A nurse is caring for a client who refuses a prescribed influenza immunization. Which of the following actions should the nurse take first?
Ask the client to describe their concerns.
Contact the provider who prescribed the immunization.
Provide the client with education about the immunization.
Document the client’s refusal of the immunization.
The Correct Answer is A
Choice A rationale
Asking the client to describe their concerns allows the nurse to understand the client’s perspective and address any misconceptions or fears they may have about the influenza immunization.
Choice B rationale
Contacting the provider is important but should be done after understanding the client’s concerns to provide a comprehensive report.
Choice C rationale
Providing education is essential but should follow understanding the client’s specific concerns to tailor the information effectively.
Choice D rationale
Documenting the refusal is necessary but should be done after addressing the client’s concerns and providing education.
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Correct Answer is A
Explanation
Choice A rationale
Vomiting is a common sign of digoxin toxicity. Other symptoms include nausea, confusion, and visual disturbances.
Choice B rationale
Dilated pupils are not a typical sign of digoxin toxicity. Symptoms are more related to gastrointestinal and cardiac effects.
Choice C rationale
Bruising is not directly associated with digoxin toxicity. It may indicate other issues such as coagulopathy.
Choice D rationale
Peripheral edema is not a specific sign of digoxin toxicity. It is more commonly associated with heart failure.
Correct Answer is C
Explanation
Choice A rationale
Metoclopramide is not used to suppress cough. It is primarily used to treat nausea, vomiting, and gastroparesis.
Choice B rationale
Metoclopramide does not have a primary effect on muscle relaxation. Its main action is to increase gastrointestinal motility.
Choice C rationale
Reduced nausea is a primary outcome for evaluating the effectiveness of metoclopramide. It is commonly prescribed to manage nausea and vomiting.
Choice D rationale
Metoclopramide is not typically used to decrease pain. Its primary indications are related to gastrointestinal symptoms.