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.

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