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
Repeating up to four doses until pain is relieved is incorrect. The correct instruction is to take one tablet at the onset of pain and repeat every 5 minutes if needed, up to a maximum of three tablets in 15 minutes.
Choice B rationale
Storing unused tablets at room temperature is correct. Nitroglycerin tablets should be stored in their original container at room temperature, away from moisture and heat.
Choice C rationale
Taking two tablets at the onset of pain is incorrect. The correct instruction is to take one tablet at the onset of pain and repeat every 5 minutes if needed, up to a maximum of three tablets in 15 minutes.
Choice D rationale
Taking the medication two hours prior to exercise is incorrect. Nitroglycerin should be taken 5 to 10 minutes before an activity that may cause chest pain.
Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"A"}
Explanation
The client is at risk for developing cardiac arrhythmia due to hypokalemia.
Hypokalemia (low potassium levels) can lead to cardiac arrhythmias, which are irregular heartbeats. The client’s potassium level is 3.1 mEq/L, which is below the normal range (3.5-5.0 mEq/L). This, combined with his symptoms of dizziness, palpitations, and weakness, indicates a risk for developing cardiac arrhythmias.
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