The nurse is caring for a client with digoxin toxicity. Which findings are consistent with this diagnosis? Select all that apply.

a. Kussmaul respirations: Metabolic acidosis leads to an accumulation of acids in the body, resulting in compensatory hyperventilation to try to decrease the levels of carbon dioxide and increase pH. Kussmaul respirations are deep, rapid, and labored breathing patterns characteristic of this compensation mechanism.

b. Muscle spasms: While muscle spasms can occur in various conditions, they are not specific to metabolic acidosis. Other factors, such as electrolyte imbalances or dehydration, may cause muscle spasms.

c. Paresthesia in fingers: Paresthesia (tingling or numbness) in the fingers can occur due to metabolic acidosis. Acidosis affects nerve function, leading to abnormal sensations in the extremities. It is not specific to metabolic acidosis.

d. Tinnitus: Tinnitus is not typically associated with metabolic acidosis. It is more commonly associated with conditions such as ototoxicity, Meniere's disease, or vascular disorders affecting the inner ear.

a. Monitor urine output: Monitoring urine output is important in clients with heart failure to assess renal perfusion and renal function. Decreased urine output may indicate worsening heart failure or inadequate response to treatment. Therefore, monitoring urine output is appropriate in this situation to assess the client's fluid status and response to therapy.

b. Assess pulse oximetry: Assessing pulse oximetry is essential to evaluate the client's oxygen saturation levels, especially in a client presenting with dyspnea and crackles throughout bilateral lung fields. Decreased oxygen saturation may indicate respiratory compromise or worsening heart failure. Therefore, assessing pulse oximetry is necessary to monitor the client's respiratory status and guide interventions.

c. Check PT/INR: Checking PT/INR (Prothrombin Time/International Normalized Ratio) is not indicated in this situation. PT/INR monitoring is typically performed in clients on anticoagulant therapy such as warfarin to assess coagulation status and therapeutic levels. It is not directly relevant to the client's current presentation of dyspnea, tachycardia, and crackles.

d. Infuse 0.9% NS with 20 mEq KCl at 50 ml/hr: Infusing normal saline (0.9% NS) with potassium chloride (KCl) is not appropriate based solely on the client's presentation of dyspnea, anxiety, tachycardia, and crackles. While fluid and electrolyte balance are important considerations in heart failure management, administering IV fluids and electrolytes should be guided by the client's fluid status, electrolyte levels, and response to treatment.

e. Administer 40 mg furosemide IV now: Administering furosemide IV (intravenous loop diuretic) is appropriate in this situation to manage the client's symptoms of dyspnea and crackles indicative of fluid overload in heart failure. Furosemide helps promote diuresis and reduce fluid volume, thereby alleviating symptoms of congestion and improving respiratory distress.