A nurse is caring for a client prescribed Digoxin. Which nur… | MyMerci
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Medical EmergenciesPA
Question
A nurse is caring for a client prescribed Digoxin. Which nursing action is most appropriate regarding assessing apical pulse and withholding the dose if signs of toxicity occur?
1Discard the entire prefilled syringe as pharmaceutical waste, notify the pharmacy that the available concentration is unsafe for the ordered dose, and wait for a replacement syringe with a lower concentration such as 1 mg/mL to prevent a potential medication error.✓ Correct answer
2Convert the dose using an equianalgesic table, determine that 1 mg hydromorphone is equivalent to 7 mg morphine, obtain that morphine dose from stock, and administer it instead of hydromorphone to avoid manipulating the high-concentration prefilled syringe.
3Recognize the high-alert mismatch, do not give the syringe as drawn, draw 0.25 mL (1 mg) from the prefilled syringe with a separate syringe and waste 0.75 mL with a witness, double-check the dose with another nurse, and document the wasted volume.
4Administer the full 1 mL volume from the prefilled syringe because the order is for 1 mg and the syringe is labeled as 1 mL, so the entire contents match the ordered dose when the concentration is 1 mg/mL, which is a standard concentration for hydromorphone.
Explanation
When administering Digoxin, key nursing considerations include monitoring patient status, checking critical laboratory values, and providing appropriate safety education. Unsafe practices such as stopping medications abruptly or doubling missed doses are incorrect.
High-alert recognition + waste with witness + double check is the safe path. Hydromorphone is not morphine — never assume equivalence and never give a prefilled syringe at face value.