A nurse is reviewing the prescriptions for a client who is pregnant and is taking digoxin. Which of the following actions should the nurse take to best evaluate the client's medication adherence?
Ask the client if they are taking the medication as prescribed.
Determine the client's apical pulse rate.
Check the client's serum medication level.
Assess the client's kidney function.
The Correct Answer is C
Explanation
Choice A Reason:
While asking the client can provide some information, it relies on self-reporting, which may not always be accurate. Clients might forget doses, misunderstand instructions, or provide inaccurate information, whether intentional or unintentional. Therefore, this method is not the most reliable way to assess medication adherence.
Choice B Reason:
Digoxin can affect the heart rate, so checking the apical pulse is important for monitoring potential side effects, such as bradycardia. However, the pulse rate alone does not provide direct evidence of whether the client is taking the medication consistently or correctly. The pulse can be influenced by various factors and may not accurately reflect medication adherence.
Choice C Reason:
Checking the serum medication level provides an objective measurement of whether the client is taking digoxin as prescribed. This is a direct indicator of medication adherence and is particularly important for a medication like digoxin, which requires precise dosing to avoid toxicity or subtherapeutic effects.
Choice D Reason:
Assessing kidney function is crucial when managing a client on digoxin because impaired kidney function can lead to digoxin toxicity. However, this assessment does not directly measure whether the client is taking the medication as prescribed. It's more about ensuring the safe use of the drug rather than evaluating adherence.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Explanation
Choice A Reason:
Flank pain is correct. Pyelonephritis is a urinary tract infection (UTI) that involves the kidneys. Common manifestations of pyelonephritis include flank pain, which is usually unilateral and may be accompanied by fever, chills, and malaise. Flank pain is often described as a deep, dull ache or a sharp, stabbing pain in the back or side of the affected kidney.
Choice B Reason:
A temperature of 37.7°C (99.8°F) may indicate a low-grade fever, which can be associated with pyelonephritis. However, fever alone is not specific to pyelonephritis and can occur with various infections or inflammatory conditions.
Choice C Reason:
Abdominal cramping is not a typical manifestation of pyelonephritis. While some individuals with pyelonephritis may experience nonspecific abdominal discomfort or pain, the hallmark symptom is flank pain, which is localized to the back or side overlying the affected kidney.
Choice D Reason:
Epigastric discomfort, or discomfort in the upper abdomen, is not a typical manifestation of pyelonephritis. Epigastric discomfort is more commonly associated with gastrointestinal issues such as gastritis, peptic ulcer disease, or gallbladder problems. In pyelonephritis, the pain is typically localized to the flank region.
Correct Answer is D
Explanation
Explanation
Choice A Reason:
Obtaining a specimen for a Kleihauer-Betke test is incorrect. The Kleihauer-Betke test is used to determine the fetal-maternal hemorrhage in cases of Rh-negative mothers, particularly after delivery. However, in the immediate postpartum period with uterine atony and significant bleeding, the priority is to control bleeding and stabilize the patient's condition. Obtaining a Kleihauer-Betke test can be done later if indicated, but it is not the immediate action for managing uterine atony.
Choice B Reason:
Administering betamethasone IM is incorrect. Betamethasone is a corticosteroid commonly used to promote fetal lung maturity when preterm birth is anticipated. It is not indicated for managing uterine atony or postpartum hemorrhage.
Choice C Reason:
Avoiding performing sterile vaginal examinations is incorrect. Sterile vaginal examinations may be necessary to assess the extent of cervical dilation, evaluate the presence of any retained products of conception, or assist with the placement of interventions such as uterine massage or administration of medications. However, avoiding or minimizing vaginal examinations alone does not address the underlying cause of uterine atony or control postpartum hemorrhage. Therefore, it is not the most appropriate immediate action.
Choice D Reason:
Anticipating a prescription for misoprostol is correct. Uterine atony, characterized by the inability of the uterus to contract effectively after childbirth, is a significant cause of postpartum hemorrhage. Misoprostol, a prostaglandin E1 analogue, is commonly used to manage uterine atony and prevent or control postpartum hemorrhage. It helps to stimulate uterine contractions and reduce bleeding by promoting uterine muscle tone.
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