The nurse is caring for a client diagnosed with iron deficiency anemia as the result of a gastrointestinal (GI) bleed. What discharge instruction should the nurse provide if this client is also prescribed aspirin 81 mg daily?

Choice A reason: This is not a correct interpretation. An occlusion of the right coronary artery is a blockage of the blood flow to the right side of the heart, which can cause a heart attack or ischemia. This condition does not produce a systolic murmur, but rather chest pain, shortness of breath, sweating, or nausea. A systolic murmur is a sound that occurs during the contraction of the heart, when the blood flows through a narrowed or leaky valve.

Choice B reason: This is not a correct interpretation. An aneurysm of the descending aorta is a bulging or weakening of the wall of the large artery that carries blood from the heart to the lower body. This condition does not produce a systolic murmur, but rather a pulsating mass in the abdomen, back pain, or abdominal pain. A systolic murmur is a sound that occurs during the contraction of the heart, when the blood flows through a narrowed or leaky valve.

Choice C reason: This is not a correct interpretation. Decreased fluid in the pericardial sac is a condition where the amount of fluid that surrounds and cushions the heart is reduced. This can be caused by dehydration, infection, or inflammation. This condition does not produce a systolic murmur, but rather a pericardial friction rub, which is a scratching or grating sound that occurs when the layers of the pericardium rub against each other. A systolic murmur is a sound that occurs during the contraction of the heart, when the blood flows through a narrowed or leaky valve.

Choice D reason: This is the correct interpretation. Distortion of one or more heart valves is a condition where the shape or function of the valves that regulate the blood flow through the heart is altered. This can be caused by congenital defects, rheumatic fever, endocarditis, or aging. This condition can produce a systolic murmur, which is a sound that occurs during the contraction of the heart, when the blood flows through a narrowed or leaky valve. The location and the intensity of the murmur can help identify which valve is affected. A systolic murmur in the second intercostal space to the right of the sternum can indicate a problem with the aortic valve.

Choice A reason: Placing the patch on the anterior chest is not the best discharge instruction for this client. Clonidine is a drug that lowers blood pressure by stimulating alpha-2 receptors in the brain. ¹ The patch delivers the drug through the skin and into the bloodstream. ² The patch should be applied to a hairless area on the upper arm or torso, not the chest, to ensure proper absorption and avoid irritation. ³

Choice B reason: Removing the patch if a headache develops is not a good discharge instruction for this client. Headache is a common side effect of clonidine, especially when starting or changing the dose. ² Removing the patch abruptly may cause a rebound increase in blood pressure, which can be dangerous. ³ The client should keep the patch on for 7 days, unless instructed otherwise by the provider, and report any severe or persistent headaches.

Choice C reason: Rotating the application sites and inspecting the skin is the best discharge instruction for this client. Rotating the sites helps prevent skin irritation and allergic reactions from the patch. ³ Inspecting the skin helps detect any signs of infection, inflammation, or rash that may require medical attention. The client should also wash the old site with soap and water after removing the patch. ²

Choice D reason: Monitoring weight on a daily basis is not a necessary discharge instruction for this client. Weight is not a sensitive indicator of the effectiveness or safety of clonidine therapy. Weight may be monitored periodically to assess the client's fluid status and possible signs of heart failure, which clonidine can help prevent. ¹ However, this is not a priority action for the client using the patch.