A patient has been taking furosemide (Lasix) for 6 months. A prescriber has just started the patient on digoxin (Lanoxin). Which of the following assessment data should most concern the nurse prior to the administration of digoxin?
a. Crackles and respirations of 22/minutes
b. Digoxin level of 0.5 mg/dL
c. Blood pressure of 140/90
d. Apical pulse rate of 56/minute
ANS: D
With low potassium levels (ie, below 3.5 mEq/L), which can occur secondary to furosemide administration, the risk of digoxin-induced toxicity is greatly increased. The apical pulse must be monitored, and digoxin should not be administered to a patient with a pulse below 60/minutes.
Crackles and respirations of 22/minute would be indications for furosemide and digoxin therapy and therefore not a concern for the nurse related to administration.
A digoxin level of 0.5 mg/dL is considered therapeutic, therefore digoxin should be continued with no concern.
A blood pressure of 140/90 would not be affected by digoxin and may actually be helped by furosemide, which would reduce volume and thus help reduce blood pressure.
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