A nurse is reviewing the laboratory results for a female client who is receiving furosemide and digoxin. Which of the following findings should the nurse recognize increases the client's risk for developing digoxin toxicity?

Rationale:
A. Select a vein on the back of the hand: Veins on the dorsum of the hand are more fragile in older adults and have less subcutaneous tissue, increasing the risk of infiltration or phlebitis. Larger veins on the forearm are preferred for safer and more stable IV access.

B. Apply a tourniquet firmly above the insertion site: Excessive tourniquet pressure can damage fragile veins and impair circulation in older adults. The tourniquet should be applied gently enough to distend the vein without causing bruising or discomfort.

C. Clean the site using vigorous friction: Vigorous scrubbing can irritate or damage delicate skin in older adults. The site should be cleansed using gentle, circular motions with appropriate antiseptic solution to reduce infection risk without causing trauma.

D. Use a 22-gauge catheter for insertion: A 22-gauge catheter provides an appropriate balance between ease of insertion and adequate flow rate for older adult clients. Smaller-gauge catheters minimize trauma to fragile veins while still allowing effective IV therapy.

Rationale for Correct Choices

• Administer oxygen at 2 L/min via nasal cannula: The client’s oxygen saturation of 92% indicates mild hypoxemia, which can worsen myocardial ischemia. Administering low-flow oxygen enhances myocardial oxygen delivery and helps reduce chest pain and tissue damage.

• Administer sublingual nitroglycerin: After oxygen therapy, sublingual nitroglycerin is the next appropriate step to relieve ischemic chest pain. It dilates coronary arteries, improves blood flow, and reduces myocardial oxygen demand. The nurse should monitor blood pressure and pain relief closely after administration.

Rationale for Incorrect Choices

• Request a prescription for an increase in statin medication: Although the client’s total cholesterol and LDL levels are elevated, statin adjustment is a long-term management measure. It does not address the acute chest pain or compromised oxygenation that the client is currently experiencing.

• Prepare the client for cardiac catheterization: While cardiac catheterization may be needed if myocardial infarction is confirmed, immediate stabilization of oxygen and pain takes priority. The nurse must first implement emergency interventions before preparing for invasive procedures.

• Request a prescription for a beta-blocker: Beta-blockers help lower heart rate and myocardial oxygen demand but are not administered during initial emergency management. They are prescribed only after the client is stabilized and contraindications have been ruled out.

• Checking a STAT cardiac troponin: Checking a STAT cardiac troponin is an important diagnostic action to rule in or out an acute myocardial infarction, however, clinical management of acute symptoms takes precedence over waiting for a laboratory result.