When should the nurse reassess a client after administering 0.4 mg nitroglycerin sublingual to a client with chest pain?

Choice A reason: This choice is incorrect because there is no need to recheck the heart rate in one hour before giving the digoxin. The client's apical heart rate is within the normal range (60 to 100 beats per minute) and does not indicate bradycardia (slow heart rate), which is a sign of digoxin toxicity. The nurse should check the apical heart rate for one full minute before giving the digoxin and withhold the dose if the heart rate is below 60 beats per minute.

Choice B reason: This choice is correct because the client's digoxin level is within the therapeutic range (0.5 to 2.0 ng/mL) and does not indicate digoxin toxicity or underdosing. The client's vital signs and labs are also stable and do not indicate any adverse effects of digoxin. Digoxin is a cardiac glycoside that improves the contractility and efficiency of the heart and helps to control the heart rate and rhythm in clients with heart failure. The nurse should give the digoxin as ordered and monitor the client's response and digoxin level.

Choice C reason: This choice is incorrect because there is no indication for a chest x-ray for this client. A chest x-ray is a diagnostic test that can show the size and shape of the heart and lungs and detect any abnormalities, such as fluid accumulation, infection, or tumors. The client's symptoms and labs do not suggest any pulmonary complications or worsening of heart failure that would require a chest x-ray. The nurse should follow the provider's orders and protocols for chest x-ray indications.

Choice D reason: This choice is incorrect because there is no reason to hold the digoxin and call the MD for this client. The client's digoxin level is not too high or too low and does not require dose adjustment or discontinuation. The client's vital signs and labs are also normal and do not indicate any signs of digoxin toxicity or adverse effects. Holding the digoxin could cause the client's heart failure to worsen or cause arrhythmias. The nurse should only hold the digoxin and call the MD if the client has signs of digoxin toxicity, such as nausea, vomiting, visual disturbances, confusion, or bradycardia. .

Choice A reason: This choice is incorrect because fluids should not be limited to 1000 mL daily for a client taking hydrochlorothiazide. Hydrochlorothiazide is a diuretic that causes the body to lose water and salt through urine. Limiting fluids can lead to dehydration, electrolyte imbalance, and kidney damage. The client should drink enough fluids to prevent thirst and dry mouth, and follow the doctor's advice on fluid intake.

Choice B reason: This choice is incorrect because this medication is not best taken at night for a client taking hydrochlorothiazide. Hydrochlorothiazide can cause frequent urination, which can disrupt the sleep cycle and cause fatigue. The client should take this medication in the morning or at least 4 hours before bedtime to avoid nocturia (nighttime urination).

Choice C reason: This choice is incorrect because dairy products should not be avoided while on this medication for a client taking hydrochlorothiazide. Hydrochlorothiazide can lower the level of calcium in the blood, which can cause muscle weakness, cramps, and osteoporosis. Dairy products are a good source of calcium and can help prevent calcium deficiency. The client should consume adequate amounts of calcium and vitamin D, and have their blood calcium level checked regularly.

Choice D reason: This choice is correct because the client should consume high potassium foods such as bananas and oranges while on this medication. Hydrochlorothiazide can lower the level of potassium in the blood, which can cause irregular heartbeat, muscle weakness, and numbness. Potassium-rich foods can help prevent potassium deficiency and maintain normal heart and muscle function. The client should also have their blood potassium level checked regularly and avoid salt substitutes that contain potassium.