A nurse is caring for a client in an emergency department (ED).

Which of the following medications should the nurse expect the physician to prescribe for this client?
Select All That Apply

Digoxin is a cardiac glycosidethat inhibits the sodium-potassium ATPasepump, increasing intracellular calcium and myocardial contractility. It possesses a narrow therapeutic index, making toxic accumulations common. Early toxicity manifests as anorexia, nausea, and blurred or yellow-tinted vision, while severe toxicity causes life-threatening dysrhythmias.

Rationale:

A.Notifying the provider is a necessary step in the management of a medication error, but it is not the initial action. The nurse must first possess objective clinical data regarding the client's current physiological status to provide a comprehensive report. Assessment always precedes notification in the nursing process to ensure the provider can make informed decisions.

B.Obtaining the client's vital signs is the priority action because the nurse must assess for immediate life-threatening complications like severe bradycardia or hypotension. Since digoxin significantly affects cardiac conduction, an overdose can trigger various arrhythmias. Assessing the client's stability provides the essential data needed to determine the urgency of further medical interventions.

C.Initiating a medication error incident report is an administrative requirement that ensures institutional quality improvement and safety tracking. However, documentation is never the first priority when a client's safety is potentially compromised by a pharmacological overdose. The nurse must focus on clinical assessment and stabilization before completing necessary internal paperwork regarding the error.

D.Checking the client's digoxin level is an important diagnostic step to quantify the severity of the overdose, but it takes time to process. Laboratory results do not provide immediate information about the client's current hemodynamic tolerance of the excess dose. The nurse should prioritize the physical assessment of the client over waiting for laboratory confirmation of serum levels.

Hydroxyzine is a first-generation antihistaminethat crosses the blood-brain barrier, leading to significant anticholinergicand sedative effects. In contrast, hydralazine is a peripheral vasodilatorused for hypertension. This look-alike, sound-alike error involves switching a sedative for an antihypertensive, requiring close neurological and cardiovascular monitoring.

Rationale:

A.Sedation is a primary adverse effect of hydroxyzine due to its ability to block H1 receptors in the central nervous system. Because the client received this instead of a blood pressure medication, the nurse must monitor for extreme drowsiness, dizziness, and a possible risk for falls. Sedation is the most immediate and expected neurological consequence of this specific medication error.

B.Drooling is not associated with hydroxyzine; rather, this medication has anticholinergic properties that typically cause dry mouth (xerostomia). Hydroxyzine reduces secretions and blocks parasympathetic activity, making drooling an unlikely finding. If the client experiences drooling, the nurse should investigate other causes, such as neurological impairment or the effect of different pharmacological agents.

C.Diarrhea is not a common side effect of hydroxyzine administration. Antihistamines with anticholinergic effects are more likely to cause constipation due to slowed gastrointestinal motility. The nurse should monitor for decreased bowel sounds rather than increased frequency of stools. Diarrhea would be an atypical response to the mistaken administration of an antihistamine.

D.While hydralazine (the intended drug) treats hypertension, the nurse should monitor for high blood pressure because the client missedtheir antihypertensive dose. However, the prompt asks for the adverse effect of the medication actually given. Hydroxyzine itself does not cause hypertension; instead, the primary risk of the drug actually administered is central nervous system depression and potential hypotension.