A client who has had long standing hypertension has been prescribed a clonidine patch. Which discharge instruction should the nurse provide?

Place the patch on the anterior chest.

Remove the patch if a headache develops.

Rotate the application sites and inspect the skin.

Monitor weight on a daily basis.

Answer and Explanation

The Correct Answer is C

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.

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Correct Answer is C

Explanation

Choice A reason: This is incorrect. Assessing the apical pulse is not enough to determine if the client is safe to receive digoxin. The client's digoxin level is already above the therapeutic range of 0.5 to 2 ng/mL¹² and giving another dose could increase the risk of toxicity and arrhythmias.

Choice B reason: This is incorrect. Administering 0.25 mcg of digoxin and potassium 20 mEq IV is not appropriate for this client. The client does not need more digoxin or potassium, as both could worsen the client's condition. Potassium levels should be monitored closely in clients taking digoxin, as low or high levels can affect the drug's action and toxicity³.

Choice C reason: This is correct. Withholding the medication and notifying the healthcare provider of the digoxin level is the most appropriate action for this client. The client's digoxin level is dangerously high and could cause serious adverse effects such as nausea, vomiting, vision changes, bradycardia, and cardiac arrest³. The healthcare provider may order to stop digoxin temporarily, adjust the dose, or prescribe an antidote such as digoxin immune fab⁴.

Choice D reason: This is incorrect. Administering the digoxin with a potassium supplement is not advisable for this client. The client's digoxin level is already too high and adding potassium could increase the risk of hyperkalemia, which can impair the heart's electrical activity and lead to cardiac arrest³. Potassium supplements should only be given to clients with digoxin-induced hypokalemia, and only under the supervision of the healthcare provider³..

A. Take a baby aspirin with a full glass of cold water at bedtime. B. You can take 81 mg of enteric coated aspirin with orange juice at lunch time. C. It's ok to take the aspirin with some ginseng tea in the evening. D. Take the aspirin with a glass of milk or food in the morning.

Correct Answer is D

Explanation

Choice A reason: Taking a baby aspirin with a full glass of cold water at bedtime is not a good discharge instruction for this client. Aspirin can increase the risk of bleeding, especially in the stomach and intestines. ¹ Taking aspirin at bedtime may increase the exposure of the GI mucosa to the drug and worsen the bleeding. ² Cold water may also irritate the stomach lining and cause discomfort.

Choice B reason: Taking 81 mg of enteric coated aspirin with orange juice at lunch time is not a good discharge instruction for this client. Enteric coated aspirin is designed to dissolve in the small intestine, not the stomach, to reduce the risk of GI bleeding. ³ However, orange juice is acidic and may damage the coating and release the aspirin in the stomach. ⁴ This may increase the bleeding and cause pain or ulcers.

Choice C reason: Taking the aspirin with some ginseng tea in the evening is not a good discharge instruction for this client. Ginseng is an herbal supplement that may interact with aspirin and increase the risk of bleeding. ⁵ Taking the aspirin in the evening may also have the same drawbacks as taking it at bedtime, as explained in choice A.

Choice D reason: Taking the aspirin with a glass of milk or food in the morning is the best discharge instruction for this client. Milk and food can help protect the stomach lining from the irritating effects of aspirin and reduce the risk of bleeding. Taking the aspirin in the morning can also minimize the exposure of the GI mucosa to the drug during the night, when the stomach is empty and more vulnerable. ²

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A client who has had long standing hypertension has been prescribed a clonidine patch. Which discharge instruction should the nurse provide?

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Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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