A nurse is caring for a client who is taking digoxin. Which of the following findings should the nurse identify as an indication of digoxin toxicity?

A. Diarrhea: Cephalexin, like other antibiotics, can disrupt normal gut flora and lead to antibiotic-associated diarrhea. Severe or persistent diarrhea may indicate a more serious condition, such as Clostridioides difficile infection, which requires prompt medical evaluation. Monitoring and reporting this symptom is important for preventing complications.

B. Insomnia: Insomnia is not a common adverse effect of cephalexin. While some medications can cause sleep disturbances, cephalexin’s side-effect profile primarily involves gastrointestinal and hypersensitivity reactions rather than central nervous system effects.

C. Vertigo: Vertigo is not typically associated with cephalexin therapy. Neurological symptoms are rare and usually linked to other drug classes or preexisting conditions. Persistent dizziness would require evaluation, but it is not expected with standard cephalexin use.

D. Hypotension: Cephalexin does not normally cause hypotension. Blood pressure changes are uncommon unless a severe allergic reaction occurs, which would present with multiple systemic symptoms, such as rash, swelling, or difficulty breathing.

• Place the client on 24-hr urine collection: This is appropriate to monitor kidney function, fluid balance, and response to diuretics in a client with heart failure, especially with rapid weight gain.
• Place on sodium restriction of less than 1,500 mg per day: Sodium restriction is standard in heart failure management to prevent fluid retention and reduce the risk of worsening edema and hypertension.
• Request for an increased dosage of furosemide: The client shows weight gain (1.8 kg in 24 hr) and low oxygen saturation, suggesting fluid overload. Increasing the diuretic is an expected intervention to remove excess fluid.
• Decrease the client's oxygen to 1 L/min via nasal cannula: The client’s oxygen saturation is 90% on 2 L/min, indicating hypoxemia. Reducing oxygen would worsen tissue oxygenation and is contraindicated.
• Weigh the client daily: Daily weight monitoring helps detect early fluid retention or loss, which is critical in managing heart failure exacerbations.

• Request to hold the client's metoprolol: Holding a beta-blocker without a clear contraindication (e.g., severe bradycardia, hypotension, or acute decompensation) is unnecessary. Continuing metoprolol helps control heart rate and manage atrial fibrillation.