A nurse is caring for a 65-year-old male client in a cardiac clinic. The client was recently discharged from an acute hospital stay for worsening heart failure. Below are the exhibits related to the client’s condition:
Exhibit 1: Nurses’ Notes 2 Weeks Ago
The client was admitted to the hospital two weeks ago with worsening heart failure. He was experiencing significant shortness of breath, fatigue, and 2+ edema on bilateral lower extremities. Upon auscultation, an S3 heart sound was noted, and occasional expiratory wheezing was present. The client was managed with furosemide, captopril, and metoprolol at home, but these medications were not sufficient to control his symptoms.
Exhibit 2: Nurses’ Notes Today
The client reports some improvement in shortness of breath with exertion but continues to feel fatigued. Upon auscultation, an S3 heart sound is still noted, and lung sounds are clear. The client has 1+ edema on the ankles and reports nausea, constipation, and blurred vision.
Exhibit 3: History and Physical
The client was discharged from the hospital two days ago after being treated for worsening heart failure. During the hospitalization, he was prescribed digoxin and a potassium supplement in addition to his existing medications. The client will return to the office in two weeks to review lab work and medication management.
Exhibit 4: Laboratory Results Today
- Digoxin: 2.2 ng/mL (0.8 to 2 ng/mL)
- Potassium: 4.8 mEq/L (3.5 to 5 mEq/L)
Exhibit 5: Vital Signs Today
- Temperature: 36.8°C (98.2°F)
- Heart rate: 55/min
- Respiratory rate: 16/min
- Blood pressure: 110/80 mm Hg
- Oxygen saturation: 96% on room air
Click to highlight the findings that indicate the client may be experiencing digoxin toxicity. To deselect a finding, click on the finding again.
Digoxin: 2.2 ng/mL (0.8 to 2 ng/mL)
Heart rate: 55/min
nausea
constipation
blurred vision
being treated for worsening heart failure
an S3 heart sound was noted, and occasional expiratory wheezing was present
The Correct Answer is ["A","B","C","E"]
The findings that indicate the client may be experiencing digoxin toxicity are:
- Digoxin level: 2.2 ng/mL (above the therapeutic range of 0.8 to 2 ng/mL)
- Heart rate: 55/min (bradycardia, which can be a sign of digoxin toxicity)
- Nausea
- Blurred vision
These symptoms and lab results are consistent with digoxin toxicity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Weight gain is not a common side effect of pramlintide. Monitoring for hypoglycemia is more critical.
Choice B rationale
Pramlintide can cause hypoglycemia, especially within 3 hours after administration. Monitoring for hypoglycemia is essential.
Choice C rationale
Pramlintide should be injected into the abdomen or thigh, not the upper arm.
Choice D rationale
Pramlintide should be administered immediately before a meal, not 30 minutes prior.
Correct Answer is C
Explanation
Choice A rationale
Rifampin is an antibiotic used to treat tuberculosis and other bacterial infections. It does not have a known interaction with St. John’s wort.
Choice B rationale
Furosemide is a diuretic used to treat fluid retention and high blood pressure. It does not have a known interaction with St. John’s wort.
Choice C rationale
Citalopram is a selective serotonin reuptake inhibitor (SSRI) used to treat depression. St. John’s wort can interact with SSRIs like citalopram, potentially leading to serotonin syndrome, a serious condition caused by excessive levels of serotonin in the brain.
Choice D rationale
Allopurinol is used to treat gout and kidney stones. It does not have a known interaction with St. John’s wort.
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