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Obtain a baseline blood glucose level
Although sotalol has beta-blocking effects that may mask symptoms of hypoglycemia, blood glucose monitoring is not the most critical assessment prior to the first dose. This action is secondary to renal and cardiac safety considerations.

Encourage increased oral fluid intake
While adequate hydration supports general cardiovascular and renal health, increased oral fluid intake does not directly address the primary risks associated with sotalol initiation. It does not prevent QT prolongation or drug accumulation.

Administer potassium supplementation prophylactically
Electrolyte balance, particularly potassium and magnesium levels, is important when using antidysrhythmics. However, prophylactic supplementation without documented hypokalemia is inappropriate and may cause hyperkalemia. Electrolytes should be assessed and corrected only if abnormal, not supplemented routinely.

Sodium bicarbonate. Sodium bicarbonate is used primarily to treat metabolic acidosis, certain drug toxicities (such as tricyclic antidepressant overdose), or severe hyperkalemia. It has no role in reversing calcium channel blockade and would not correct the underlying cause of hypotension in this scenario.

Potassium chloride. Potassium chloride is indicated for hypokalemia, which may contribute to dysrhythmias. However, potassium does not counteract verapamil’s negative inotropic or vasodilatory effects. Administering potassium in a hypotensive client without documented hypok

Magnesium sulfate. Magnesium sulfate is commonly used for torsades de pointes, preeclampsia, or certain ventricular dysrhythmias. While magnesium can influence cardiac conduction, it does not reverse the calcium channel blockade-induced hypotension seen with verapamil toxicity and is therefore not the priority medication.

Hypertension. Verapamil is frequently used to manage hypertension through arterial vasodilation. It reduces systemic vascular resistance, which lowers blood pressure effectively, making it appropriate for this condition.

Tachycardia. Verapamil slows heart rate by depressing AV nodal conduction, making it suitable for treating certain tachyarrhythmias such as supraventricular tachycardia. It is not contraindicated unless accompanied by severe heart failure or AV block.

Angina. Verapamil is effective for vasospastic and effort-related angina by dilating coronary arteries and reducing myocardial oxygen demand. It is a first-line or adjunct therapy in clients with stable or Prinzmetal’s angina.

“Nausea and vomiting.” These are not common or expected acute effects of adenosine. While mild nausea may occur occasionally, it is not the primary concern during IV administration and does not necessitate immediate monitoring.

“Muscle tetany.” Adenosine does not affect skeletal muscle function or calcium channels in a manner that produces tetany. Monitoring for this is unnecessary.

“Hypertension.” Adenosine typically causes transient hypotension, not hypertension, due to its vasodilatory and AV nodal slowing effects. Therefore, preparing for hypertension is inappropriate.

“This is an expected side effect and should go away soon.” Blue-gray pigmentation is not transient and may persist despite continued therapy. Describing it as temporary is misleading and may delay provider intervention.

“This is a harmless effect. As long as the medication is working, we’ll just monitor your skin.” While amiodarone efficacy is important, this skin change indicates potential chronic photosensitivity and tissue accumulation, which requires provider evaluation. Passive monitoring alone is unsafe.

“How much sun exposure have you had recently?” Although sun exposure worsens pigmentation, asking this does not address the seriousness of the adverse effect or prompt appropriate clinical action. Immediate provider notification is required.

“Pale and cool extremities.” These findings suggest poor perfusion, which is a sign of ongoing heart failure and inadequate cardiac output. They do not indicate improvement and may signal worsening of the condition.

“Urine output of 60 mL/4 h.” This is below normal expected output (typically 30 mL/h or 120 mL/4 h) and may indicate decreased renal perfusion, a sign of persistent heart failure or pre-renal compromise. It does not reflect improvement.

“Complaints of increasing dyspnea.” Worsening shortness of breath indicates progression or exacerbation of heart failure, suggesting inadequate symptom control. Improvement would be evidenced by decreased dyspnea on exertion and improved activity tolerance.