A nurse is reinforcing teaching with a client who is starting digoxin therapy to treat heart failure. The nurse should reinforce with the client that which of the following adverse effects is a possible indication of digoxin toxicity and should be reported to the provider?

Choice A Reason:

Applying antibiotic ointment is typically not recommended after a Plastibell circumcision, as it may interfere with the natural healing process.

Choice B Reason:

Ensuring that the baby's diaper is applied snugly can potentially cause friction and discomfort around the circumcision site. It's generally recommended to use loose-fitting diapers to avoid irritation.

Choice C Reason:

Wiping away yellow crusts (scabs) that form around the incision is not advised, as this can disrupt the healing process. It's best to let these crusts fall off naturally as the area heals.

Choice D Reason:

"I will apply pressure with gauze if I see bleeding." This statement by the parent indicates an understanding of circumcision care following a Plastibell circumcision. Applying gentle pressure with gauze if bleeding occurs is an appropriate response to manage bleeding and promote clotting at the circumcision site.

Choice A Reason:

Blaming the assistive personnel without additional information or evidence may not be appropriate and should be investigated further.

Choice B Reason:

Mentioning that an incident report has been completed and sent to risk management is important for institutional record-keeping and follow-up but does not provide details about the incident itself.

Choice C Reason:

"Client stated, 'I lost my balance and fell when I got out of bed to go to the bathroom'." In the documentation of a client fall, it is important to include the client's own account of the incident, as this can provide valuable information about the circumstances surrounding the fall. Including direct quotes or statements from the client helps to accurately capture their perspective and can be useful for assessing the root causes of the fall and developing appropriate interventions to prevent future falls.

Choice D Reason:

Documenting that the client does not appear to have any injuries is relevant but does not provide information about the circumstances of the fall, which is important for a comprehensive understanding of the event.