Which nursing assessment confirms that the angiotensin II receptor blocker (ARB) that a patient is taking is effective?

Choice A reason: This is not a symptom that would indicate withholding a nonselective beta-adrenergic blocker. Hyperglycemia is a high level of glucose in the blood, which can be caused by diabetes or other conditions. Nonselective beta-adrenergic blockers do not affect blood glucose levels directly, but they may mask the signs of hypoglycemia (low blood glucose) in diabetic patients.

Choice B reason: This is not a symptom that would indicate withholding a nonselective beta-adrenergic blocker. Dizziness is a common side effect of many medications, especially those that lower blood pressure. Nonselective beta-adrenergic blockers can cause dizziness by reducing the heart rate and cardiac output, but this is usually mild and transient.

Choice C reason: This is not a symptom that would indicate withholding a nonselective beta-adrenergic blocker. Peripheral edema is swelling of the ankles, feet, or legs, which can be caused by heart failure, kidney disease, or venous insufficiency. Nonselective beta-adrenergic blockers do not cause peripheral edema, but they may worsen it in patients with heart failure.

Choice D reason: This is a symptom that would indicate withholding a nonselective beta-adrenergic blocker. Wheezing is a high-pitched sound that occurs when breathing is obstructed, usually due to asthma or chronic obstructive pulmonary disease (COPD). Nonselective beta-adrenergic blockers can aggravate or cause wheezing by blocking the beta-2 receptors in the lungs, which normally cause bronchodilation (widening of the airways). Therefore, nonselective beta-adrenergic blockers are contraindicated in patients with asthma or COPD.

Choice A reason: This is the correct instruction by the nurse. Nausea and vomiting are signs of digoxin toxicity, which can be life-threatening. The patient should report these symptoms to their health care provider as soon as possible and have their digoxin level checked.

Choice B reason: This is not a correct instruction by the nurse. Auditory hallucinations are not common adverse effects of digoxin. They are more likely to occur with other drugs, such as antipsychotics or opioids.

Choice C reason: This is not a correct instruction by the nurse. Decreasing the amount of high-potassium foods can increase the risk of digoxin toxicity, as potassium competes with digoxin for binding sites on the cardiac cells. The patient should maintain a normal potassium intake and avoid sudden changes in their diet.

Choice D reason: This is not a correct instruction by the nurse. Omitting the dose of digoxin if the pulse is 70 can lead to underdosing and ineffective treatment of heart failure. The patient should only omit the dose of digoxin if their pulse is below 60, as this indicates bradycardia, which is another sign of digoxin toxicity.