A nurse is preparing to administer digoxin orally to a client. Identify the sequence of steps the nurse should take (Move the steps into the box on the right, placing them in the order of performance. Use all the steps)

Remove the medication from the dispensing system.

Compare the client’s wristband to the medication administration record.

Document administration of the medication.

Open the medication package.

Obtain the client’s apical heart rate.

Answer and Explanation

The Correct Answer is E, A, B, D, C

Before administering digoxin, the nurse should check the patient's apical heart rate. If the heart rate is below 60 beats per minute for an adult, or below the prescribed limit for a child, the nurse should hold the medication and notify the healthcare provider. This is the first step because the nurse needs to have the medication in hand before proceeding with the other steps. This step is crucial to ensure that the right medication is being given to the right patient. It's a part of the "five rights" of medication administration: right patient, right medication, right dose, right route, and right time. Once the nurse has confirmed the patient's identity and heart rate, the next step is to open the medication package. After administering the medication, the nurse should document it in the patient's medical record. This is important for maintaining an accurate record of the patient's medication history.

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Correct Answer is B

Explanation

B. Thrombocytopenia, or low platelet count, increases the risk of spontaneous bleeding, which can manifest as occult blood in the urine or stool. Regular monitoring allows for early detection of bleeding complications, prompting timely intervention and preventing further complications.
A. While using a large gauge IV catheter may be appropriate to minimize trauma and bleeding risk during blood sampling in a client with thrombocytopenia, it is not the highest priority intervention.
C. Removing cold and frozen foods from dietary trays may be advised in clients with thrombocytopenia to minimize the risk of cold-induced platelet aggregation and potential vascular occlusion, known as cold agglutinin disease. However, this intervention is not directly related to preventing bleeding complications associated with thrombocytopenia.
D. Wrapping bruised areas with elastic bandage dressings may provide support and protection but is not the most appropriate intervention for managing thrombocytopenia-related bleeding complications.

A. Use a space heater to keep the workspace warm. B. Take a multivitamin that contains vitamin D daily. C. Keep both hands elevated during work breaks. D. Obtain a keyboard designed to limit wrist flexion.

Correct Answer is A

Explanation

A. Raynaud's syndrome is characterized by vasospasm of the small arteries, often triggered by exposure to cold temperatures or stress. Keeping the workspace warm can help prevent vasospasm and reduce the risk of Raynaud's attacks while the client is working. Using a space heater or adjusting the office temperature can help maintain a comfortable environment for the client.
B. While vitamin D supplementation may have various health benefits, it is not specifically indicated for managing Raynaud's syndrome.
C. Elevating the hands during work breaks may help reduce swelling or discomfort associated with certain conditions, but it is not a specific recommendation for managing Raynaud's syndrome. Elevating the hands may not address the underlying issue of reduced blood flow to the fingers that occurs during Raynaud's attacks.
D. Limiting wrist flexion may help reduce strain on the wrists and hands but would not directly address the symptoms of Raynaud's syndrome related to blood flow. While ergonomic keyboards can be beneficial for preventing repetitive strain injuries and improving comfort during typing, they are not specifically indicated for managing Raynaud's syndrome.

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A nurse is preparing to administer digoxin orally to a client. Identify the sequence of steps the nurse should take (Move the steps into the box on the right, placing them in the order of performance. Use all the steps)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

A client who works as a data entry clerk is concerned as to how a recent diagnosis of Raynaud's syndrome is going to affect the client's job performance. Which instruction should the nurse provide this client?

Correct Answer is A

Explanation

Patient Data Exhibits After administration of medication, the client remains short of breath. Wheezes are noted bilaterally. Oxygen saturation is 91% with supplemental oxygen. Which action(s) should the nurse take next? Select all that apply.

Exhibits What order(s) should the nurse anticipate being prescribed after an update is reported to the healthcare providers? Select all that apply.

A client who had colon surgery 3 days ago is anxious and requesting assistance to reposition. While the nurse is turning the client, the wound dehisces and eviscerates. The nurse moistens an available sterile dressing and places it over the wound. Which intervention should the nurse implement next?

Patient Data Exhibits The nurse has identified the priority problem for the client and now must determine proper care interventions. Based on the client's history and the assessment data, what action(s) should the nurse anticipate? Select all that apply.

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The nurse assesses a client with petechiae and ecchymosis scattered across the arms and legs. Which laboratory result should the nurse review?

Which dietary instruction is most important for the nurse to explain to a client who has had gastric bypass surgery?