A patient is being treated for heart failure. Labs: Sodium 146 meq/L, Potassium 4.2 mmol/L, Hemoglobin 10.5 gm/dL, White Blood Cells 12.2, digoxin level 0.8 ng/mL

VS: BP 118/66, apical heart rate 68, O2 96% on 2L nasal cannula, temperature 98.4°F

What will the nurse do with the digoxin order?

Choice A reason: How to check apical heart rate is not a priority education for this client. Apical heart rate is the number of heartbeats per minute that can be heard at the apex of the heart. It can be used to monitor the effect of cardiac medications, such as atenolol or digoxin. This client is taking atenolol, but the nurse can check the client's radial pulse (at the wrist) instead of the apical pulse, unless there is a discrepancy or an irregular rhythm. The nurse should teach the client how to check their radial pulse and report any changes or symptoms.

Choice B reason: Signs and symptoms of hypothyroidism are not a priority education for this client. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones, which regulate the metabolism and energy of the body. Hypothyroidism can cause symptoms such as fatigue, weight gain, cold intolerance, dry skin, hair loss, and depression. This client is not taking any medication that affects the thyroid function, and there is no evidence of hypothyroidism in the client's history or labs. The nurse should assess the client's thyroid function and teach the client about the signs and symptoms of thyroid disorders.

Choice C reason: Bleeding precautions are a priority education for this client. Bleeding precautions are measures to prevent or minimize bleeding in clients who are at risk of bleeding, such as those who are taking anticoagulants, have low platelets, or have bleeding disorders. This client is taking warfarin, an anticoagulant that increases the risk of bleeding.

Choice D reason: Increasing potassium rich foods in the diet is not a priority education for this client. Potassium is a mineral that helps regulate the fluid balance, nerve impulses, and muscle contractions in the body. Potassium levels can be affected by medications, such as diuretics, ACE inhibitors, or potassium supplements. This client is taking captopril, an ACE inhibitor that can increase the potassium level in the blood. The client's potassium level is normal (4.8 mmol/L), and there is no need to increase the intake of potassium rich foods, such as bananas, oranges, potatoes, tomatoes, or beans. The nurse should monitor the client's potassium level and teach the client about the signs and symptoms of high or low potassium, such as muscle weakness, cramps, irregular heartbeat, or numbness.

Choice A reason: This is incorrect because labetalol is a safe and effective medication for treating hypertension in pregnancy. Labetalol is a beta-blocker that lowers blood pressure by reducing the heart rate and the force of contraction. It does not affect the blood flow to the placenta or the fetus.

Choice B reason: This is incorrect because labetalol is not contraindicated for smokers. However, smoking is a risk factor for cardiovascular disease and should be discouraged by the nurse. Smoking can increase blood pressure, heart rate, and the risk of blood clots.

Choice C reason: This is correct because labetalol is contraindicated for clients with a history of uncontrolled asthma. Labetalol is a non-selective beta-blocker that can block the beta-2 receptors in the lungs and cause bronchoconstriction. This can worsen asthma symptoms and trigger an asthma attack.

Choice D reason: This is incorrect because labetalol is a suitable medication for clients who had a myocardial infarction. Labetalol can prevent further damage to the heart muscle by reducing the oxygen demand and the workload of the heart. It can also prevent arrhythmias and angina.