A nurse is assessing a client who has a sliding hiatal hernia.
Which of the following findings should the nurse expect?

Choice A rationale

Digoxin slows the heart rate by inhibiting the sodium-potassium pump, which increases intracellular calcium and enhances myocardial contractility. Tachycardia is an increase in heart rate, which is the opposite of the expected effect of digoxin. Bradycardia is a more common sign of digoxin toxicity.

Choice B rationale

Insomnia is not a recognized or common side effect of digoxin toxicity. The central nervous system effects of digoxin toxicity typically include confusion, fatigue, and lethargy. Digoxin does not directly interfere with the sleep-wake cycle in a way that would cause insomnia.

Choice C rationale

Hearing loss is not a known symptom of digoxin toxicity. The drug's primary effects are on the cardiovascular and gastrointestinal systems, and to a lesser extent, the central nervous system. Auditory disturbances are not a typical finding associated with the toxic effects of digoxin.

Choice D rationale

Digoxin toxicity often affects the central nervous system and sensory organs. The drug can cause visual disturbances such as blurred vision, photophobia, and a characteristic yellow-green halo around objects (xanthopsia), which is an early sign of toxicity. This effect is a result of digoxin's impact on neural pathways

Choice A rationale

The herpes zoster vaccine, also known as the shingles vaccine, is specifically recommended for older adults. The incidence and severity of shingles, which is caused by the reactivation of the varicella-zoster virus, increase significantly with age, particularly after 50 years. The vaccine works by boosting the immune response to the virus, thereby reducing the risk of developing shingles and the associated long-term neuropathic pain.

Choice B rationale

The human papillomavirus (HPV) vaccine is recommended for individuals up to age 26, with a primary target age of 11 or 12. It is not typically recommended for older adults because most have already been exposed to the virus, and the vaccine is most effective before sexual activity begins. The immune response in older adults is also less robust than in younger individuals, making the vaccine less effective in this population.

Choice C rationale

The rotavirus vaccine is recommended for infants and young children, usually in a series of doses starting at 2 months of age. Rotavirus is a common cause of severe diarrhea in infants and young children, but it does not pose a significant health threat to older adults. The vaccine is not indicated for older adults because they have usually developed immunity from previous exposures to the virus.

Choice D rationale

Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine is primarily given to infants and young children in a series of doses. For older adults, the Tdap or Td booster is recommended. The Tdap vaccine provides protection against tetanus, diphtheria, and pertussis, which is important for older adults as their immunity wanes over time. However, the DTaP formulation is not the one typically recommended for this age group. .