A high INR indicates that the client is at risk of bleeding due to excessive anticoagulation. The nurse should first assess for signs of bleeding, such as bruising, petechiae, hematuria, or melena.

Then, the nurse should notify the provider and follow orders to reverse the anticoagulation effect, such as administering vitamin K or fresh frozen plasma.

Holding the next dose of warfarin may be appropriate, but it is not the priority action.

Incorrect choices:

a) Administer vitamin K: Vitamin K is an antidote for warfarin overdose, but it should not be given without a provider's order. It may also take several hours to reverse the anticoagulation effect.

b) Notify the provider: Notifying the provider is an important step, but it is not the first action. The nurse should assess the client's condition before calling the provider.

c) Hold the next dose of warfarin: Holding the next dose of warfarin may prevent further anticoagulation, but it does not address the current risk of bleeding. The nurse should assess and intervene for bleeding before holding the medication.

When mixing two types of insulin in one syringe, the nurse should follow the mnemonic RN or "regular before NPH". This means that the nurse should first inject air into the NPH vial, then inject air into the regular vial, then withdraw regular insulin from the vial, and finally withdraw NPH insulin from the vial. This order prevents contamination of the regular insulin with NPH insulin and ensures accurate dosing.

Incorrect choices:

a) Inject air into the NPH vial: This is correct, but it is not the next action. The nurse should inject air into the NPH vial before drawing up any insulin.

c) Withdraw NPH insulin from the vial: This is incorrect and can lead to a medication error. The nurse should withdraw NPH insulin after withdrawing regular insulin.

d) Withdraw regular insulin from the vial: This is correct, but it is not the next action. The nurse should inject air into the regular vial before withdrawing regular insulin.

The first step in managing a missed or delayed medication is to check if another nurse has given or withheld the medication for some reason. This can prevent duplicate or omitted doses and ensure continuity of care. The nurse should also check if there are any contraindications or changes in orders for giving the medication.

Incorrect choices:

b) Give the medication as soon as possible: Giving the medication as soon as possible may be appropriate, but it is not the first action. The nurse should verify if another nurse has given or withheld the medication before administering it.

c) Document why the medication was delayed: Documenting why the medication was delayed is important, but it is not the first action. The nurse should verify if another nurse has given or withheld the medication and give it if indicated before documenting.

d) Report the incident to the charge nurse: Reporting the incident to the charge nurse may be necessary, but it is not the first action. The nurse should verify if another nurse has given or withheld the medication and give it if indicated before reporting.

The nurse should check the placement of the tube before administering any medication or fluid via an NG tube. This can prevent aspiration, infection, or injury to the client. The nurse can check the placement by aspirating gastric contents and measuring the pH, or by using a carbon dioxide detector.

Incorrect choices:

a) Flush the tube with 30 mL of water: Flushing the tube with water is correct, but it is not the next action. The nurse should flush the tube before and after administering the medication to prevent clogging and ensure delivery.

c) Clamp the tube for 30 minutes: Clamping the tube for 30 minutes is incorrect and can cause complications. The nurse should not clamp the tube unless ordered by the provider. Clamping the tube can increase the risk of reflux, aspiration, or tube displacement.

d) Elevate the head of the bed: Elevating the head of the bed is correct, but it is not the next action. The nurse should elevate the head of the bed at least 30 degrees before and during the administration of the medication to prevent aspiration and promote gastric emptying.

All of the instructions are correct and important for a client who is taking digoxin. Digoxin is a cardiac glycoside that can improve the contractility and rhythm of the heart. However, it can also cause serious side effects, such as bradycardia, arrhythmias, or toxicity.

Naloxone is a medication that can reverse the effects of opioids, such as morphine. One of the main effects of opioids is respiratory depression, which can be life-threatening. Naloxone can increase the respiratory rate by blocking opioid receptors in the brain and restoring normal breathing.

Incorrect choices:

b) Decreased pain level: Naloxone can decrease pain level by reversing opioid analgesia, but this is not the expected effect. The nurse should monitor for increased pain levels and administer non-opioid analgesics as ordered.

c) Increased sedation: Naloxone can decrease sedation by reversing opioid-induced central nervous system depression, but this is not the expected effect. The nurse should monitor for agitation or withdrawal symptoms and provide comfort measures as needed.

d) Decreased blood pressure: Naloxone can increase blood pressure by reversing opioid-induced hypotension, but this is not the expected effect. The nurse should monitor for hypertension or tachycardia and administer antihypertensives as ordered.

All of the medications are used to treat hyperkalemia, which is a high level of potassium in the blood. Hyperkalemia can cause cardiac arrhythmias, muscle weakness, or paralysis.