A patient was brought to the emergency department with complaints of extreme fatigue, nausea, vomiting, and muscle weakness. Lab results reveal the following: Na+ = 140 mEq/L; K+ = 2.0 mEq/L; Ca2+ = 8.6 mg/dL; Mg2+ = 1.4 mg/dL; and Cl– = 96 mEq/L. The electrocardiogram (ECG) tracing has a flat T wave and frequent PVCs (premature ventricular contractions). The patient's prescribed daily oral medications include furosemide 20 mg, digoxin 0.25 mg, and aspirin 81 mg. Why might the nurse question the order for digoxin 0.25 mg orally daily?
1) Based on the digoxin level, the dose may need to be increased.
2) The patient is at risk for an elevated digoxin level at this time.
3) Digoxin and furosemide should never be taken together.
4) The nurse should not be concerned about the order as written.
- 2) The patient is at risk for an elevated digoxin level at this time.
- Rationale: The hypokalemic patient on digoxin is at high risk for digoxin toxicity. The patient's serum digoxin level will need to be assessed as she receives potassium supplementation. Digoxin and furosemide can be taken together.