A client arrives to the emergency department with dizziness, blurred vision with greenish halos, constipation and fatigue. The client's partner states that that client has been "a little off - kinda confused" this morning. Vital signs: Temp 98.8, HR 44, RR 26. BP 112/68 SpO2 97% on room air. Medical history: obesity, hypothyroidism, heart failure, hypercholesterolemia. Medication reconciliation shows: Furosemide 40 mg daily, levothyroxine 25 mcg daily, digoxin 0.5 mg, simvastatin 40 mg. Based on the above information the nurse suspects that the patient has:
Hypothyroidism
Digoxin toxicity
Glaucoma
Unstable angina
The Correct Answer is B
A. Hypothyroidism: While the client has a history of hypothyroidism, the clinical presentation of visual disturbances and profound bradycardia is not typical of a thyroid deficit. Low thyroid hormone levels usually present with weight gain, cold intolerance, and dry skin rather than greenish halos. The dose of 25 mcg is a standard replacement and does not explain the acute confusion or visual changes.
B. Digoxin toxicity: The combination of bradycardia with a heart rate of 44, greenish-yellow visual halos, and new-onset confusion are classic signs of digitalis overdose. Furosemide use often leads to hypokalemia, which significantly sensitizes the myocardium to the toxic effects of digoxin. A dose of 0.5 mg is also relatively high, increasing the risk of systemic accumulation and toxic side effects.
C. Glaucoma: This ocular condition causes increased intraocular pressure and can lead to vision loss or seeing halos around lights. However, glaucoma does not cause systemic symptoms like profound bradycardia, confusion, or gastrointestinal disturbances such as constipation. The visual symptoms in this case are a secondary manifestation of a systemic pharmacological toxicity rather than a primary eye disease.
D. Unstable angina: Unstable angina presents with crescendo chest pain at rest and is often associated with EKG changes or hemodynamic instability. It does not typically manifest with bradycardia, constipation, or the characteristic visual disturbances described in the stem. The client's symptoms point toward a metabolic or drug-induced etiology rather than acute coronary artery narrowing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Give 2 rescue breaths: In cardiac arrest due to V.Fib, the priority is circulation. High-quality chest compressions are initiated immediately to maintain perfusion until defibrillation can be performed. Rescue breaths are not the first step.
B. Start chest compressions: V.Fib is a lethal rhythm with no effective cardiac output. Immediate chest compressions are essential to circulate oxygenated blood to vital organs while preparing for defibrillation. This is the first action in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS).
C. Assess the client: While assessment is important, in the context of a witnessed rhythm strip showing V.Fib and an alarm, the nurse should assume cardiac arrest and act immediately. Delaying compressions to reassess wastes critical seconds.
D. Call a code blue/call 911: This is necessary, but it comes after starting chest compressions. The priority is to begin CPR without delay, then activate emergency response and prepare for defibrillation.
Correct Answer is B
Explanation
A. Macaroni and cheese: This food is high in carbohydrates and fats but does not contain significant amounts of Vitamin K. While not particularly heart-healthy, it does not directly interfere with the mechanism of warfarin. Patients on anticoagulants do not need to avoid this food specifically for PT/INR stability.
B. Kale chips: Kale is extremely high in Vitamin K, which is the direct physiological antagonist to warfarin. Consuming large or inconsistent amounts of leafy greens can lower the INR, making the blood more prone to clotting and reducing the medication's efficacy. Patients must maintain a consistent intake of Vitamin K to ensure stable anticoagulation levels.
C. Fast food burger and fries: High-fat meals can affect overall cardiovascular health and lipid levels but do not have a direct, acute impact on Vitamin K levels or warfarin metabolism. While the nurse should encourage better nutrition, this meal does not present the same immediate risk to PT/INR monitoring as high-Vitamin K foods.
D. Fruit salad: Most fruits are naturally low in Vitamin K and are safe for patients taking warfarin to consume. Fruit provides essential vitamins and fiber without interfering with the anticoagulant effects of the medication. This is a healthy dietary choice that does not require specific education regarding warfarin interactions.
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