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?

Tinnitus

Constipation

Joint pain

Blurry vision

Answer and Explanation

The Correct Answer is D

Answer: D. Blurry vision

Rationale: Blurry vision, along with yellow-green halos around lights, is a sign of digoxin toxicity that can occur when the serum level of the drug exceeds 2 ng/mL. Other signs of digoxin toxicity include nausea, vomiting, anorexia, confusion, arrhythmias, and bradycardia. Tinnitus, constipation, and joint pain are not related to digoxin toxicity.

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Correct Answer is D

Explanation

The correct answer is D.

Incident report. An incident report is a form that nurses fill out when an error, accident, or injury occurs involving a client, staff, or visitor. The purpose of an incident report is to document the facts, identify the causes, and prevent recurrence of similar incidents. The nurse should document the medication error in an incident report and notify the provider and supervisor as soon as possible.

A. Demonstrating a nonjudgmental attitude toward the client when providing care for her surgical wounds B. Providing the client with information on community resources that will strengthen her coping skills C. Identifying the client's perception of the changes in her physical appearance D. Encouraging the client to write about her feelings in a journal each day

Correct Answer is C

Explanation

The correct answer is C. Identifying the client's perception of the changes in her physical appearance is essential for developing a plan of care that addresses her psychosocial needs and promotes her self-esteem and body image. The client may experience grief, anger, depression, anxiety, or guilt after losing her breasts, which can affect her quality of life and recovery. The nurse should explore how the client feels about herself and her sexuality, and provide emotional support and empathy. The other actions are also important, but they are not as a priority as understanding how the client views herself.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a prescription for acetaminophen 300 mg with codeine 30 mg, 1 tablet every 3 to 4 hr PRN for pain. The nurse inadvertently administers 2 tablets to the client. In which of the following locations should the nurse document this client care incident?

Correct Answer is D

Explanation

A nurse is caring for a client who is 2 days postoperative following a total bilateralmastectomy. The client is tearful and looks away when her surgical dressings are removed. The nurse should place the priority on which of the following actions?

Correct Answer is C

Explanation

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