the nurse is caring for a client on digoxin with a heart rate of 48 bpm what is the nurses priority action
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Nursing Elites

ATI RN

Cardiovascular System Exam

1. The nurse is caring for a client on digoxin with a heart rate of 48 bpm. What is the nurse’s priority action?

Correct answer: A

Rationale: In this scenario, the nurse's priority action should be to hold the digoxin and notify the healthcare provider. A heart rate of 48 bpm is low, and digoxin, being a medication that can further decrease the heart rate, should be withheld. Administering the digoxin as ordered (Choice B) would not be appropriate in this situation as it can exacerbate bradycardia. Atropine (Choice C) is not the initial treatment for this scenario; holding the digoxin is the first action. Increasing the dose of digoxin (Choice D) would be contraindicated due to the client's bradycardia. Therefore, the correct action is to hold the digoxin and inform the healthcare provider for further guidance.

2. The client is on a beta blocker for hypertension. What should the nurse monitor for?

Correct answer: A

Rationale: Corrected Rationale: When a client is on a beta blocker for hypertension, the nurse should monitor for bradycardia. Beta blockers are known to decrease heart rate, which can lead to bradycardia. Tachycardia (choice B) is unlikely as beta blockers have the opposite effect. Hypertension (choice C) is the condition being treated, not a side effect of beta blockers. Respiratory distress (choice D) is not a common effect of beta blockers and is not typically monitored in clients taking beta blockers.

3. What is a condition where the arteries supplying blood to the legs and feet become narrowed or blocked, causing pain and difficulty walking?

Correct answer: A

Rationale: The correct answer is A, Peripheral artery disease (PAD). PAD is characterized by the narrowing or blockage of arteries that supply blood to the legs and feet, resulting in pain and difficulty walking. Choice B, Atherosclerosis, is a condition involving the buildup of plaque in the arteries but is not specific to the legs and feet. Varicose veins (Choice C) refer to enlarged, twisted veins usually occurring in the legs. Raynaud's disease (Choice D) involves episodes of reduced blood flow to the extremities, typically triggered by cold temperatures or stress, but it is not directly related to the arteries in the legs and feet.

4. What is a type of medication that helps to prevent blood clots by thinning the blood?

Correct answer: A

Rationale: Anticoagulants are medications specifically designed to prevent blood clots by thinning the blood. They work by interfering with the body's blood clotting process. Beta-blockers, ACE inhibitors, and calcium channel blockers are medications used for different purposes such as managing blood pressure, heart conditions, and regulating heart rhythm, respectively. However, they do not have the primary function of preventing blood clots like anticoagulants.

5. The client is receiving digoxin and has a potassium level of 2.8 mEq/L. What is the nurse’s priority action?

Correct answer: A

Rationale: The correct answer is to hold the digoxin and notify the healthcare provider. A potassium level of 2.8 mEq/L indicates hypokalemia, which can increase the risk of digoxin toxicity. Holding the medication and informing the healthcare provider is crucial to prevent adverse effects. Choice B is incorrect because increasing the dose of digoxin would further raise the risk of toxicity. Choice C is incorrect as continuing the current dose could exacerbate the toxicity risk. Choice D is incorrect because administering potassium supplements alone is not sufficient to address the potential digoxin toxicity; the first step should be to hold the digoxin and seek further guidance.

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