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.

Answer and Explanation

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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Correct Answer is B

Explanation

Choice A rationale:

BUN (blood urea nitrogen) measures kidney function and hydration status but is not a specific indicator for withholding triamterene.

Choice B rationale:

Triamterene is a potassium-sparing diuretic. With a potassium level of 5.3 mEq/L, which is elevated, the nurse should withhold the medication to prevent further potassium retention.

Choice C rationale:

Sodium level of 142 mEq/L is within the normal range and does not indicate a need to withhold triamterene.

Choice D rationale:

Albumin level of 4 g/dL is within the normal range and does not directly impact the decision to withhold triamterene.

A. The client tests negative for HIV. B. The client has a positive purified protein derivative test. C. The client has a negative sputum culture. D. The client's liver function test results are within the expected reference range.

Correct Answer is C

Explanation

Choice A rationale:

Testing negative for HIV does not mean that the client is taking the antibiotics as prescribed. HIV is a virus that weakens the immune system and makes people more susceptible to tuberculosis, but it is not related to the medication regimen for tuberculosis.

Choice B rationale:

having a positive purified protein derivative test does not mean that the client is taking the antibiotics as prescribed. A purified protein derivative test is a skin test that checks for exposure to tuberculosis bacteria, but it does not measure the effectiveness of the medication regimen. A positive test means that the client has been exposed to tuberculosis bacteria at some point in their life, but it does not mean that they have an active infection or that they are taking the antibiotics as prescribed.

Choice C rationale:

The client has a negative sputum culture. A sputum culture is a test that checks for the presence of tuberculosis bacteria in the mucus that is coughed up from the lungs. A negative sputum culture means that the bacteria are no longer detectable and that the medication regimen is effective. A positive sputum culture means that the bacteria are still present and that the medication regimen may need to be adjusted.

Choice D rationale:

Having normal liver function test results does not mean that the client is taking the antibiotics as prescribed. Liver function tests are blood tests that check for damage to the liver caused by medications or other factors. Isoniazid and rifampin can cause liver damage, so the nurse should monitor the client's liver function tests regularly to prevent or detect any problems. However, having normal liver function test results does not mean that the client is taking the antibiotics as prescribed or that the medication regimen is effective.

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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 placing them in the order of performance. Use all the steps.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is taking triamterene. For which of the following laboratory values should the nurse withhold the medication?

Correct Answer is B

Explanation

A nurse is caring for a client who has tuberculosis and is taking isoniazid and rifampin. Which of the following outcomes indicates that the client is adhering to the medication regimen?

Correct Answer is C

Explanation

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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 placing them in the order of performance. Use all the steps.)