The patient is ordered Glucerna 1.2 calories. You're supplied with a can of Glucerna that contains 237 mL. The doctor orders the tube feeding to be administered at a 1/2 strength with a rate of 65 mL/hr. How much water will you add to dilute the tube feeding formula as prescribed?

A) Check the weight of the patient:
While weight monitoring is important in managing heart failure and tracking fluid retention, it is not the most critical action before administering digoxin. Digoxin primarily affects heart rate and rhythm, so the priority assessment is related to the cardiovascular system.

B) Check the skin for bruising:
Checking for bruising is not a necessary step before administering digoxin. Bruising could be an indication of an underlying bleeding disorder or anticoagulant therapy, but it is not directly related to the administration of digoxin. The primary concern with digoxin is its effect on the heart, particularly heart rate and rhythm.

C) Check the apical pulse:
It is crucial to check the apical pulse before administering digoxin, as one of the major effects of the drug is to slow the heart rate (negative chronotropy). If the heart rate is below 60 beats per minute (bpm), the nurse should hold the medication and consult the healthcare provider, as digoxin can further decrease the heart rate and lead to bradycardia or other complications.

D) Check the temperature of the patient:
Although monitoring vital signs, including temperature, is important in overall patient care, temperature does not specifically impact the administration of digoxin. A normal or abnormal temperature would not typically influence the decision to give digoxin unless the patient had a fever due to an underlying infection that could complicate the clinical picture. The priority is assessing the pulse to ensure safe administration of the medication.

A) Flushing of the face:
Flushing is a common and usually harmless side effect of nitroglycerin, caused by its vasodilation properties. It often resolves quickly and is not typically a cause for concern. While it can be uncomfortable, it is not a sign of a serious problem that would require immediate medical attention.

B) Dizziness upon standing:
Dizziness upon standing (orthostatic hypotension) is a known side effect of nitroglycerin due to its blood pressure-lowering effects. It typically occurs when the patient rises too quickly from a sitting or lying position. While it can be uncomfortable and may cause the patient to feel lightheaded, it is usually not an emergency and can often be managed by rising slowly. If dizziness persists or is severe, the healthcare provider should be notified, but it is not an immediate emergency.

C) Persistent chest pain that lasts longer than 15 minutes:
Chest pain lasting longer than 15 minutes could indicate a myocardial infarction (heart attack) rather than stable angina, even if nitroglycerin has been administered. Chest pain that is not relieved by nitroglycerin or persists for more than a few minutes is an emergency situation and should be reported immediately to the healthcare provider or emergency services.

D) Mild headache:
Headache is a common and benign side effect of nitroglycerin, caused by its vasodilation effect. It is usually mild and transient and does not require immediate medical attention. In most cases, the headache improves over time or with the use of over-the-counter pain relievers, and it is not a reason to contact the healthcare provider unless it becomes severe or persistent.