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 B
Explanation
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.
Correct Answer is ["B","D","E"]
Explanation
A. Limiting physical activity: Sedentary behavior is a risk factor for hypertension and cardiovascular disease. Regular aerobic exercise helps lower blood pressure by improving vascular compliance and reducing systemic resistance. Clients should be encouraged to increase, rather than limit, their level of moderate physical activity.
B. Giving up smoking cigarettes: Nicotine causes immediate vasoconstriction and increases heart rate, leading to acute elevations in blood pressure. Long-term smoking damages the arterial walls and accelerates the development of atherosclerosis. Cessation is one of the most effective lifestyle changes for improving overall vascular health and reducing pressure.
C. Eating canned vegetables daily: Canned foods are typically very high in sodium, which is used as a preservative. High sodium intake leads to water retention and increased blood volume, which raises blood pressure. Clients should be advised to choose fresh or frozen vegetables to minimize their sodium consumption.
D. Pursuing measures for losing weight: Excess body weight increases the workload on the heart and is closely linked to metabolic changes that raise blood pressure. Even a modest reduction in weight can lead to a significant decrease in systolic and diastolic readings. Weight management is a cornerstone of non-pharmacological hypertension treatment.
E. Reducing sodium in the diet: High dietary salt intake triggers the body to retain fluid, increasing the total volume within the vascular system. Reducing sodium intake to less than 2,300 mg per day helps lower blood pressure and reduces the risk of stroke. This change directly addresses the fluid-volume component of hypertension.
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