A nurse is preparing to administer digoxin orally to a client. Identify the sequence of steps the nurse should take.
(Move the steps 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.
Open the medication package.
Document administration of the medication.
The Correct Answer is A,B,C,D
Choice A rationale:
The first step is to remove the medication from the dispensing system. This ensures that the nurse has the right medication and dose for the client. The nurse should also check the label of the medication against the medication administration record (MAR) at this point. Choice B rationale:
The second step is to compare the client's wristband to the MAR. This verifies the client's identity and prevents medication errors. The nurse should use two identifiers, such as name and date of birth, to confirm the client's identity.
Choice C rationale:
The third step is to open the medication package. This prepares the medication for administration and prevents contamination. The nurse should also check the expiration date of the medication before opening it.
Choice D rationale:
The fourth step is to document administration of the medication. This completes the medication administration process and provides a record of the client's care. The nurse should document the medication name, dose, route, time, and any relevant observations or outcomes.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Taking ferrous gluconate with 8 ounces of milk is incorrect. Calcium in milk can interfere with the absorption of iron, reducing its effectiveness. The client should be instructed to avoid taking iron supplements with dairy products.
B. It is not necessary to notify the provider if stools turn black. Black stools are a common and harmless side effect of iron supplementation due to the unabsorbed iron in the gastrointestinal tract. The client should be informed of this expected side effect.
C. Taking an antacid with ferrous gluconate is incorrect. Antacids can reduce the absorption of iron by altering the stomach's pH. If the client experiences stomach upset, the medication can be taken with food, although this may slightly reduce absorption.
D. Staying upright for at least 15 minutes after taking ferrous gluconate is correct. This practice helps prevent esophageal irritation, which can occur if the medication remains in contact with the esophageal lining. This statement indicates an understanding of the teaching.
Correct Answer is C
Explanation
Choice A rationale:
A hematocrit (Hct) value of 44% is within the expected range and does not require immediate reporting.
Choice B rationale:
A white blood cell (WBC) count of 5,000/mm3 falls within the normal range and does not require immediate reporting.
Choice C rationale:
Elevated total bilirubin levels can indicate potential liver dysfunction, which can be a concern when a client is taking medications like amitriptyline. The nurse should report this value for further evaluation.
Choice D rationale:
A potassium level of 4.2 mEq/L is within the normal range and does not require immediate reporting.
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