A) Tinnitus: While tinnitus can be concerning, it is not a classic side effect of digoxin. It may indicate other issues such as hearing problems or medication interactions, but it does not typically warrant immediate communication with the healthcare provider in the context of digoxin use.

B) Constipation: Although constipation can occur in some patients taking digoxin, it is generally not considered a critical side effect that requires urgent attention. Patients are encouraged to manage this symptom through dietary changes or over-the-counter remedies unless it becomes severe.

C) Visual disturbances: Experiencing visual disturbances, such as seeing halos around lights or blurred vision, can be a sign of digoxin toxicity. Since these symptoms can indicate an elevated level of the drug in the bloodstream, it is crucial for the patient to contact their healthcare provider promptly to assess the situation and prevent further complications.

D) Vertigo: While vertigo can occur in various medical conditions and may be a side effect of other medications, it is not specifically linked to digoxin. If a patient experiences vertigo, they should monitor it but are not necessarily required to contact their healthcare provider immediately unless it is severe or persistent.

A) Express no complaints of chest discomfort or shortness of breath: This outcome directly relates to the goal of improving tissue perfusion. Chest discomfort and shortness of breath can indicate inadequate perfusion, particularly in a client with coronary artery disease. By achieving this outcome, the nurse can assess that tissue perfusion is sufficient and the client is stable.

B) Discuss which lifestyle modifications will be necessary to maintain health: While this is an important aspect of ongoing care and management for coronary artery disease, it does not directly address the immediate concern of impaired tissue perfusion. The priority is to ensure the client is currently experiencing effective perfusion rather than just planning for future health modifications.

C) Have clear breath sounds bilaterally upon auscultation: Clear breath sounds are a positive indicator of pulmonary function but do not directly measure tissue perfusion related to coronary artery disease. While this is important for overall health, it does not specifically target the issue of impaired perfusion in cardiac tissue.

D) Have a urinary output of greater than 30 ml per hour for 24 hours: While adequate urinary output can be a sign of good kidney perfusion and overall fluid balance, it is not a direct indicator of cardiac tissue perfusion. The priority in this scenario is more closely tied to the client’s cardiac status and symptoms related to coronary artery disease.

A) "I usually wait about two hours after I feel chest discomfort to seek medical attention.": This statement is particularly concerning as it suggests a dangerous delay in seeking help during a potentially critical situation. Waiting to seek medical attention for chest discomfort can indicate a lack of understanding of the seriousness of the symptoms, which may hinder effective adaptation to the illness and could result in severe health risks.

B) "I know that I should carry my medication with me in case I develop chest pain.": This statement shows that the client is aware of the importance of having their medication accessible during a potential cardiac event. It indicates a level of preparedness and understanding of their condition, suggesting that the client is adapting well to managing their illness.

C) "My wife and I will learn to cook using the 'good' cooking methods.": This statement reflects a proactive approach to lifestyle modifications, indicating that the client is willing to make dietary changes to improve their health. Such positive steps are a sign of adapting effectively to coronary artery disease.
D) "I feel a little anxious when I get chest discomfort.": While anxiety is a natural response to experiencing chest discomfort, this statement alone does not indicate an inability to adapt. Acknowledging feelings of anxiety can be part of a healthy coping mechanism as the client learns to manage their condition.

A) Withhold the dose and reassess the blood pressure in 30 minutes: Given that the client's blood pressure is 90/60, which indicates hypotension, withholding the furosemide is the safest initial action. Administering a diuretic in the context of low blood pressure could exacerbate the hypotensive state, potentially leading to further complications. It is prudent to reassess the blood pressure before proceeding with the medication.

B) Administer the medication and notify the healthcare provider of the blood pressure: Administering furosemide despite the hypotensive reading may pose significant risks to the client. While notifying the healthcare provider is important, the immediate priority should be to ensure the client's safety by withholding the medication until the blood pressure can be reassessed.

C) Administer the dose and continue to monitor the vital signs: This approach is not advisable due to the low blood pressure. Administering the medication without addressing the hypotension could lead to a further drop in blood pressure and increase the risk of adverse effects such as dizziness or syncope.

D) Call the healthcare provider to obtain an order for oral furosemide: While oral furosemide may be a reasonable alternative, the priority is to manage the client's current hypotensive state. The immediate action should focus on reassessing the blood pressure and ensuring the client is stable before considering alternative routes of medication administration.

A) Depending on the client's age, the findings may be normal: While changes in hair growth and nail texture can occur with aging, the specific combination of hair loss on the legs and thick toenails in a client with peripheral vascular disease is indicative of underlying circulatory issues rather than simply a normal aging process.

B) A blood clot may be forming and the client needs immediate intervention: While peripheral vascular disease does increase the risk of blood clots, the presence of no hair on the legs and thick toenails is more directly related to chronic insufficient blood flow rather than an acute clotting situation requiring immediate intervention.

C) Decreased oxygen to the tissues causes changes in hair growth and nail texture: This statement accurately describes the physiological changes occurring in peripheral vascular disease. Reduced blood flow and oxygen delivery to the lower extremities result in hair loss and thickened nails, as hair follicles and nail growth depend on adequate perfusion.

D) Decreased hair is most likely a hereditary condition and nail changes are related to fungus: While hereditary factors can influence hair loss and fungal infections can affect nails, in the context of peripheral vascular disease, the findings are primarily due to inadequate blood supply rather than hereditary issues or fungal infections.

A) "You can take 81 mg of enteric coated aspirin with orange juice at lunch time": While enteric-coated aspirin can help reduce gastrointestinal irritation, taking it with orange juice is not advisable. Citrus can increase gastric acidity, which might irritate the GI tract further, especially in a patient with a history of GI bleeding.

B) "Take the aspirin with a glass of milk or food in the morning": This instruction is appropriate as taking aspirin with food or milk can help minimize gastrointestinal irritation and promote safer use, especially in a client with iron deficiency anemia from a GI bleed. It also helps with absorption and can reduce the risk of an upset stomach.

C) "Take a baby aspirin with a full glass of cold water at bedtime": Taking aspirin with only water, particularly at bedtime, may increase the risk of gastric irritation and does not provide the protective effect that food or milk would. This is not the best practice for someone with a history of GI issues.

D) "It's ok to take the aspirin with some ginseng tea in the evening": Ginseng can interact with blood-thinning medications and may increase bleeding risk. Advising the client to combine aspirin with ginseng tea could be harmful, especially given their history of GI bleeding. This is not a safe or appropriate recommendation.

A) Total cholesterol 198 mg/dL: While this value is within normal limits, it does not specifically indicate the effectiveness of atorvastatin treatment, which primarily aims to lower LDL levels. An optimal outcome would focus more on the LDL reduction rather than total cholesterol alone.

B) Low density lipoprotein (LDL) 90 mg/dL: This finding indicates an expected outcome of atorvastatin therapy. Atorvastatin is effective at lowering LDL cholesterol, which is a key target in managing hyperlipidemia and reducing the risk of cardiovascular events. An LDL level below 100 mg/dL is generally considered optimal.

C) Serum albumin 6 g/L: This value is low and indicates potential malnutrition or liver dysfunction, which are not expected outcomes for a client on atorvastatin. A normal serum albumin level typically ranges from 3.5 to 5.0 g/dL, so this finding is concerning.

D) Alanine aminotransferase (ALT) 25 units/L: While this ALT level is within the normal range, it does not directly reflect the primary goal of atorvastatin therapy, which is to lower LDL cholesterol. Monitoring liver enzymes is important, but the expected outcome would be more clearly indicated by improved lipid profiles, particularly LDL levels.

A) Baked chicken, baked beans, french fries, and cake: While baked chicken and baked beans may have some nutritional benefits, the inclusion of french fries and cake adds unhealthy fats and sugars, which are not recommended for a client with hypertension. High sodium levels in processed foods can also be problematic.

B) Grilled steak, fresh green beans, mashed potatoes, and ice cream: Grilled steak can be high in saturated fat, and mashed potatoes may be loaded with butter or cream. Ice cream adds excessive sugar and fat, which are not ideal for managing hypertension.

C) Tomato soup, fried flounder, white rice, and an apple: Fried flounder is high in unhealthy fats, and white rice can be high in carbohydrates without the fiber found in whole grains. While the apple is a healthy choice, the overall menu does not support hypertension management effectively.

D) Baked salmon, fresh broccoli, brown rice, and fresh fruit: This option is the most appropriate for a client with hypertension. Baked salmon is rich in omega-3 fatty acids, fresh broccoli provides fiber and vitamins, brown rice offers whole grains, and fresh fruit adds essential nutrients without excessive sugars. This combination supports heart health and helps manage blood pressure effectively.

A) Allow for rest periods between activities throughout the day: This intervention is essential for a client with activity intolerance. Incorporating rest periods helps to manage fatigue and allows for recovery, particularly when hypoxemia is a concern due to sickle cell anemia.
B) Provide supplemental oxygen when the pulse oximetry falls below 96%: Administering supplemental oxygen when oxygen saturation levels drop below 96% is crucial for preventing further hypoxemia and ensuring adequate tissue perfusion, thus addressing the client's activity intolerance.

C) Perform serial neurologic assessments to maintain safety and prevent injury: Regular neurologic assessments are vital, especially in clients with sickle cell anemia, who are at risk for complications like stroke. This intervention helps monitor for changes in neurological status, ensuring prompt action if needed.

D) Assess ability to perform activities of daily living (ADLs): Evaluating the client’s ability to perform ADLs provides valuable information on their functional status and helps tailor interventions to promote independence while considering their limitations due to hypoxemia.

E) Monitor blood pressure, pulse, and respirations after activity: This monitoring is important to evaluate the client’s response to activity and to detect any changes that could indicate distress or worsening hypoxemia. This information helps guide further interventions and ensures the client’s safety.

A) Working on an arithmetic quiz for 20 minutes without getting out of their seat: This outcome indicates improved focus and attention span, which are desired effects of methylphenidate in managing ADHD symptoms. The ability to stay seated and concentrate on a task for an extended period is a positive sign of the medication’s effectiveness.

B) Family members report no episodes of pica: Pica, the consumption of non-food items, is not typically associated with ADHD. Therefore, the absence of pica episodes is not a relevant outcome for evaluating the effectiveness of methylphenidate in this context.

C) Does not tell untrue information: While honesty is important, it is not a primary focus of ADHD treatment. Methylphenidate aims to improve attention, focus, and reduce hyperactivity, rather than directly addressing truthfulness.
D) Completing a jigsaw puzzle with a friend: Successfully completing a jigsaw puzzle with a friend demonstrates improved attention, focus, and social interaction skills. These are positive outcomes of methylphenidate treatment for ADHD, indicating better management of hyperactivity and distractibility.