A nurse is caring for a client who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take?
Weigh the client.
Measure the client's blood pressure.
Measure the client's apical pulse.
Offer the client a light snack.
The Correct Answer is C
Choice A reason: Weighing the client is not a necessary action before administering digoxin, as it does not affect the dosage or effectiveness of the medication. Weighing the client may be important for monitoring fluid balance and edema, but it is not related to digoxin therapy.
Choice B reason: Measuring the client's blood pressure is not a necessary action before administering digoxin, as it does not affect the dosage or effectiveness of the medication. Digoxin is not a blood pressure-lowering medication, but a cardiac glycoside that increases the contractility and efficiency of the heart. Measuring the blood pressure may be important for monitoring hypertension, but it is not related to digoxin therapy.
Choice C reason: Measuring the client's apical pulse is a necessary action before administering digoxin, as it can help determine the safety and appropriateness of the medication. Digoxin can cause bradycardia (slow heart rate) as a side effect, which can be dangerous and symptomatic. The nurse should check the apical pulse for one full minute and withhold the medication if the pulse is below 60 beats per minute or above 100 beats per minute. The nurse should also report any abnormal or irregular rhythms to the provider.
Choice D reason: Offering the client a light snack is not a necessary action before administering digoxin, as it does not affect the absorption or effectiveness of the medication. Digoxin can be taken with or without food. Offering the client a light snack may be important for maintaining nutrition and hydration, but it is not related to digoxin therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Taking this medication with food is not necessary, as lisinopril can be taken with or without food. Food does not affect the absorption or effectiveness of lisinopril.
Choice B reason: Facial swelling is not an expected effect of this medication, but a serious adverse reaction that indicates angioedema. Angioedema is a life-threatening condition that causes swelling of the face, tongue, throat, and airway. It requires immediate medical attention and discontinuation of lisinopril.
Choice C reason: Reporting a cough to the provider is an important instruction, as a cough is a common and annoying side effect of lisinopril. Lisinopril belongs to the class of angiotensin-converting enzyme (ACE) inhibitors, which can cause a dry, persistent, nonproductive cough. The cough may interfere with the client's quality of life and adherence to the medication. The provider may prescribe an alternative medication, such as an angiotensin II receptor blocker (ARB), to avoid the cough.
Choice D reason: Increasing the intake of potassium-rich foods is not advisable, as lisinopril can cause hyperkalemia (high potassium levels) due to decreased potassium excretion in the urine. Clients should monitor their potassium levels and avoid excessive intake of potassium supplements or foods, such as bananas, oranges, potatoes, and tomatoes.
Correct Answer is D
Explanation
Choice A reason: This is incorrect because aspirin is not a suitable medication for preventing venous thromboembolism (VTE) in a client who is postoperative following hip arthroplasty. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that has antiplatelet and analgesic effects, but it is not as effective as anticoagulants for VTE prophylaxis.
Choice B reason: This is incorrect because alteplase is not a medication for preventing VTE, but for treating it. Alteplase is a thrombolytic agent that dissolves existing blood clots by activating plasminogen. It is used for acute ischemic stroke, myocardial infarction, and massive pulmonary embolism, but it has a high risk of bleeding and is contraindicated in clients who have had recent surgery.
Choice C reason: This is incorrect because clopidogrel is not a medication for preventing VTE, but for preventing arterial thrombosis. Clopidogrel is an antiplatelet agent that inhibits the adenosine diphosphate (ADP) receptor on platelets, preventing their aggregation. It is used for clients who have had acute coronary syndrome, percutaneous coronary intervention, or ischemic stroke, but it is not effective for VTE prophylaxis.
Choice D reason: This is correct because enoxaparin is a medication for preventing VTE in a client who is postoperative following hip arthroplasty. Enoxaparin is a low molecular weight heparin (LMWH) that inhibits factor Xa and thrombin, preventing the formation of fibrin. It is administered subcutaneously once or twice daily and does not require routine laboratory monitoring. It has a lower risk of bleeding and heparin-induced thrombocytopenia (HIT) than unfractionated heparin.
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