A nurse is applying a nitroglycerin transdermal patch for a client who has angina. Which of the following actions should the nurse take?

Choice A Reason:
Visual disturbances is the correct findings. In individuals taking digoxin, visual disturbances such as blurred or yellow-tinted vision can indicate early signs of medication toxicity. This symptom often requires prompt medical attention, as it can precede more severe complications.
Choice B Reason:
Sudden weight gain is not correct. While weight gain can be a symptom of worsening heart failure, it's not typically associated specifically with digoxin toxicity. It's more commonly related to fluid retention in heart failure.
Choice C Reason:
Potassium 4.4 mEq/L is not correct. This potassium level is within the normal range. Digoxin toxicity can be exacerbated by low potassium levels, but a normal potassium level doesn't directly indicate digoxin toxicity.
Choice D Reason:
Insomnia is not a typical early sign of digoxin toxicity. It's more commonly associated with issues like difficulty sleeping rather than being a direct symptom of digoxin toxicity.

Choice A Reason:
Hct 44% is incorrect. A hematocrit (Hct) level of 44% falls within the normal range for most adults. It represents the proportion of red blood cells in the blood and is not typically concerning unless it significantly deviates from the normal range, indicating anemia or polycythemia.
Choice B Reason:
WBC count 5,000/mm3 is incorrect. A white blood cell (WBC) count of 5,000/mm3 falls within the normal range for adults, reflecting a normal immune response. There's usually no cause for immediate concern unless there are specific clinical symptoms or significant deviations from the normal range.
Choice C Reason:
Potassium 4.2 mEq/L is incorrect. A potassium level of 4.2 mEq/L is within the normal range for serum potassium levels. It's crucial to monitor potassium levels, especially with medications that can affect electrolyte balance, but this value falls within the typical range and may not prompt immediate action unless there are notable fluctuations or clinical symptoms related to potassium imbalance.
While the majority of the laboratory values provided fall within the normal range, the value that the nurse should consider reporting to the provider, particularly when a client is taking amitriptyline, is:
Choice D Reason:
Total bilirubin 1.5 mg/dL is correct. Elevated levels of total bilirubin might indicate potential liver function impairment. Amitriptyline, an antidepressant, can affect liver enzymes in some individuals, causing hepatic changes. Therefore, it's crucial to monitor liver function tests, including total bilirubin, during amitriptyline therapy. An increase in bilirubin levels could signal hepatotoxicity or liver dysfunction related to the medication.