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An older adult client with heart failure comes to the emergency room because of nausea, vomiting, and anorexia. Based on the client's signs and symptoms, which data from the medical history has the most significance when planning this client's care?

A.

Coronary artery bypass procedure was performed in 1995.

B.

Colonoscopy performed for routine screening six months ago.

C.

Digoxin and furosemide daily since 1996.

D.

Suffered with depression following death of spouse in 1999.

Answer and Explanation

The Correct Answer is C

Rationale:

 

A. The history of coronary artery bypass surgery is important but does not directly relate to the current symptoms.

 

B. A recent colonoscopy is not relevant to the client's current symptoms.

 

C. Long-term use of digoxin and furosemide is highly significant as these medications can lead to digoxin toxicity, especially in the context of dehydration or renal insufficiency. Symptoms like nausea, vomiting, and anorexia are classic signs of digoxin toxicity.

 

D. A history of depression is important but not immediately relevant to the current symptoms of nausea, vomiting, and anorexia.


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Correct Answer is C

Explanation

Rationale:

A. Hypertension is not a common side effect of phenytoin. It is not typically associated with the medication.

B. Peripheral edema is not commonly linked to phenytoin use.

C. Gingival hyperplasia, or overgrowth of the gums, is a common side effect of phenytoin, particularly with long-term use.

D. Hematuria is not a typical side effect of phenytoin and may indicate a different medical issue.

Correct Answer is C

Explanation

Rationale:

A. Examining feet daily is important for preventing foot complications, such as ulcers, in diabetics but is not directly related to preventing retinopathy and nephropathy.

B. Wearing compression stockings is not specifically recommended for preventing retinopathy or nephropathy in diabetes.

C. Maintaining stable blood glucose levels is crucial for preventing or slowing the progression of diabetic complications such as retinopathy and nephropathy. Good glycemic control minimizes the damage to blood vessels in the eyes and kidneys.

D. While regular eye exams are important for detecting retinopathy early, maintaining stable blood glucose levels is key to preventing the development of complications in the first place.

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