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A nurse is caring for a client who has heart failure and has been taking digoxin 0.25 mg daily. The client refuses breakfast and reports nausea. Which of the following actions should the nurse take first?

A.

Suggest that the client rests before eating the meal.

B.

Check the client's vital signs.

C.

Request a dietary consult.

D.

Request an order for an antiemetic.

Answer and Explanation

The Correct Answer is B

A. Suggest that the client rests before eating the meal. Although rest can help with nausea, it does not address the potential issue of digoxin toxicity, which can cause nausea.

 

B. Check the client's vital signs. Checking vital signs, especially heart rate, is the priority because nausea can indicate digoxin toxicity, which affects heart function.

 

C. Request a dietary consult. A dietary consult may be helpful if the client continues to refuse meals, but it does not address the immediate potential for digoxin toxicity.

 

D. Request an order for an antiemetic. Although an antiemetic may help with nausea, assessing for toxicity takes priority.


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View Related questions

Correct Answer is A

Explanation

A. To prevent blood clotting: Aspirin is an antiplatelet agent, and it reduces blood clot formation, which helps prevent further cardiac events after an MI.

B. To reduce inflammation: Although aspirin has anti-inflammatory properties, this is not the primary reason for its use in post-MI clients.

C. To prevent fever: Aspirin can reduce fever, but this is not its purpose in MI prevention.

D. To provide analgesia: Aspirin can relieve pain, but in this context, it is used to prevent blood clotting, not as an analgesic.

Correct Answer is B

Explanation

A. "Your heart condition is caused from stiffening of the walls of the ventricles." Stiffening of the ventricular walls describes restrictive cardiomyopathy, not DCM.

B. "Your heart condition is caused by excessive stretching of the ventricles." DCM involves excessive stretching and thinning of the ventricular walls, leading to impaired contraction.

C. "Your heart condition is caused when the ventricular tissue becomes fibrous and fatty." This describes arrhythmogenic right ventricular dysplasia, not DCM.

D. "Your heart condition is caused by thickening of the ventricular walls and septum." This describes hypertrophic cardiomyopathy, not DCM.

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