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 ["A","C","D","E","F"]
Explanation
A. Pulse ox of 88% on 3 1pm NC: An oxygen saturation of 88% while receiving 3 liters of oxygen indicates significant impairment in gas exchange. This value is below the standard therapeutic target and suggests worsening pulmonary involvement or ventilation-perfusion mismatch. This finding requires immediate medical evaluation and potential adjustment of respiratory support.
B. Lungs are clear to auscultation: This is a normal finding indicating that, at the time of assessment, there is no audible fluid in the alveoli. While heart failure often causes crackles, clear lungs do not require immediate follow-up as an abnormal finding. It serves as a baseline for monitoring future respiratory changes.
C. + 2 pitting edema of the bilateral hands: Edema in the upper extremities is an atypical finding for standard dependent edema and suggests severe systemic fluid retention. It indicates that the venous backup has progressed beyond the lower extremities to involve more superior vascular beds. This requires investigation into the underlying cause of generalized anasarca.
D. + 2 pitting edema of the ankles and feet: Pitting edema in the lower extremities is a clinical manifestation of systemic venous congestion and fluid volume excess. This finding indicates that the current treatment for peripheral edema is not yet effective. The nurse must monitor this to evaluate the patient's response to diuretic therapy.
E. Blood pressure of 150/82: This reading indicates Stage 2 hypertension, which contributes to increased afterload and exacerbates heart failure. Elevated systemic vascular resistance places additional strain on the myocardium and impairs efficient pumping. Persistent hypertension requires pharmacological management to prevent further cardiac remodeling and damage.
F. Respiratory rate is 24: A rate of 24 breaths per minute is tachypneic and suggests the patient is compensating for hypoxia or decreased lung compliance. This increased work of breathing often precedes more severe respiratory distress in fluid-overloaded patients. It correlates with the low pulse oximetry and necessitates closer clinical observation.
G. Abdomen is soft, non-tender, non-distended: This is a normal physical assessment finding indicating the absence of ascites or organomegaly at this time. It suggests that the fluid volume excess has not yet resulted in significant peritoneal accumulation. No acute nursing or medical follow-up is required for this specific result.
H. Client is alert and oriented x 3: Normal mentation indicates that cerebral perfusion is currently adequate despite the patient's low oxygen saturation. It is a positive sign that the patient is not yet experiencing hypercapnia or severe hypoxia-induced encephalopathy. This baseline is used to monitor for any future neurological decline.
I. Heart rate is 88 bpm: A heart rate of 88 is within the normal adult range of 60 to 100 beats per minute. This indicates that the heart is not currently in a state of compensatory tachycardia to maintain cardiac output. It is a stable finding that does not require immediate clinical follow-up.
Correct Answer is C
Explanation
A. Troponin levels will always be elevated: Troponin is a biomarker for myocardial necrosis and cell death, which does not occur in stable angina. In stable angina, the ischemia is transient and reversible, meaning cardiac enzymes typically remain within normal limits. Elevated troponin levels are diagnostic of an acute myocardial infarction rather than angina.
B. The pain is sharp and last for hours, usually radiating down the left leg: Anginal pain is characteristically described as a dull, crushing, or squeezing pressure in the substernal region. It typically lasts only a few minutes and may radiate to the left arm, neck, or jaw, but not the leg. Prolonged pain lasting for hours suggests a more serious acute coronary syndrome.
C. The pain is predictable with exertion and is relieved by rest or nitroglycerin: Stable angina follows a consistent pattern where chest discomfort is triggered by specific levels of physical activity or emotional stress. The increased myocardial demand is eased once the activity stops or when nitroglycerin causes coronary vasodilation. This predictability is the defining feature that differentiates it from unstable angina.
D. Pain occurs at rest and is relieved by nitroglycerin: Pain that occurs without exertion or while the patient is resting is classified as unstable angina or Prinzmetal's angina. This represents a more dangerous clinical state where blood flow is compromised even at baseline. Stable angina requires an external stressor to trigger the imbalance in oxygen supply.
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