A nurse is evaluating the response of a client who received twice the prescribed dose of digoxin. Which of the following actions should the nurse take first?

Amphotericin B is a potent polyene antifungalagent utilized for systemic mycotic infections and endocarditis by binding to fungal ergosterolto create membrane pores. Due to its significant nephrotoxicityand risk of infusion-related reactions, specific administration protocols must be strictly followed to ensure patient safety.

Rationale:

A.Administering the medication over 2 hr is the standard protocol to minimize the risk of severe infusion-related reactions and cardiovascular instability. Rapid infusion of amphotericin B can lead to hypotension, bronchospasm, and arrhythmias. By extending the infusion time, the nurse allows for better systemic tolerance and reduces the acute inflammatory response associated with this medication.

B.Using a gravity flow set is incorrect because amphotericin B must be administered via an electronic infusion pump to ensure a precise and consistent rate. Gravity sets are prone to fluctuations that could inadvertently result in a rapid bolus, increasing the risk of cardiac arrest. Precise flow control is a mandatory nursing safety intervention for this high-alert medication.

C.Priming the tubing with 0.9% sodium chloride is contraindicated because amphotericin B is incompatible with saline and will precipitate into solid crystals. The IV line must be primed and flushed exclusively with 5% dextrose in water (D5W) before and after administration. Crystallization in the tubing can lead to emboli or catheter occlusion, posing a significant risk to the patient.

D.Discarding the medication if it is yellow is unnecessary because the amphotericin B lipid complex emulsion is naturally yellow or opaque in appearance. The nurse should only discard the medication if there is evidence of foreign particulate matter or distinct precipitation. Understanding the normal physical characteristics of the drug prevents the wasteful disposal of expensive and essential antifungal therapy.

Safe medical documentation requires the use of standardized terminologyand the avoidance of dangerous abbreviations to prevent medication errors. The Joint Commission maintains a "Do Not Use" list, which prohibits notations that are easily misinterpreted, such as trailing zeros or missing leading zeros.

Rationale:

A.This entry is incorrect because it uses the abbreviation "QD" for daily, which is on the prohibited list as it can be mistaken for "QID" (four times daily). Additionally, it fails to include the unit of measurement "mg" after the dosage, which is a critical safety component. Standardized documentation requires writing out the word "daily" and including full units to ensure there is no ambiguity in the medical record.

B.This is the correct entry because it follows all safety protocols, including the use of a leading zero (0.25 mg) and writing out "daily" and "by mouth." It also correctly documents that it was a verbal order (VO) and identifies both the prescribing provider and the receiving nurse. This level of detail ensures the order is legally sound and minimizes the risk of a ten-fold dosing error or route confusion.

C.This entry is unsafe because it lacks a leading zero (.25 mg), which could result in the patient receiving 25 mg instead of 0.25 mg if the decimal point is missed. Such a massive overdose of digoxin would likely be fatal due to its narrow therapeutic index and cardiac toxicity. Furthermore, it fails to document that the order was a verbal order, which is necessary for legal and clinical accountability.

D.Similar to choice C, this entry is incorrect due to the omission of the leading zero before the decimal point (.25 mg). While it correctly uses "VO" and "daily," the lack of a leading zero is a high-risk charting error that directly violates patient safety standards. Proper notation must always place a zero before a decimal to highlight the fractional nature of the dose to all clinical staff.