Which drug class should not be used when a patient is taking nitrates?

Digoxin is a medication that can help the heart pump more blood and slow down the heart rate in certain conditions, such as heart failure and atrial fibrillation.However, digoxin has a narrow therapeutic range, which means that too much or too little of it can be harmful.The therapeutic range of digoxin levels in the blood is 0.5-2 ng/mL, and the toxic level is >2.4 ng/mL.Digoxin should be held if the resting apical pulse of an infant is <90 bpm, an older child is <70 bpm, or an adult is <60 bpm.A pulse of 48/min in an adult is too low and could indicate digoxin toxicity, which can cause life-threatening arrhythmias. Therefore, the nurse should withhold the dose and notify the health care provider immediately.

Choice B is wrong because notifying the health care provider and monitoring the patient’s vital signs are not enough.

The nurse should also withhold the dose to prevent further exposure to digoxin.

Choice C is wrong because rechecking the pulse, making sure to count for 1 full minute, is not necessary.The nurse should already have counted the pulse for 1 full minute before administering digoxin, as per standard procedure.

Choice D is wrong because administering the dose could worsen the patient’s condition and increase the risk of digoxin toxicity and arrhythmias.

These are all modifiable risk factors for cardiovascular disease, meaning they can be changed through lifestyle choices or medication.Cholesterol level, blood pressure, weight, and smoking all affect the health of the heart and blood vessels, and can increase the risk of developing conditions such as atherosclerosis, hypertension, heart attack, or stroke.

Choice C, family history, is not a modifiable risk factor for cardiovascular disease.

It is a non-modifiable risk factor, meaning it cannot be changed and is determined by genetics.

Having a family history of cardiovascular disease can increase the risk of developing it, but it does not mean that it is inevitable.Other non-modifiable risk factors include sex, older age, race and ethnicity.

Some normal ranges for the modifiable risk factors are:

• Cholesterol level: total cholesterol should be less than 200 mg/dL; LDL cholesterol should be less than 100 mg/dL; HDL cholesterol should be more than 40 mg/dL for men and more than 50 mg/dL for women; triglycerides should be less than 150 mg/dL.

• Blood pressure: normal blood pressure is less than 120/80 mmHg; elevated blood pressure is 120-129/less than 80 mmHg; hypertension stage 1 is 130-139/80-89 mmHg; hypertension stage 2 is 140 or higher/90 or higher mmHg.

• Weight: body mass index (BMI) is a measure of weight relative to height; normal BMI is 18.5-24.9 kg/m2; overweight BMI is 25-29.9 kg/m2; obese BMI is 30 or higher kg/m2.

• Smoking: smoking any amount of tobacco products can harm the cardiovascular system; quitting smoking can lower the risk of cardiovascular disease and improve overall health.