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 ["A","B","C","E"]
Explanation
Choice A rationale
Prednisone, a corticosteroid, can cause hypokalemia by increasing renal potassium excretion.
Choice B rationale
Torsemide, a loop diuretic, can lead to hypokalemia by promoting potassium loss through urine.
Choice C rationale
Polystyrene sulfonate is used to treat hyperkalemia, but it can cause hypokalemia as it removes potassium from the body.
Choice E rationale
Hydrochlorothiazide, a thiazide diuretic, can cause hypokalemia by increasing potassium excretion in the urine.
Correct Answer is D
Explanation
Choice A rationale
Hyperglycemia is not a common adverse effect of colesevelam. Colesevelam is primarily used to lower cholesterol levels and can also help control blood sugar levels in patients with type 2 diabetes.
Choice B rationale
Stomatitis, or inflammation of the mouth, is not typically associated with colesevelam. This medication works in the intestines and is not absorbed into the bloodstream, so it does not commonly cause systemic side effects.
Choice C rationale
Fever is not a known adverse effect of colesevelam. The medication’s side effects are generally limited to the gastrointestinal system.
Choice D rationale
Constipation is a common adverse effect of colesevelam. This medication binds to bile acids in the intestines, which can lead to gastrointestinal side effects such as constipation.
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