the client is on digoxin and has severe digoxin toxicity what is the nursing priority action
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Nursing Elites

ATI RN

Physical Exam Cardiovascular System

1. The client is on digoxin and has severe digoxin toxicity. What is the nursing priority action?

Correct answer: B

Rationale: The correct answer is to give Digibind as an antidote in cases of severe digoxin toxicity. Digibind works by binding to digoxin and preventing it from causing further harm. Checking the potassium level (choice A) is important but not the priority when the client has severe toxicity. Changing the dosing to every other day (choice C) is not appropriate in the setting of severe toxicity where immediate action is required. Giving a potassium supplement (choice D) may be needed eventually, but the priority is to administer Digibind to counteract the toxic effects of digoxin.

2. What is the condition where the lung collapses due to air leaking into the space between the lung and chest wall?

Correct answer: A

Rationale: Pneumothorax is the correct answer. It is the collapse of a lung due to air leaking into the space between the lung and chest wall. This condition often requires emergency treatment. Choice B, Pleural effusion, is the buildup of excess fluid between the layers of the pleura outside the lung, not air. Choice C, Pulmonary fibrosis, is a lung disease characterized by scarring and thickening of lung tissue, not related to lung collapse. Choice D, Lung cancer, is the uncontrolled growth of abnormal cells in the lung, not directly causing lung collapse.

3. What is a condition where the alveoli are gradually destroyed, leading to shortness of breath and reduced oxygen exchange?

Correct answer: A

Rationale: The correct answer is A: Emphysema. Emphysema is a chronic lung condition where the alveoli (air sacs) in the lungs are damaged, reducing the surface area available for gas exchange. This destruction leads to symptoms like shortness of breath and reduced oxygen exchange. Choice B, pulmonary fibrosis, involves scarring and thickening of the lung tissue, not destruction of alveoli. Choice C, pulmonary edema, is the accumulation of fluid in the lungs, not destruction of alveoli. Choice D, lung cancer, is the uncontrolled growth of abnormal cells in the lungs, not destruction of alveoli.

4. Which condition is characterized by chest pain due to reduced blood flow to the heart muscle?

Correct answer: A

Rationale: The correct answer is A, Angina. Angina is chest pain or discomfort caused by reduced blood flow to the heart muscle, often due to coronary artery disease. Choice B, Myocardial infarction, involves the death of heart muscle tissue due to a lack of blood supply, presenting with symptoms similar to angina but more severe. Pericarditis (Choice C) is inflammation of the pericardium, the sac surrounding the heart, which may cause chest pain but is not primarily due to reduced blood flow. Arrhythmia (Choice D) refers to abnormal heart rhythms but is not directly related to chest pain due to reduced blood flow.

5. Which of the following is a chronic condition where the heart muscle is weakened and unable to pump blood effectively, often leading to heart failure?

Correct answer: A

Rationale: Dilated cardiomyopathy is characterized by the heart muscle being weakened and unable to pump blood effectively, ultimately resulting in heart failure. Choice B, Hypertrophic cardiomyopathy, involves the heart muscle becoming abnormally thick, reducing the heart's efficiency. Choice C, Restrictive cardiomyopathy, refers to the heart becoming rigid and less able to fill with blood properly. Myocarditis, as in Choice D, is inflammation of the heart muscle usually caused by a viral infection and is different from the chronic weakening seen in dilated cardiomyopathy.

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