A nurse is reviewing the laboratory results for a female client who is receiving furosemide and digoxin. Which of the following findings should the nurse recognize increases the client's risk for developing digoxin toxicity?

Potassium 3.1 mEq/L (3.5 to 5 mEq/L)

WBC count 12,000/mm³ (5,000 to 10,000/mm³)

Fasting glucose 150 mg/dL (74 to 106 mg/dL)

Triglycerides 140 mg/dL (35 to 135 mg/dL)

Answer and Explanation

The Correct Answer is A

Rationale:
A. Potassium 3.1 mEq/L (3.5 to 5 mEq/L): Hypokalemia increases the risk of digoxin toxicity because low potassium levels enhance digoxin’s effects on the myocardium, potentially leading to arrhythmias and other toxic effects. Monitoring electrolytes is crucial for clients taking digoxin, especially when on diuretics like furosemide.

B. WBC count 12,000/mm³ (5,000 to 10,000/mm³): An elevated WBC may indicate infection or inflammation but does not directly influence digoxin toxicity. This finding requires assessment but is not a risk factor for digoxin-related complications.

C. Fasting glucose 150 mg/dL (74 to 106 mg/dL): Elevated glucose reflects hyperglycemia but does not affect digoxin levels or toxicity risk. It should be managed separately according to the client’s metabolic needs.

D. Triglycerides 140 mg/dL (35 to 135 mg/dL): Mildly elevated triglycerides are a cardiovascular risk factor but do not directly increase the likelihood of digoxin toxicity. Lipid management is a separate consideration.

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Correct Answer is B

Explanation

Rationale:
A. A client who has an open compound fracture of the humerus: A compound fracture involves broken bone protruding through the skin and carries a risk of infection and significant blood loss. This client requires urgent care and should be tagged yellow (delayed) or red (immediate) depending on other injuries.

B. A client who has multiple facial lacerations: Facial lacerations that are not life-threatening can be treated after higher-acuity clients are stabilized. These clients are mobile, alert, and their injuries are minor, which qualifies them for a green tag (minimal, “walking wounded”).

C. A client who has a puncture wound in the right lower lung: A puncture wound to the lung can compromise respiratory function and oxygenation. This is a life-threatening injury, requiring immediate intervention and a red tag.

D. A client who has full-thickness burns over the lower extremities: Full-thickness burns compromise skin integrity and can lead to fluid loss, infection, and shock. This client needs urgent treatment and should be tagged red (immediate) or yellow (delayed) depending on the extent of burns and airway status.

A. Initiate fibrinolytic therapy. B. Place the client in a supine position. C. Prepare the client for a chest x-ray. D. Insert an indwelling urinary catheter.

Correct Answer is A

Explanation

Rationale:
A. Initiate fibrinolytic therapy: Fibrinolytic therapy, such as tissue plasminogen activator (tPA), is most effective when administered within a 3- to 4.5-hour window from the onset of ischemic stroke symptoms. Early administration can dissolve the clot, restore cerebral blood flow, and improve neurological outcomes.

B. Place the client in a supine position: Clients with ischemic stroke are usually positioned with the head of the bed elevated 15–30 degrees unless contraindicated. Supine positioning can increase intracranial pressure and risk aspiration, which may worsen neurological status.

C. Prepare the client for a chest x-ray: A chest x-ray is not a priority in acute ischemic stroke management. Immediate neuroimaging, typically a CT scan, is required to differentiate ischemic from hemorrhagic stroke before initiating fibrinolytic therapy.

D. Insert an indwelling urinary catheter: Inserting a catheter is not indicated as an initial intervention for acute stroke unless the client is unable to void or requires strict output monitoring. Priority actions focus on neuroprotection and reperfusion therapy.

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A nurse is reviewing the laboratory results for a female client who is receiving furosemide and digoxin. Which of the following findings should the nurse recognize increases the client's risk for developing digoxin toxicity?

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