A nurse is caring for a client in a cardiac clinic. Exhibits Click to highlight the findings that indicate the client may be experiencing digoxin toxicity. To deselect a finding, click on the finding again. Nurses' Notes Today: The client reports some improvement in shortness of breath with exertion. Also reports feelings of fatigue. Upon auscultation, S3 heart sound noted and lung sounds clear. Client has 1+ edema on ankles. Client reports nausea, constipation, and blurred vision. 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) Vital Signs Today: Temperature 36.8° C (98.2° F) Heart rate 55/min Respiratory rate 16/min Blood pressure 110/80 mm Hg Answer: Nurses' Notes Today: The client reports some improvement in shortness of breath with exertion. Also reports feelings of fatigue. Upon auscultation, S3 heart sound noted and lung sounds clear. Client has 1+ edema on ankles. Client reports nausea, constipation, and blurred vision. 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) Vital Signs Today: Temperature 36.8° C (98.2° F) Heart rate 55/min Respiratory rate 16/min Blood pressure 110/80 mm Hg

Heart rate 55/min: Bradycardia is a common sign of digoxin toxicity. Digoxin slows the heart rate, and a heart rate below 60 bpm in a client taking digoxin should be a red flag for possible toxicity. Digoxin level of 2.2 ng/mL: The therapeutic range for digoxin is 0.8 to 2.0 ng/mL, and the client's level of 2.2 ng/mL is above this range, indicating that the client may be at risk for digoxin toxicity. Nausea and constipation: These are classic symptoms of digoxin toxicity. Gastrointestinal symptoms such as nausea and constipation often appear in the early stages of toxicity and should be closely monitored. Blurred vision: Visual disturbances, including blurred vision or seeing halos around objects, are signs of digoxin toxicity and should be promptly reported. Rationale for Incorrect Choices: Improvement in shortness of breath: The improvement in shortness of breath suggests that the client’s heart failure symptoms are better managed, likely due to the medication regimen, and is not a direct indicator of digoxin toxicity. 1+ edema on ankles: Mild edema is common in heart failure but is not a sign of digoxin toxicity. It reflects fluid retention, which may be due to heart failure rather than medication side effects. Potassium 4.8 mEq/L: Potassium is within the normal range (3.5 to 5 mEq/L), and normal potassium levels reduce the risk of digoxin toxicity. Low potassium levels would increase the risk of toxicity. S3 heart sound: An S3 heart sound is indicative of heart failure and reflects fluid overload, not digoxin toxicity. It is a common finding in clients with heart failure and should be monitored, but it is unrelated to digoxin levels. Vital signs (Temperature 36.8°C, Respiratory rate 16/min, Blood pressure 110/80 mm Hg): These vital signs are stable and within normal limits, indicating that the client's condition is relatively stable. There is no indication of a crisis or adverse effect from digoxin in these parameters. A low heart rate of 55/min is the only abnormal vital sign related to toxicity.