# A client is being admitted for dofetilide initiation. Which actions belong in the nursing safety plan? Select exactly 4 responses.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=602992&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client is being admitted for dofetilide initiation. Which actions belong in the nursing safety plan? Select exactly 4 responses.

Select exactly 4 responses.

1

Initiate the drug at home if a wearable heart-rate monitor is available.

2

Obtain a baseline QTc or QT before the first dose.

3

Calculate creatinine clearance to select the starting dose.

4

Correct hypokalemia and review QT-prolonging or contraindicated drugs.

5

Discharge immediately after conversion without completing the monitoring period.

6

Maintain continuous ECG monitoring and check QT after protocol doses.

## Explanation

Dofetilide must be initiated or reinitiated in a monitored facility using baseline QT, creatinine clearance, electrolyte correction, and serial ECG assessment.

## In-depth explanation

Quick answer
Prevent concentration-related QT prolongation and torsades.

Why this is correct
Dofetilide labeling requires at least 3 days in a facility with continuous ECG monitoring, creatinine-clearance calculation, and cardiac resuscitation capability. Potassium must be normal and interacting drugs reviewed.

Easy analogy or mental picture
The starting dose and each early QT check are guardrails on a narrow mountain road.

Memory hook
Dofetilide: hospital, QT, CrCl, potassium, repeat QT.

NCLEX decision rule
Verify the monitored initiation algorithm rather than treating this as an ordinary outpatient prescription.

Why the other choices are wrong
A wearable monitor does not replace the required facility, and early discharge can miss delayed QT-related risk.References
1DailyMed: TIKOSYNInpatient initiation, QT and creatinine-clearance dosing, electrolyte correction, and torsades prevention

## Clinical scenario

Dofetilide initiation bundle
Record baseline rhythm and QT, creatinine clearance, potassium and magnesium, interacting drugs, each dose, post-dose QT, conversion time, and discharge eligibility.

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