The doctor orders Pepcid 10 mg by mouth three times a day. Instructions on the container say to reconstitute with water to make a concentration of 0.5 g/3 mL. How many ml/dose would you administer?

A) Nausea and vomiting:
Nausea and vomiting are common gastrointestinal side effects of ibuprofen, which is a nonsteroidal anti-inflammatory drug (NSAID). Ibuprofen can irritate the stomach lining, leading to nausea, vomiting, or even gastritis and peptic ulcers with long-term use. This is a well-known side effect of NSAIDs, and clients are often advised to take the medication with food to reduce the risk.

B) Drowsiness:
While some individuals may experience fatigue or a mild sedative effect, it is not typically associated with ibuprofen. Other pain medications, such as opioids or certain antihistamines, are more likely to cause drowsiness, but this is rare for ibuprofen.

C) Blurred vision:
While serious side effects of NSAIDs can include vision changes (e.g., from elevated blood pressure or kidney dysfunction), blurred vision is not directly related to ibuprofen use. If blurred vision occurs, it is important to investigate other potential causes or conditions.

D) Increased heart rate:
Ibuprofen primarily affects the inflammatory pathways and the gastrointestinal system, and does not typically cause changes in heart rate. However, in rare cases, NSAIDs can lead to cardiovascular issues such as increased blood pressure, which could indirectly affect heart rate, but tachycardia is not a common or expected side effect.

A) RR 18 bpm:
A respiratory rate of 18 breaths per minute is within the normal range for adults (12-20 bpm). Therefore, this finding does not pose a significant concern in the context of digoxin therapy. Respiratory rate should be monitored, especially if the patient is experiencing signs of heart failure or digoxin toxicity, but 18 bpm alone is not alarming.

B) 1+ pitting edema of the lower extremities:
Pitting edema, especially with a grade of 1+ (slight indentation), is a common finding in patients with congestive heart failure (CHF). It indicates fluid retention due to the heart's inability to pump blood effectively. While edema should be monitored, it is not immediately life-threatening or specific to digoxin toxicity.

C) BP 138/90 mm Hg:
A blood pressure of 138/90 mm Hg is slightly elevated, but it is not excessively high. This finding is manageable and should be monitored, particularly in heart failure patients, but it does not present an immediate concern in this case. Blood pressure management is crucial in CHF, but it does not directly correlate with digoxin toxicity.

D) Heart rate 54 beats/min:
A heart rate of 54 beats per minute is considered bradycardic, especially in a patient taking digoxin. Digoxin can lower heart rate by increasing vagal tone and inhibiting the AV node. Bradycardia is a well-known sign of digoxin toxicity, and this finding is concerning because it may indicate that the patient is experiencing toxicity. Digoxin-induced bradycardia can lead to more serious arrhythmias or hemodynamic instability, making this the most concerning finding that requires immediate assessment and possibly intervention.