A nurse is caring for a client who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take?
Weigh the client.
Measure the client's blood pressure.
Measure the client's apical pulse.
Offer the client a light snack.
The Correct Answer is C
Choice A reason: Weighing the client is not a necessary action before administering digoxin, as it does not affect the dosage or effectiveness of the medication. Weighing the client may be important for monitoring fluid balance and edema, but it is not related to digoxin therapy.
Choice B reason: Measuring the client's blood pressure is not a necessary action before administering digoxin, as it does not affect the dosage or effectiveness of the medication. Digoxin is not a blood pressure-lowering medication, but a cardiac glycoside that increases the contractility and efficiency of the heart. Measuring the blood pressure may be important for monitoring hypertension, but it is not related to digoxin therapy.
Choice C reason: Measuring the client's apical pulse is a necessary action before administering digoxin, as it can help determine the safety and appropriateness of the medication. Digoxin can cause bradycardia (slow heart rate) as a side effect, which can be dangerous and symptomatic. The nurse should check the apical pulse for one full minute and withhold the medication if the pulse is below 60 beats per minute or above 100 beats per minute. The nurse should also report any abnormal or irregular rhythms to the provider.
Choice D reason: Offering the client a light snack is not a necessary action before administering digoxin, as it does not affect the absorption or effectiveness of the medication. Digoxin can be taken with or without food. Offering the client a light snack may be important for maintaining nutrition and hydration, but it is not related to digoxin therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: The client has a history of hypertension is not the correct answer. Hypertension is a condition in which the blood pressure is abnormally high, usually above 140/90 mmHg. Propranolol is a beta-blocker that lowers the blood pressure and reduces the workload of the heart. Propranolol is indicated for the treatment of hypertension and angina pectoris, which is a type of chest pain caused by reduced blood flow to the heart. The nurse does not need to report this finding to the provider, as it is consistent with the prescription.
Choice B reason: The client has a history of hypothyroidism is not the correct answer. Hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormones, which regulate the metabolism and energy levels. Propranolol can mask some of the signs of hypothyroidism, such as tachycardia, tremors, and anxiety. Propranolol can also interfere with the absorption and conversion of thyroid hormones. The nurse should monitor the client's thyroid function tests and report any abnormal values to the provider, but this finding is not a contraindication to the use of propranolol.
Choice C reason: The client has a history of bronchial asthma is the correct answer. Bronchial asthma is a chronic inflammatory disorder of the airways that causes wheezing, coughing, and shortness of breath. Propranolol is a non-selective beta-blocker that blocks the beta-1 receptors in the heart and the beta-2 receptors in the lungs. Blocking the beta-2 receptors can cause bronchoconstriction, which can worsen the symptoms of asthma and trigger an asthma attack. Propranolol is contraindicated in clients who have bronchial asthma, and the nurse should report this finding to the provider immediately.
Choice D reason: The client has a history of migraine headaches is not the correct answer. Migraine headaches are recurrent episodes of severe and throbbing pain, usually on one side of the head, that can be accompanied by nausea, vomiting, and sensitivity to light and sound. Propranolol is effective in preventing migraine headaches, as it reduces the frequency and severity of the attacks. Propranolol is indicated for the prophylaxis of migraine headaches, and the nurse does not need to report this finding to the provider, as it is consistent with the prescription.
Correct Answer is C
Explanation
Choice A reason: Naloxone is not the correct medication. Naloxone is an opioid antagonist that reverses the effects of opioid overdose, such as respiratory depression, sedation, and hypotension. Naloxone has no effect on magnesium sulfate, which is a mineral and electrolyte that is used to prevent seizures in clients with preeclampsia or eclampsia.
Choice B reason: Protamine is not the correct medication. Protamine is a heparin antagonist that reverses the effects of heparin overdose, such as bleeding, bruising, and thrombocytopenia. Protamine has no effect on magnesium sulfate, which is not an anticoagulant.
Choice C reason: Calcium gluconate is the correct medication. Calcium gluconate is a calcium salt that antagonizes the effects of magnesium sulfate overdose, such as hypotension, bradycardia, respiratory depression, and muscle weakness. Calcium gluconate is the antidote for magnesium sulfate toxicity, which can occur when the serum magnesium level is above 7.5 mEq/L. The nurse should monitor the client's vital signs, deep tendon reflexes, and urine output, and report any signs of toxicity to the provider.
Choice D reason: Flumazenil is not the correct medication. Flumazenil is a benzodiazepine antagonist that reverses the effects of benzodiazepine overdose, such as drowsiness, confusion, and coma. Flumazenil has no effect on magnesium sulfate, which is not a sedative.
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