A nurse is caring for a client who is on warfarin therapy for atrial fibrillation. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer?

The Correct answer is A.

Choice A reason: Evaluating the client for nausea, vomiting, and anorexia is important because these are common signs of digoxin toxicity. Digoxin is a cardiac glycoside used to treat heart failure and certain arrhythmias, but it has a narrow therapeutic window. Toxicity can occur due to various factors, including renal insufficiency or drug interactions. Monitoring gastrointestinal symptoms like nausea, vomiting, and loss of appetite can help detect toxicity early.

Choice B reason: Withholding digoxin if the heart rate is above 100/min is not typically recommended. Digoxin has a negative chronotropic effect, meaning it can decrease heart rate. However, the decision to withhold medication usually depends on a heart rate that is too low (bradycardia), not high. The normal range for resting heart rate in adults is 60-100 beats per minute. Therefore, withholding digoxin for a heart rate above 100/min without other clinical justifications would not be appropriate.

Choice C reason: Measuring the apical pulse rate for 30 seconds before administration is not the standard practice. The apical pulse should be measured for a full minute to ensure accuracy, especially in clients with heart failure who are receiving digoxin. This is because digoxin can cause arrhythmias, and a shorter measurement period may not provide a true representation of the heart's rhythm.

Choice D reason: Instructing the client to eat foods that are low in potassium is incorrect. Clients taking digoxin should maintain a normal potassium level, as hypokalemia can increase the risk of digoxin toxicity. The normal serum potassium level is 3.5-5.0 mEq/L. Foods high in potassium can help maintain this balance and should not be avoided unless there is a specific clinical indication, such as hyperkalemia.

Choice A reason: Hematocrit 45% is not the correct data. Hematocrit is the percentage of red blood cells in the blood. The normal range for hematocrit is 37% to 47% for women and 42% to 52% for men. Hematocrit 45% is within the normal range and does not indicate any abnormality related to heparin therapy. Heparin does not affect the production or destruction of red blood cells.

Choice B reason: Platelets 74,000/mm3 is the correct data. Platelets are the blood cells that are responsible for clotting and preventing bleeding. The normal range for platelets is 150,000 to 400,000/mm3. Platelets 74,000/mm3 is below the normal range and indicates thrombocytopenia, which is a low platelet count. Thrombocytopenia is a serious complication of heparin therapy that can cause bleeding, bruising, and petechiae. The nurse should report this finding to the provider immediately and stop the heparin infusion.

Choice C reason: Partial thromboplastin time (PTT) 65 seconds is not the correct data. PTT is a blood test that measures the time it takes for the blood to clot. The normal range for PTT is 25 to 35 seconds. PTT 65 seconds is above the normal range and indicates that the blood is taking longer to clot. This is an expected effect of heparin therapy, as heparin is an anticoagulant that inhibits the formation of blood clots. The nurse should monitor the PTT and adjust the heparin dose according to the provider's orders and the protocol.

Choice D reason: White blood cell count 8,000/mm3 is not the correct data. White blood cells are the blood cells that are involved in the immune system and fight infections. The normal range for white blood cells is 4,500 to 11,000/mm3. White blood cell count 8,000/mm3 is within the normal range and does not indicate any abnormality related to heparin therapy. Heparin does not affect the production or function of white blood cells.