A nurse assesses a client who presents to the provider's office to evaluate multiple nevi. Which finding should the nurse identify to the provider as possible sign of malignancy?

A) Hydration with IV fluids:
IV hydration may be ordered to improve kidney function and help facilitate the excretion of excess digoxin from the body. Digoxin toxicity is often related to impaired renal clearance, so improving hydration can promote renal perfusion and enhance the elimination of the drug. This is a common supportive measure to help in managing digoxin toxicity.

B) Nothing as the digoxin level is within normal ranges:
This is incorrect because the patient's digoxin level is 4 ng/ml, which is significantly above the normal therapeutic range of 0.8–2.0 ng/ml. A level of 4 ng/ml is toxic, and immediate action is required. Symptoms like severe bradycardia, nausea, and vomiting are indicative of digoxin toxicity, and they necessitate prompt intervention.

C) Hold the Digoxin:
In the case of digoxin toxicity, it is crucial to hold the digoxin. Digoxin should be discontinued immediately if toxicity is suspected, as continuing the medication could worsen symptoms like bradycardia and increase the risk of potentially life-threatening arrhythmias. This step is essential to prevent further complications.

D) Digibind:
Digibind (Digoxin immune fab) is a digoxin-specific antibody used in cases of severe digoxin toxicity or overdose. It binds to the digoxin molecules and helps to neutralize its effects. Given the elevated level of digoxin (4 ng/ml) and the presence of symptoms like severe bradycardia, nausea, and vomiting, Digibind is likely to be ordered to reverse the effects of the toxicity.

E) Narcan:
Narcan (naloxone) is used to reverse opioid overdoses, not digoxin toxicity. There is no indication for the use of Narcan in this scenario, as digoxin toxicity does not involve opioid overdose. This intervention would be inappropriate and irrelevant to the management of digoxin toxicity.

A) Begin initial discharge teaching on home care activities:
While discharge teaching is a vital part of the care process, it is typically an activity assigned to a registered nurse (RN) because it involves comprehensive patient education on topics such as medication management, follow-up care, and recognizing signs of complications. Guillain-Barré syndrome (GBS) often requires intensive care in the acute phase, and the RN is responsible for evaluating the client’s readiness for discharge and ensuring they fully understand the care required at home

B) Begin administration of red blood cells:
Administering blood products, such as red blood cells, requires close monitoring for potential reactions, and it is typically the responsibility of the RN. The RN must assess the client’s baseline status, monitor for transfusion reactions, and adjust care accordingly during the procedure. This task requires a higher level of clinical judgment and nursing knowledge than an LPN.

C) Reassess the client's mobility in the upper extremity:
Reassessing a client’s mobility, especially in a neurological condition like Guillain-Barré syndrome, requires detailed and ongoing assessment to determine changes in the patient’s strength, motor function, and overall neurological status. This activity is a more complex task that requires a registered nurse's clinical expertise.

D) Administration of morphine for pain:
The administration of pain medications, including morphine, can be appropriately assigned to the LPN under the supervision of an RN. The LPN is trained to administer medications and monitor for common side effects such as respiratory depression, especially in clients who may be at risk due to their neurological condition. However, it is essential for the LPN to communicate with the RN and report any significant changes in the client’s condition during pain management.