The nurse is evaluating the blood pressure for a client with hypertension who is taking a prescribed diuretic, an angiotensin-converting enzyme (ACE) inhibitor, and an angiotensin II receptor blocker (ARB). The client's first blood pressure is 145/92 mm Hg and the second measurement obtained is 150/89 mm Hg. Which of the following actions should the nurse take first?

Choice A rationale

Exposure to cold climates does not directly prevent or mitigate symptoms of thalassemia. Thalassemia involves abnormalities in hemoglobin production, leading to anemia. Climate factors do not influence this pathophysiology. The emphasis for management lies in optimizing red blood cell health and addressing anemia-related complications.

Choice B rationale

Increasing oral fluid intake does not have a specific effect on the prevention of thalassemia symptoms. While adequate hydration is essential for overall health, it does not target the underlying genetic causes of hemoglobinopathies, such as mutations in alpha or beta-globin chains.

Choice C rationale

Iron and vitamin B12-rich diets may worsen complications in thalassemia. Individuals with thalassemia, especially those receiving frequent blood transfusions, are at risk of iron overload. B12 supplementation is beneficial only when deficiency exists, but routine intake does not manage thalassemia symptoms.

Choice D rationale

Many medications and substances, such as oxidative drugs, can exacerbate hemolysis or interact with blood transfusion protocols in thalassemia patients. Reviewing these lists helps prevent complications, thereby reducing symptom severity and improving management outcomes.

Choice A rationale

Referring the client to see an optometrist is inappropriate because visual disturbances can be a sign of digoxin toxicity, which requires immediate medical attention rather than routine visual examination. Toxicity manifests due to elevated serum digoxin levels, with symptoms including blurred vision and yellow-green halos. Normal digoxin range is 0.5-2.0 ng/mL.

Choice B rationale

Asking if the client wears glasses or contact lenses does not address the root cause of visual disturbances, which is likely linked to digoxin toxicity. Such queries delay prompt medical intervention needed to evaluate and manage the client’s condition. Ocular aids are unrelated to pharmacological adverse effects.

Choice C rationale

Obtaining a prescription for stat laboratory tests is essential for assessing serum digoxin levels and electrolytes, particularly potassium, as hypokalemia increases sensitivity to digoxin toxicity. Prompt identification of toxicity allows timely interventions, including discontinuation of digoxin or administration of antidotes like Digibind.

Choice D rationale

Obtaining the client’s blood pressure is irrelevant in this scenario, as visual disturbances are not indicative of blood pressure abnormalities but rather digoxin toxicity. Immediate focus should be on confirming and managing toxicity through laboratory evaluation and clinical assessment.