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
Explanation
Choice A rationale
Benzonatate is a non-narcotic cough suppressant that works by numbing the throat and lungs, making the cough reflex less active. It can cause drowsiness and dizziness, so patients are advised not to drive or operate heavy machinery while taking this medication.
Choice B rationale
Benzonatate does not help in coughing up mucus. It suppresses the cough reflex, which can be beneficial for dry, irritating coughs but is not suitable for productive coughs where mucus needs to be expelled.
Choice C rationale
There is no need to decrease dietary fiber intake while taking benzonatate. Dietary fiber does not interact with the medication or its effectiveness.
Choice D rationale
Benzonatate capsules should not be chewed or crushed, as this can cause numbness of the mouth and throat, leading to potential choking hazards.
Correct Answer is ["A","B","C"]
Explanation
Choice A rationale
Potassium level should be reviewed because captopril can cause hyperkalemia due to its effect on aldosterone secretion.
Choice B rationale
WBC with differential should be reviewed because captopril can cause neutropenia or agranulocytosis, especially in patients with renal impairment or collagen vascular disease.
Choice C rationale
BUN level should be reviewed because captopril can affect renal function, leading to increased BUN levels.
Choice D rationale
Hemoglobin level is not typically affected by captopril, so it is not a priority for review.
Choice E rationale
Glucose level is not typically affected by captopril, so it is not a priority for review.
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