NCLEX-RNPharmacological and Parenteral TherapiesHard
A client taking digoxin and furosemide has a serum potassium level of 3.0 mEq/L. The nurse notes the client reports seeing yellow-green halos around lights and has a pulse of 52 beats/min. Which is the priority nursing action?
- ADocument the findings as an expected side effect of furosemide
- BEncourage the client to increase dietary potassium intake and administer digoxin
- CHold the digoxin dose and notify the provider of the findings
- DAdminister the scheduled digoxin dose and recheck the pulse in 1 hour
Show answer & explanationAnswer & explanation
Correct answer: C. Hold the digoxin dose and notify the provider of the findings
Hypokalemia potentiates digoxin toxicity, and this client is showing classic signs of toxicity—visual disturbances (yellow-green halos) and bradycardia (pulse 52). The nurse should hold the digoxin and notify the provider immediately, since continuing digoxin in the presence of hypokalemia could cause life-threatening dysrhythmias.
Why the other options are wrong
- A. Yellow-green halos and bradycardia are signs of toxicity, not merely expected furosemide effects.
- B. Dietary potassium alone is too slow and digoxin should not be given until toxicity is ruled out.
- D. Administering digoxin with these toxicity signs and low potassium could worsen dysrhythmias.
Digoxin Toxicity & Hypokalemia
Low serum potassium increases the risk of digoxin toxicity, presenting with visual disturbances, bradycardia, nausea, and arrhythmias.
- Therapeutic digoxin level: 0.5-2.0 ng/mL
- Hold digoxin if pulse <60 bpm in adults
- Digoxin toxicity is potentiated by hypokalemia and hypomagnesemia
Memory trick: 'Low K, high risk' — hypokalemia sensitizes the heart to digoxin