Order: Digoxin 0.25 mg

On hand: 250 mcg tablets

How many tablets will the nurse give?

Choice A reason: This is incorrect because 30 minutes is too long to wait for reassessing a client with chest pain. Nitroglycerin has a rapid onset of action and should relieve chest pain within 5 minutes. If not, the client may need another dose or emergency care.

Choice B reason: This is correct because 5 minutes is the appropriate time to reassess a client after administering nitroglycerin sublingual. The nurse should check the client's blood pressure, heart rate, and pain level. If the pain persists, the nurse should follow the protocol for giving another dose or calling for help.

Choice C reason: This is incorrect because 1 hour is too long to wait for reassessing a client with chest pain. Nitroglycerin has a short duration of action and may need to be repeated every 5 minutes for up to 3 doses. Waiting for an hour may put the client at risk of worsening cardiac ischemia or infarction.

Choice D reason: This is incorrect because 15 minutes is too long to wait for reassessing a client with chest pain. Nitroglycerin should have an effect within 5 minutes. If the pain is not relieved by then, the client may need another dose or emergency care.

Choice A reason: Diet cola PO is not an appropriate recommendation for a client with a blood glucose of 30, because diet cola does not contain any sugar and will not raise the blood glucose level. Moreover, the client is lethargic and unable to follow commands, which means they may have difficulty swallowing and may aspirate the liquid.

Choice B reason: Dextrose 50% IV is a potential recommendation for a client with a blood glucose of 30, because it can rapidly increase the blood glucose level and reverse the symptoms of hypoglycemia. However, the nurse is unable to get an IV line started on the client, which makes this option impossible.

Choice C reason: Glucagon IM is the best recommendation for a client with a blood glucose of 30, because it can stimulate the liver to release glucose into the bloodstream and raise the blood glucose level. Glucagon can be given intramuscularly or subcutaneously, which does not require an IV access. Glucagon is usually given as an emergency treatment for severe hypoglycemia when the client is unconscious or unable to swallow.

Choice D reason: Insulin glargine SQ is not an appropriate recommendation for a client with a blood glucose of 30, because insulin glargine is a long-acting insulin that lowers the blood glucose level. Giving insulin to a client with hypoglycemia can worsen their condition and cause coma or death. ⁹