A nurse in a provider's office is reviewing the laboratory results of four clients who take digoxin.
Which of the following clients is at risk for developing digoxin toxicity?
A client who takes glyburide for type 2 diabetes mellitus.
A client who takes furosemide for hypertension.
A client who takes cimetidine to reduce gastric acid secretion.
A client who takes azelastine for allergic rhinitis.
The Correct Answer is B
Choice A rationale:
A client who takes glyburide for type 2 diabetes mellitus is not at significant risk for developing digoxin toxicity. Glyburide is an antidiabetic medication and does not interact directly with digoxin.
Choice B rationale: Furosemide, a loop diuretic, can cause electrolyte imbalances such as hypokalemia (normal potassium levels: 3.5 to 5.0 mEq/L) and hypomagnesemia (normal magnesium levels: 1.7 to 2.2 mg/dL). These imbalances increase the sensitivity to digoxin and the risk of toxicity. Digoxin toxicity is associated with symptoms like nausea, vomiting, and arrhythmias. Furosemide's impact on electrolytes makes it a significant risk factor for digoxin toxicity.
Choice C rationale: Cimetidine, a histamine H2 receptor antagonist, can inhibit the metabolism of certain drugs by affecting liver enzymes. However, it does not significantly alter digoxin levels or increase the risk of toxicity. Normal liver enzyme levels include ALT (7 to 56 U/L) and AST (10 to 40 U/L). While cimetidine may interact with other medications, its effect on digoxin is minimal.
Choice D rationale:
A client who takes azelastine for allergic rhinitis is not at significant risk for developing digoxin toxicity. Azelastine is an antihistamine and does not interact directly with digoxin.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is Choice D: Headache.
Rationale for Choice D (Headache): Hyponatremia, defined as a serum sodium level below 135 mEq/L, can lead to various neurological symptoms due to the altered osmotic pressure in the brain cells. When the sodium level drops below normal, water moves into the cells, causing them to swell, which can lead to increased intracranial pressure and subsequent headaches. Therefore, a client with a sodium level of 128 mEq/L is likely to experience headaches as a manifestation of hyponatremia.
Rationale for other choices:
Choice A: Hyporeflexia Hyporeflexia refers to diminished or absent reflexes. While hyponatremia can affect neurological function, hyporeflexia is not a typical manifestation. Instead, hyperreflexia may occur in severe cases due to cerebral edema and increased intracranial pressure.
Choice B: Constipation Constipation is not a common manifestation of hyponatremia. Gastrointestinal symptoms such as nausea, vomiting, and abdominal cramping may occur, but constipation is not typically associated with sodium imbalances.
Choice C: Increased appetite Hyponatremia does not typically cause increased appetite. Instead, gastrointestinal symptoms such as nausea and anorexia are more commonly observed. Increased appetite is not directly related to sodium levels but may be seen in conditions such as hyperthyroidism or certain medications.
Therefore, based on the provided data and typical manifestations of hyponatremia, the correct answer is Choice D: Headache. This is because headaches are a common neurological symptom associated with low sodium levels and increased intracranial pressure.
Correct Answer is C
Explanation
The correct answer is choice C. Monitor the client for black, tarry stools.
Choice A rationale:
Administering clopidogrel with each meal is not necessary. Clopidogrel can be taken with or without food. The primary concern with clopidogrel is its potential to cause bleeding, so monitoring for signs of bleeding is more critical.
Choice B rationale:
Having suction equipment at the bedside is not specifically required for clients taking clopidogrel. This action is more relevant for clients at risk of airway obstruction or those undergoing procedures that might require suctioning.
Choice C rationale:
Monitoring the client for black, tarry stools is essential because it can indicate gastrointestinal bleeding, a known side effect of clopidogrel. This medication increases the risk of bleeding, so observing for signs of internal bleeding, such as melena (black, tarry stools), is crucial.
Choice D rationale:
Initiating contact precautions is not necessary for clients taking clopidogrel. Contact precautions are typically used to prevent the spread of infections, not for managing clients on antiplatelet therapy.
By understanding these rationales, the nurse can ensure the safe administration and monitoring of clopidogrel therapy.
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