The physician orders a dose of procainamide to be administered to a patient. Which of the following is most important for the nurse to assess before administering this medication?  


• Procainamide is an antiarrhythmic agent used for both ventricular and atrial arrhythmias. Procainamide can cause or worsen hypotension and bradycardia, so it is important to know baseline measurements of these two vital signs before administering procainamide.  

• The nurse should assess the patient's vital signs, particularly the blood pressure and heart rate, before administering any antiarrhythmic. Depending on the arrhythmia, oxygen saturation may also be low (as a result of low cardiac output) and oxygen may need to be administered as well.

• Urine output, BUN and creatinine, and hemoglobin are all values the nurse should monitor for each patient, but these are not directly affected by the administration of procainamide. It is more important to have baseline measurements for blood pressure and heart rate. However, urine output may be decreased due to low blood perfusion of the kidneys caused by decreased cardiac output. Low hemoglobin may contribute to certain arrhythmias. An elevated BUN and creatinine (as with kidney disease) may call for an adjusted dose of procainamide.

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