A nurse is caring for a 65-year-old male client in a cardiac clinic. The client was recently discharged from an acute hospital stay for worsening heart failure. Below are the exhibits related to the client’s condition:
Exhibit 1: Nurses’ Notes 2 Weeks Ago
The client was admitted to the hospital two weeks ago with worsening heart failure. He was experiencing significant shortness of breath, fatigue, and 2+ edema on bilateral lower extremities. Upon auscultation, an S3 heart sound was noted, and occasional expiratory wheezing was present. The client was managed with furosemide, captopril, and metoprolol at home, but these medications were not sufficient to control his symptoms.
Exhibit 2: Nurses’ Notes Today
The client reports some improvement in shortness of breath with exertion but continues to feel fatigued. Upon auscultation, an S3 heart sound is still noted, and lung sounds are clear. The client has 1+ edema on the ankles and reports nausea, constipation, and blurred vision.
Exhibit 3: History and Physical
The client was discharged from the hospital two days ago after being treated for worsening heart failure. During the hospitalization, he was prescribed digoxin and a potassium supplement in addition to his existing medications. The client will return to the office in two weeks to review lab work and medication management.
Exhibit 4: Laboratory Results Today
- Digoxin: 2.2 ng/mL (0.8 to 2 ng/mL)
- Potassium: 4.8 mEq/L (3.5 to 5 mEq/L)
Exhibit 5: Vital Signs Today
- Temperature: 36.8°C (98.2°F)
- Heart rate: 55/min
- Respiratory rate: 16/min
- Blood pressure: 110/80 mm Hg
- Oxygen saturation: 96% on room air
Click to highlight the findings that indicate the client may be experiencing digoxin toxicity. To deselect a finding, click on the finding again.
Digoxin: 2.2 ng/mL (0.8 to 2 ng/mL)
Heart rate: 55/min
nausea
constipation
blurred vision
being treated for worsening heart failure
an S3 heart sound was noted, and occasional expiratory wheezing was present
The Correct Answer is ["A","B","C","E"]
The findings that indicate the client may be experiencing digoxin toxicity are:
- Digoxin level: 2.2 ng/mL (above the therapeutic range of 0.8 to 2 ng/mL)
- Heart rate: 55/min (bradycardia, which can be a sign of digoxin toxicity)
- Nausea
- Blurred vision
These symptoms and lab results are consistent with digoxin toxicity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","E"]
Explanation
Choice A rationale
Glucose levels are not typically monitored for patients receiving gentamicin.
Choice B rationale
Prothrombin time is not typically monitored for patients receiving gentamicin.
Choice C rationale
Serum creatinine should be monitored because gentamicin can cause nephrotoxicity, and elevated serum creatinine levels can indicate kidney damage.
Choice D rationale
Cardiac enzymes are not typically monitored for patients receiving gentamicin.
Choice E rationale
WBC count should be monitored because gentamicin can cause leukopenia or other changes in white blood cell counts.
Correct Answer is C
Explanation
Choice A rationale
Expecting to have drowsiness while taking this medication is a common side effect of many seizure medications. However, it is not an indication of understanding the teaching about seizure medication management.
Choice B rationale
Taking an extra dose of the medication if a dose is missed is incorrect. Patients should not take an extra dose if they miss one. They should follow their healthcare provider’s instructions on what to do if a dose is missed.
Choice C rationale
Having blood checked to monitor the medication level indicates an understanding of the teaching. Monitoring blood levels of seizure medications is important to ensure therapeutic levels and avoid toxicity.
Choice D rationale
Taking the medication with an antacid to prevent indigestion is incorrect. Antacids can interfere with the absorption of some seizure medications.
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