which may precipitate constipation; straining at stool should be avoided to prevent the Valsalva maneuver, which increases demands on the heart. Digoxin is unrelated to intestinal peristalsis and the potential for constipation. Docusate sodium is a stool softener which would relieve, not cause, constipation. A side effect of fluoxetine is diarrhea, not constipation.

A client admitted with a myocardial infarction is prescribed docusate and morphine and takes digoxin and fluoxetine at home. Which drug should the nurse recognize as a risk factor for straining due to constipation? 1 Digoxin 2 Morphine 3 Docusate 4 Fluoxetine

4. Digoxin toxicity occurs rapidly in the presence of hypokalemia. Furosemide promotes potassium excretion, and low potassium (hypokalemia) increases cardiac excitability. Digoxin is more likely to cause dysrhythmias when potassium is low. Digoxin does not affect potassium excretion. Furosemide causes potassium excretion. Potassium is excreted by the kidneys, not destroyed by the liver. Furosemide causes diuresis and consequent potassium loss regardless of the serum potassium level.

A client has been given a prescription for furosemide 40 mg every day in conjunction with digoxin. What would prompt the nurse to ask the provider about potassium supplements? 1 Digoxin causes significant potassium depletion. 2 The liver destroys potassium as digoxin is detoxified. 3 Lasix requires adequate serum potassium to promote diuresis. 4 Digoxin toxicity occurs rapidly in the presence of hypokalemia.

4. "The medication may need to be discontinued. Come to the clinic this afternoon." Yellow vision indicates digoxin toxicity; the medication should be withheld until the healthcare provider can assess the client and check the digoxin blood level. Yellow vision is related to digoxin therapy, not the client's underlying medical condition. Yellow vision is a sign of digoxin toxicity; taking more digoxin will escalate the digoxin toxicity.

A client has been receiving digoxin. The client calls the clinic and complains of "yellow vision." What is the nurse's best response? 1 "This is related to your illness rather than to your medication." 2 "Take the medication because this is not a serious side effect." 3 "This side effect is only temporary. You should continue the medication." 4 "The medication may need to be discontinued. Come to the clinic this afternoon."

3. Amiodarone Amiodarone suppresses ventricular activity; therefore, it is used for treatment of premature ventricular complexes (PVCs). It works directly on the heart tissue and slows the nerve impulses in the heart. Atropine blocks vagal stimulation; it increases the heart rate and is used for bradycardia, not PVCs. Epinephrine increases myocardial contractility and heart rate; therefore, it is contraindicated in the treatment of PVCs. Sodium bicarbonate increases the serum pH level; therefore, it combats metabolic acidosis.

A client is admitted to the cardiac care unit with a myocardial infarction. The cardiac monitor reveals several runs of ventricular tachycardia. The nurse anticipates that the client will be receiving a prescription for which drug? 1 Atropine 2 Epinephrine 3 Amiodarone 4 Sodium bicarbonate

1. Maintaining potassium levels Orange juice is an excellent source of potassium. Furosemide promotes excretion of potassium, which can result in hypokalemia. Digoxin toxicity can occur in the presence of hypokalemia. Neither drug increases sodium levels. Digoxin does not potentiate the action of furosemide; therefore, the client should not experience dehydration. Orange juice will not prevent an interaction between digoxin and furosemide.

A client is taking furosemide and digoxin for heart failure. Why does the nurse advise the client to drink a glass of orange juice every day? 1 Maintaining potassium levels 2 Preventing increased sodium levels 3 Limiting the drugs' synergistic effects 4 Correcting the associated dehydration

3. Myocardial depression Both digoxin and verapamil decrease cardiac impulse conduction, with resultant depression of the myocardium; verapamil decreases conduction at the sinoatrial (SA) and atrioventricular (AV) nodes, which may cause bradycardia, AV block, and cardiac arrest. Digoxin and verapamil together do not cause agitation. Side effects of verapamil include fatigue and depression, not agitation. Digoxin and verapamil do not influence the reflexes of the body. Digoxin and verapamil do not influence respirations.

A client with a cardiac dysrhythmia is receiving digoxin and verapamil. Because of the combined effect of these two medications, what adverse effect does the nurse anticipate? 1 Physical agitation 2 Reflex stimulation 3 Myocardial depression 4 Respiratory stimulation

4. "Coffee has caffeine that can affect your heart. It should be avoided." Caffeine is a stimulant that causes vasoconstriction and is contraindicated for a client with a dysrhythmia. Although "Hot drinks such as coffee are not good for your heart" is a true statement, it does not provide information as to why it is not good for the heart. Adherence to a medical regimen increases when the client understands the rationale for recommendations. Tea contains caffeine and should be avoided by a client with a dysrhythmia.

A client with a dysrhythmia is admitted to telemetry for observation. In the morning the client asks for a cup of coffee. What is the nurse's best response? 1 "Hot drinks such as coffee are not good for your heart." 2 "Coffee is not permitted on the diet that was prescribed for you." 3 "You cannot have coffee. I can bring you a cup of tea if you like." 4 "Coffee has caffeine that can affect your heart. It should be avoided."

1, 2, 3 In pulmonary infections, the respiratory rate may increase and oxygen saturation may decrease. In fluid volume deficit, the blood pressure may be decreased. A respiratory rate of 14 breaths/minute, a blood pressure of 120/80 mmHg, and an oxygen saturation of 95% are normal readings. Therefore, the registered nurse should reassess these vital signs. The normal temperature range is 36 to 38 0C; this range is unaffected by a pulmonary infection. Therefore, the nurse does not need to reassess the temperature. Cardiac dysrhythmias are associated with a pulse deficit in which the radial pulse would be irregular. Therefore reassessment would not be required.

A client with a history of cardiac dysrhythmias is admitted to the hospital due to a fluid volume deficit caused by a pulmonary infection. The registered nurse is assessing the vital signs recorded by the student nurse. Which vital sign assessments require reassessment based on the data given by the student nurse? Select all that apply. 1 Respiratory rate of 14 breaths/minute 2 Blood pressure of 120/80 mmHg 3 Oxygen saturation of 95% 4 Temporal temperature of 37.4 °C 5 Radial pulse rate of 72 and irregular

2. Small, frequent intake of juices, broth, or milk Small, frequent intake of juices, broth, or milk will provide gradual replacement of both fluid and electrolytes without overloading the intravascular compartment. Water does not supply the necessary electrolytes, and hyponatremia may result. No data are presented to indicate that the client cannot take fluids orally; an NG tube is not necessary when the client can take fluids by mouth. A rapid IV infusion of an electrolyte and glucose solution is unsafe; rapid correction of a fluid and electrolyte imbalance is dangerous. Therapy should promote a gradual correction.

A client with a history of cardiac dysrhythmias is admitted to the hospital with dehydration. What does the nurse add to the client's plan of care? 1 A glass of water every hour until hydrated 2 Small, frequent intake of juices, broth, or milk 3 Short-term nasogastric (NG) replacement of fluids and nutrients 4 A rapid intravenous (IV) infusion of an electrolyte and glucose solution

1. Keep a record of the day's activities. The purpose of monitoring is to correlate dysrhythmias with the client's reported activity. Laser-activated doors have no effect on a Holter monitor and will not affect the readings. Recording the pulse and blood pressure every 4 hours is not required for interpretation of the test. The client should take medication as prescribed and note it in the activities diary.

A client with a suspected dysrhythmia is to wear a Holter monitor for 24 hours at home. What should the nurse instruct the client to do? 1 Keep a record of the day's activities. 2 Avoid going through laser-activated doors. 3 Record the pulse and blood pressure every 4 hours. 4 Delay taking prescribed medications until the monitor is removed

1. Diuresis and decreased pulse rate Digoxin slows the heart rate, which is reflected in a slowing of the pulse; it also increases kidney perfusion, which promotes urine formation, resulting in diuresis and decreased edema. Digoxin will decrease, not increase, the blood pressure; digoxin does promote weight loss through diuresis. Although digoxin produces diuresis as a result of improved cardiac output, which increases fluid output, it does not regulate an irregular pulse. Digoxin will not correct a heart murmur or decrease the pulse pressure.

A client with heart failure is digitalized (given a loading dose of digoxin) and placed on a maintenance dose of digoxin 0.25 mg by mouth daily. What responses does the nurse expect the client to exhibit when a therapeutic effect of digoxin is achieved? 1 Diuresis and decreased pulse rate 2 Increased blood pressure and weight loss 3 Regular pulse rhythm and stable fluid balance 4 Corrected heart murmur and decreased pulse pressure

4. Slows and strengthens cardiac contractions Digoxin increases the strength of myocardial contractions (positive inotropic effect) and, by altering the electrophysiological properties of the heart, slows the heart rate (negative chronotropic effect). Digoxin increases the strength of the contractions but decreases the heart rate. Although a reduction in edema may result from the increased blood supply to the kidneys, it is not the reason for administering digoxin. Digoxin decreases, not increases, cardiac impulses through the conduction system of the heart.

A client with heart failure is to receive digoxin and asks the nurse why the medication is necessary. What physiologic response will the nurse include when answering the client's question? 1 Reduces edema 2 Increases cardiac conduction 3 Increases rate of ventricular contractions 4 Slows and strengthens cardiac contractions

2. Bradycardia Metoprolol and digoxin both exert a negative chronotropic effect, resulting in a decreased heart rate. Metoprolol reduces, not produces, headaches. These drugs may cause hypotension, not hypertension. These drugs may depress nodal conduction; therefore, junctional tachycardia would be less likely to occur.

A client with hypertensive heart disease, who had an acute episode of heart failure, is to be discharged on a regimen of metoprolol and digoxin. What outcome does the nurse anticipate when metoprolol is administered with digoxin? 1 Headaches 2 Bradycardia 3 Hypertension 4 Junctional tachycardia

1. Support systems that can assist the client at home The rehabilitative phase requires a balance between activity and rest; supportive individuals are needed to perform more strenuous household tasks and to provide emotional support. A client with mild heart failure does not need inpatient care. A support system should be identified before considering community agencies. More information is needed before encouraging the development of relationships with neighbors.

A client with mild chronic heart failure is to be discharged with prescriptions for daily oral doses of an antidysrhythmic, potassium chloride 40 mEq, docusate sodium 100 mg, and furosemide 40 mg twice a day. The client reports having no family members who can help after discharge. What should the nurse help this client identify? 1 Support systems that can assist the client at home 2 Potential nursing homes in which the client can recuperate 3 Agencies that can help the client regain activities of daily living 4 Ways that the client can develop relationships with neighbors

60 mL/hr The prescribed dose is 1000 mcg/min. The available concentration is 500mg/500mL (or 1mg/mL). First, convert the mcg of the prescribed dose to mg of the available medication.

A healthcare provider prescribes an antidysrhythmic to be administered intravenously (IV) at 1000 mcg/min. The directions from the pharmacy state that 500 mg of the drug should be added to 500 mL of D5W. At what rate should the nurse set the volume control device to administer the medication correctly? Record your answer using a whole number. ___ mL/hr

1. Nausea Nausea and loss of appetite are the first indications of toxicity in approximately 50% of clients who take a cardiac glycoside, such as digoxin. Urticaria is a rare, not common, manifestation of digoxin toxicity. Photophobia is a later, not early, manifestation of digoxin toxicity. Yellow vision is a later, not early, manifestation of digoxin toxicity.

A healthcare provider prescribes digoxin for a client. The nurse teaches the client to be alert for which common early indication of digoxin toxicity? 1 Nausea 2 Urticaria 3 Photophobia 4 Yellow vision

1. Diuretic therapy Diuretic therapy that affects the loop of Henle generally involves the use of drugs (e.g., bumetanide) that directly or indirectly increase urinary sodium, chloride, and potassium excretion. Sodium restriction does not necessarily accompany administration of bumetanide. Dyspnea does not directly result in a depletion of electrolytes. Unless otherwise prescribed, oral intake is unaffected.

A nurse identifies signs of electrolyte depletion in a client with heart failure who is receiving bumetanide and digoxin. What does the nurse determine is the cause of the depletion? 1 Diuretic therapy 2 Sodium restriction 3 Continuous dyspnea 4 Inadequate oral intake

4. QRS complex The QRS complex represents ventricular depolarization. The classic QRS complex begins with a negative, or downward, deflection immediately after the PR interval. The P wave represents atrial depolarization. Normally a P wave indicates that the sinoatrial node initiated the impulse that depolarized the atrium. The T wave represents ventricular repolarization. The interval from the beginning of the P wave to the next deflection from the baseline is called the PR interval.

A nurse is assessing an ECG rhythm strip. Which component of the tracing will the nurse observe to determine ventricular depolarization? 1 P wave 2 T wave 3 PR interval 4 QRS complex

1. Tachycardia Epinephrine is a sympathetic nervous system stimulant that causes tachycardia. Hyperglycemia, not hypoglycemia, may result. The pupils will be dilated, not constricted. Epinephrine is more likely to cause hypertension than hypotension.

A nurse is assessing an adolescent after the administration of epinephrine. What side effect is most important for the nurse to identify? 1 Tachycardia 2 Hypoglycemia 3 Constricted pupils 4 Decreased blood pressure

4. P waves The P wave represents atrial contraction. Regularity is assessed by using electronic or physical calipers, or a piece of paper and pencil. To determine atrial regularity, identify the P wave and place one caliper point on the peak of the P wave. Locate the next P wave and place the second caliper point on its peak. The second point is left stationary, and the calipers are flipped over. If the first caliper point lands exactly on the next P wave, the atrial rhythm is perfectly regular. If the point lands one small box or less away from the next P wave, the rhythm is essentially regular. If the point lands more than one small box away, the rhythm is considered irregular. The same process can be performed with a simple piece of paper. Place the paper parallel and below the rhythm line, make a hatch mark below the first and second P waves, and then move the paper over to determine if the distance between the second and third P waves is equal to the first and second. When an atrial rhythm is perfectly regular, each P wave is an equal distance from the next P wave. This process is also used to assess ventricular regularity, except that the caliper points are placed on the peak of two consecutive R waves. QRS intervals can lengthen in response to new bundle branch blocks or with ventricular dysrhythmias.

A nurse is determining whether or not a client's atrial rhythm is regular when reviewing the ECG rhythm strip. Which consistency of spacing will the nurse use to determine regularity? 1 P wave and the QRS complex 2 QRS complexes 3 QRS widths 4 P waves

2. Myocardial hypoxia Dysrhythmias are common and result from decreased oxygen to the cells of the myocardium. Myocardial infarction with tissue necrosis results in metabolic acidosis, not metabolic alkalosis. When physical or emotional stress is experienced, such as in an MI, catecholamine secretion increases; this is part of the "fight or flight" mechanism. Increased sympathetic, not parasympathetic, nervous system stimulation may contribute to the development of dysrhythmias.

A nurse is monitoring a client admitted with a diagnosis of myocardial infarction (MI) for dysrhythmias. Which reason for increased incidence of dysrhythmias in this client should the nurse monitor? 1 Metabolic alkalosis 2 Myocardial hypoxia 3 Decreased catecholamine secretion 4 Increased parasympathetic nervous system stimulation

3. Acute heart failure Beta blockers reduce cardiac output and must be started slowly, so they are contraindicated for clients with acute heart failure. Beta blockers are used to treat coronary artery disease because they decrease myocardial oxygen demand by reducing peripheral resistance and cardiac contractility. Beta blockers are used to treat essential hypertension because they cause vasodilation and decrease cardiac contractility. Beta blockers lower heart rate.

A nurse is preparing medications. Which client's health problem motivates the nurse to question a prescription for a beta blocker? 1 Coronary artery disease 2 Essential hypertension 3 Acute heart failure 4 Sinus tachycardia

2. Blurred vision Visual disturbances, such as blurred or yellow vision, may be evidence of digoxin toxicity. Chest pain is not a toxic effect of digoxin. Persistent hiccups are not related to digoxin toxicity. An increased urinary output is not a sign of digoxin toxicity; it may be a sign of a therapeutic response to the drug and an improved cardiac output.

A nurse is providing discharge instructions about digoxin. Which response should a nurse include as a reason for a client to withhold the digoxin? 1 Chest pain 2 Blurred vision 3 Persistent hiccups 4 Increased urinary output

1. 95 Dysrhythmias are often associated with pulse deficits. A pulse deficit is the difference between the apical and radial pulse rates. Thus, when the radial pulse (80) and the pulse deficit (15) are added together, the apical pulse would be 95.

A nursing student is recording the radial pulse rate in a client with dysrhythmias and documented a radial pulse of 80 beats per minute. The registered nurse reassesses the client and notices a pulse deficit of 15. What is the client's apical pulse? 1 95 2 85 3 75 4 65

3. Supraventricular tachycardia Cardioversion involves administration of precordial shock, which is synchronized with the R wave to interrupt the heart rate. It is used for atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia with a pulse when pharmaceutical preparations fail. The heart is stopped by the electrical stimulation, and it is hoped that the sinoatrial (SA) node will take over as pacemaker. Because there are no R waves in a cardiac standstill, defibrillation and not cardioversion should be done. Premature ventricular complexes suggest an irritable myocardium and generally respond to antidysrhythmic agents.

In addition to atrial fibrillation, which cardiac dysrhythmia exhibited by a client does the nurse determine may be converted to sinus rhythm by cardioversion? 1 Cardiac standstill 2 First degree heart block 3 Supraventricular tachycardia 4 Frequent premature complexes

1, 2, 3, 4 The dysrhythmia itself is not treated, but the cause is identified and treated appropriately. Causes of sinus tachycardia include hypovolemia, heart failure, anemia, exercise, use of stimulants, fever, sympathetic response to fear or pain. Hypothermia will cause sinus bradycardia.

The client is admitted with sinus tachycardia. To treat the dysrhythmia, the nurse will look for potential causes. Which causes will the nurse look for in this client? Select all that apply. 1 Anxiety 2 Caffeine 3 Exercise 4 Anemia 5 Hypothermia

4. "I will hold the medication until I consult with your healthcare provider." The response "I will hold the medication until I consult with your healthcare provider" is a safe practice because yellow vision indicates digitalis toxicity. The response "This is related to your heart problems, not to the medication" is incorrect; yellow vision is not a symptom of heart disease. The response "It is a medication that is necessary, and that side effect is only temporary" is incorrect; yellow vision is not a temporary side effect. The response "Take this dose, and when I see your healthcare provider I will ask about it" is unsafe.

The client who takes furosemide and digoxin reports that everything looks yellow. How will the nurse respond? 1 "This is related to your heart problems, not to the medication." 2 "It is a medication that is necessary, and that side effect is only temporary." 3 "Take this dose, and when I see your healthcare provider I will ask about it." 4 "I will hold the medication until I consult with your healthcare provider."

1. Keep a diary of activities The purpose of a Holter monitor is to correlate dysrhythmias with the client's reported activity. A microwave oven will have no effect on the Holter monitor and will not affect the results. The client should take nitroglycerin as needed and note it in the activities diary. It is unnecessary to know the client's blood pressure and pulse rate every 2 hours during the test to correctly interpret results from a Holter monitor.

The nurse is caring for a client who is experiencing signs and symptoms of a cardiac dysrhythmia and is scheduled to wear a Holter monitor for 24 hours. What should the client be instructed to do during the test? 1 Keep a diary of activities. 2 Stay away from microwave ovens. 3 Avoid taking any nitroglycerin that day. 4 Take both blood pressure and pulse every 2 hours.

4. Ensure airway, breathing, and circulation (ABC) The client with any life-threatening complication such as dysrhythmias should be assessed for ABCs immediately because the client may suffer with airway obstruction. Oxygen saturation should be monitored during ongoing assessments and after providing the client with initial treatment. Intravenous access should be established after performing initial assessments such as vital signs. After assessing ABCs in a client with dysrhythmias, the client should be provided with oxygen via nasal cannula or nonrebreather mask to maintain oxygen levels.

The registered nurse is caring for a client with dysrhythmias. Which action should the nurse perform immediately according to priority? 1 Monitoring oxygen saturation 2 Establishing intravenous access 3 Administer oxygen via nonrebreather mask 4 Ensure airway, breathing, and circulation (ABC)

2. Peaked T waves and widened QRS complexes Potassium is the principal intracellular cation, and during ketoacidosis it moves out of cells into the extracellular compartment to replace potassium lost as a result of glucose-induced osmotic diuresis; overstimulation of the cardiac muscle results. The T wave is depressed in hypokalemia. Initially, the QT segment is short, and as the potassium level rises, the QRS complex widens. P waves are abnormal because the PR interval may be prolonged and the P wave may be lost; however, the T wave is peaked, not depressed. The ST segment becomes depressed. The PR interval is prolonged, and the P wave may be lost. QRS complexes and thus T waves become irregular, and the rate does not necessarily change.

The serum potassium level of a client who has diabetic ketoacidosis is 5.4 mEq/L (5.4 mmol/L). What would the nurse expect to see on the ECG tracing monitor? 1 Abnormal P waves and depressed T waves 2 Peaked T waves and widened QRS complexes 3 Abnormal Q waves and prolonged ST segments 4 Peaked P waves and an increased number of T waves

2, 4, 5 The assessment findings having the highest priority for clients with symptomatic sinus tachycardia are orthopnea (shortness of breath while lying flat), lightheadedness, and decreased blood pressure because these assessments can help to quickly identify the client's condition and the most effective treatment for it. Anxiety and restlessness are frequently observed in a client with symptomatic sinus tachycardia, but they are not the nurse's highest priority.

To which assessment findings should the nurse give the highest priority when caring for a client with symptomatic sinus tachycardia? Select all that apply. 1 Anxiety 2 Orthopnea 3 Restlessness 4 Lightheadedness 5 Decreased blood pressure

3. Irregular pulse rate 5. Orthostatic hypotension Dysrhythmias, including second-degree heart block, are cardiovascular side effects of valsartan. It also may precipitate angina pectoris, myocardial infarction, and brain attack (cerebrovascular accident, CVA). Angiotensin II receptor antagonists, such as valsartan, block vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites, including vascular smooth muscle, thus reducing the blood pressure; dizziness, orthostatic hypotension, and excessive hypotension may occur. Diarrhea, not constipation, may occur with valsartan. Hyperkalemia, not hypokalemia, may occur with valsartan. Valsartan does not cause altered visual acuity.

Valsartan, an angiotensin II receptor antagonist, is prescribed for a client. For which possible side effects should the nurse monitor the client? Select all that apply. 1 Constipation 2 Hypokalemia 3 Irregular pulse rate 4 Change in visual acuity 5 Orthostatic hypotension

2. Decrease in cardiac dysrhythmias Amiodarone is a class III antidysrhythmic used for treating ventricular and supraventricular tachycardia and for conversion of atrial fibrillation. Results of fasting lipid profile are expected with antilipidemics. Degree of blood pressure control is expected with antihypertensives. Incidence of ischemic chest pain is expected with antianginal agents, such as nitrates.

What client response must the nurse monitor to determine the effectiveness of amiodarone? 1 Absence of ischemic chest pain 2 Decrease in cardiac dysrhythmias 3 Improvement in fasting lipid profile 4 Maintenance of blood pressure control

4. Rest periodically throughout the day Rest decreases demand on the heart and will prevent fatigue. Sleeping with the head slightly elevated facilitates respiration. The client needs potassium. A low-potassium diet when the client is taking digoxin predisposes the client to toxicity and dangerous dysrhythmias. To avoid becoming obsessed with the pulse rate, the client should take the pulse less often; once daily is adequate.

What will the nurse include when developing a teaching plan for a client receiving digoxin for left ventricular failure? 1 Sleep flat in bed 2 Follow a low-potassium diet 3 Take the pulse three times a day 4 Rest periodically throughout the day

3. Increased contractile force of the myocardium Digoxin produces a positive inotropic effect that increases the strength of myocardial contractions and thus cardiac output. The positive inotropic effect of digoxin increases, not decreases, cardiac output. Digoxin increases the strength of myocardial contractions (positive inotropic effect) and slows the heart rate (negative chronotropic effect); these effects increase the stroke volume of the heart. Digoxin decreases the refractory period of the AV node and decreases conduction through the sinoatrial (SA) and AV nodes.

When obtaining a health history, the nurse is informed that a client has been taking digoxin. What therapeutic effect of digoxin does the nurse expect? 1 Decreased cardiac output 2 Decreased stroke volume of the heart 3 Increased contractile force of the myocardium 4 Increased electrical conduction through the atrioventricular (AV) node

1. Apical heart rate Because digoxin slows the heart rate, the apical pulse should be counted for 1 minute before administration. If the apical rate is below a preset parameter (usually 60 beats/min), digoxin should be withheld because its administration may further decrease the heart rate. Some protocols permit waiting for one hour and retaking the apical rate; the result determines if it is administered or if the healthcare provider is notified. Obtaining the radial pulse on the left side is not as accurate as an apical pulse; the client also may have an atrial dysrhythmia, which cannot be detected through a radial rate alone. Obtaining the radial pulse in both right and left arms is not as accurate as an apical pulse; the client also may have an atrial dysrhythmia, which cannot be detected through a radial rate alone. Obtaining the difference between apical and radial pulses is a pulse deficit, not a pulse rate.

Which assessment should the nurse obtain before administering digoxin to a client? 1 Apical heart rate 2 Radial pulse on the left side 3 Radial pulse in both right and left arms 4 Difference between apical and radial pulses

4. Serum potassium of 7.2 mEq/L (7.2 mmol/L) Hyperkalemia causes dysrhythmias and cardiac arrest. The normal serum potassium concentration ranges between 3.5 and 5.0 mEq/L (3.5-5.0 mmol/L). A concentration of 7.2 mEq/L (7.2 mmol/L) indicates hyperkalemia. The normal concentration of sodium in the serum ranges between 135 and 145 mEq/L (135-145 mmol/L). The normal chloride concentration ranges between 96 and 106 mEq/L (96-106 mmol/L). The normal serum calcium level ranges between 9 and 10.5 mg/dL (2.25-2.625 mmol/L).

Which electrolyte concentration has the potential to precipitate dysrhythmias and cardiac arrest in a client? 1 Serum sodium of 139 mEq/L (139 mmol/L) 2 Serum chloride of 100 mEq/L (100 mmol/L) 3 Serum calcium of 10.2 mg/dL (2.55 mmol/L) 4 Serum potassium of 7.2 mEq/L (7.2 mmol/L)

1, 2, 4 Bradycardia or other dysrhythmias may occur; therefore, the heart rate and rhythm should be monitored. ECG monitoring should be continuous. The digoxin level is checked before administration to avoid toxicity. A low serum potassium level when digoxin is administered can contribute to toxicity. Digoxin should be given over a 5-minute period through a Y-tube or three-way stopcock. There are many syringe, Y-site, and additive incompatibilities; the manufacturer recommends that digoxin not be administered with other drugs.

Which nursing interventions are important when caring for clients receiving IV digoxin? Select all that apply. 1 Monitor the heart rate closely 2 Check the blood levels of digoxin 3 Administer the dose over 1 minute 4 Monitor the serum potassium level 5 Give the drug with other infusing medications