Which instruction by the nurse will be included when teaching an adult patient about digoxin (Lanoxin) for management of heart failure?
Report nausea and vomiting to your health care provider.
Auditory hallucinations are common adverse effects.
Decrease the amount of high-potassium foods you eat.
Omit your dose of digoxin if your pulse is 70.
The Correct Answer is A
Choice A reason: This is the correct instruction by the nurse. Nausea and vomiting are signs of digoxin toxicity, which can be life-threatening. The patient should report these symptoms to their health care provider as soon as possible and have their digoxin level checked.
Choice B reason: This is not a correct instruction by the nurse. Auditory hallucinations are not common adverse effects of digoxin. They are more likely to occur with other drugs, such as antipsychotics or opioids.
Choice C reason: This is not a correct instruction by the nurse. Decreasing the amount of high-potassium foods can increase the risk of digoxin toxicity, as potassium competes with digoxin for binding sites on the cardiac cells. The patient should maintain a normal potassium intake and avoid sudden changes in their diet.
Choice D reason: This is not a correct instruction by the nurse. Omitting the dose of digoxin if the pulse is 70 can lead to underdosing and ineffective treatment of heart failure. The patient should only omit the dose of digoxin if their pulse is below 60, as this indicates bradycardia, which is another sign of digoxin toxicity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This is not an adverse effect of ACE inhibitors. Constipation is a common side effect of opioid medications, which slow down the intestinal motility and cause hard stools.
Choice B reason: This is not an adverse effect of ACE inhibitors. Hypokalemia is a low level of potassium in the blood, which can be caused by diuretic medications, such as furosemide or hydrochlorothiazide, which increase the urine output and potassium excretion.
Choice C reason: This is an adverse effect of ACE inhibitors. Chronic cough is a dry, persistent cough that occurs in some patients taking ACE inhibitors, due to the accumulation of bradykinin, a substance that causes inflammation and irritation in the respiratory tract.
Choice D reason: This is not an adverse effect of ACE inhibitors. Nervousness is a common side effect of stimulant medications, such as caffeine or amphetamine, which increase the activity of the central nervous system and cause anxiety, agitation, and insomnia.
Correct Answer is A
Explanation
Choice A reason: Decrease in wheezing present on auscultation indicates that albuterol was effective. Albuterol is a bronchodilator that relaxes the smooth muscles of the airways and reduces the airway resistance. This improves the airflow and reduces the wheezing sound that is caused by the turbulent flow of air through the narrowed airways.
Choice B reason: Respiratory rate increased to 38 breaths/min does not indicate that albuterol was effective. It indicates that the patient is still experiencing respiratory distress and hypoxia. The normal respiratory rate for adults is 12 to 20 breaths/min. A high respiratory rate can also be a side effect of albuterol, as it can stimulate the sympathetic nervous system and increase the heart rate and blood pressure.
Choice C reason: Sputum production is clear and watery does not indicate that albuterol was effective. It indicates that the patient has a productive cough and is expelling mucus from the lungs. Sputum production is not directly affected by albuterol, as it does not have anti-inflammatory or mucolytic properties.
Choice D reason: Use of neck muscles does not indicate that albuterol was effective. It indicates that the patient is using accessory muscles to breathe and is exerting more effort to inhale. This is a sign of severe respiratory distress and airway obstruction. Albuterol should relieve the bronchospasm and reduce the need for accessory muscle use.
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