A male client with a brain tumor is scheduled for a biopsy in the morning. During the admission procedure, the client has a tonic-clonic seizure that lasts 50 seconds. Following the seizure, the client is lethargic and confused and his wife tells the nurse that her husband has never had a seizure before and has always been alert and communicative. Which action should the nurse take?

Choice A reason: This is a correct answer because obtaining postoperative vital signs for a client one day following unilateral knee arthroplasty is a nursing action that can be assigned to the PN. Vital signs are measurements of the body's basic functions, such as temperature, pulse, blood pressure, and respiration. Vital signs should be monitored regularly after surgery to detect any signs of infection, bleeding, shock, or pain. The PN has the knowledge and skill to measure and record vital signs and report any abnormal findings to the nurse.

Choice B reason: This is a correct answer because performing daily surgical dressing change for a client who had an abdominal hysterectomy is a nursing action that can be assigned to the PN. Surgical dressing is a material that covers and protects a wound from infection, bleeding, or contamination. Surgical dressing should be changed daily or as needed to keep the wound clean and dry and promote healing. The PN has the knowledge and skill to perform surgical dressing change using sterile technique and appropriate equipment and report any signs of wound infection or dehiscence to the nurse.

Choice C reason: Initiating patient controlled analgesia (PCA) pumps for two clients immediately postoperatively is not a nursing action that can be assigned to the PN. PCA pump is a device that allows the client to self-administer pain medication through an IV line by pressing a button. PCA pump should be initiated by the nurse after verifying the prescription, setting the parameters, educating the client, and ensuring safety and effectiveness. The PN does not have the authority or competency to initiate PCA pump or adjust its settings.

Choice D reason: Starting the second blood transfusion for a client twelve hours following a below knee amputation is not a nursing action that can be assigned to the PN. Blood transfusion is a procedure that delivers donated blood or blood products into the client's bloodstream through an IV line. Blood transfusion should be started by the nurse after verifying the prescription, checking the blood type and compatibility, obtaining informed consent, and monitoring for any adverse reactions. The PN does not have the authority or competency to start blood transfusion or manage its complications.

Choice E reason: This is a correct answer because monitoring a dose of warfarin per protocol for a client with type 2 diabetes mellitus (DM) is a nursing action that can be assigned to the PN. Warfarin is an anticoagulant medication that prevents blood clots by inhibiting vitamin K dependent clotting factors. Warfarin should be monitored per protocol by checking the international normalized ratio (INR), which measures how long it takes for blood to clot. The PN has the knowledge and skill to monitor warfarin per protocol by obtaining blood samples, performing point-of-care testing, and reporting results to the nurse.

Choice A reason: Administering a half dose now is not advisable, because it may result in underdosing or overdosing of digoxin. Digoxin has a narrow therapeutic range and a high risk of toxicity, especially in infants and children. The amount of digoxin absorbed by the infant before vomiting is unknown, so giving a partial dose may not achieve therapeutic levels or may exceed safe levels.

Choice B reason: Giving another dose is not advisable, because it may result in overdosing of digoxin. Digoxin has a narrow therapeutic range and a high risk of toxicity, especially in infants and children. The amount of digoxin absorbed by the infant before vomiting is unknown, so giving a full dose may exceed safe levels and cause adverse effects such as nausea, vomiting, bradycardia, arrhythmias, or visual disturbances.

Choice C reason: Mixing the next dose with food is not advisable, because it may affect the absorption and bioavailability of digoxin. Digoxin should be taken on an empty stomach or at least one hour before or two hours after meals, because food can interfere with its absorption from the gastrointestinal tract and reduce its effectiveness.

Choice D reason: Withholding this dose is the best instruction for the nurse to provide to this mother. Digoxin has a long half-life and accumulates in tissues, so missing one dose will not significantly affect its therapeutic effect. Withholding this dose will avoid overdosing and toxicity of digoxin, which can be life-threatening in infants and children. The nurse should also advise the mother to resume the regular dosing schedule and monitor the infant's pulse rate and signs of digoxin toxicity.