A nurse in a provider’s office is monitoring blood electrolytes for four clients who take digoxin.
Which of the following electrolyte values increases a client’s risk for digoxin toxicity?

Potassium 3.0 mEq/L.

Calcium 9.2 mg/dL.

Potassium 4.8 mEq/L.

Calcium 10.3 mg/dL.

Answer and Explanation

The Correct Answer is A

This is because digoxin inhibits the Na-K-ATPase pump on the membrane of cardiac cells, which can cause extracellular potassium levels to rise. Hypokalemia (low potassium) caused by large dosages of diuretics may result in digoxin toxicity even at low serum digoxin levels. Digoxin toxicity can cause gastrointestinal, constitutional, and/or cardiovascular symptoms, as well as ECG changes such as signs of increased automaticity and atrioventricular node blockade.

Choice B is wrong because calcium 9.2 mg/dL is within the normal range of 8.5 to 10.5 mg/dL. Hypercalcemia (high calcium) can increase sensitivity to digoxin effects and lead to toxicity even with a lower concentration of serum digoxin, but this is not the case here.

Choice C is wrong because potassium 4.8 mEq/L is within the normal range of 3.5 to 5.0 mEq/L.

Hyperkalemia (high potassium) can also increase the risk of digoxin toxicity, but this is not the case here.

Choice D is wrong because calcium 10.3 mg/dL is within the normal range of 8.5 to 10.5 mg/dL. Hypercalcemia (high calcium) can increase sensitivity to digoxin effects and lead to toxicity even with a lower concentration of serum digoxin, but this is not the case here.

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Correct Answer is B

Explanation

Diuretics are drugs that increase the amount of urine and salt (sodium) excreted by the kidneys. They are used to treat high blood pressure, heart failure, and edema (fluid retention). However, some diuretics can cause low levels of potassium in the blood (hypokalemia), which can lead to muscle weakness, cramps, and arrhythmias. To prevent this, a combination of diuretics acting on different parts of the kidney (such as a loop diuretic and a thiazide diuretic) may be prescribed.This way, the potassium-sparing effect of one diuretic can balance the potassium-wasting effect of the other, while still achieving a net sodium loss.

Choice A is wrong because they are not a part of the initial diuretic therapy.Combination diuretic therapy is usually reserved for patients who are resistant to or intolerant of monotherapy.

Choice C is wrong because little follow up is not needed after the initial treatment.Patients on combination diuretic therapy require close monitoring of their blood pressure, electrolytes, renal function, and weight to avoid adverse effects such as dehydration, hyponatremia, hypotension, and worsening renal function.

Choice D is wrong because they do not increase the risk of hypokalemia.As explained above, combination diuretic therapy aims to reduce the risk of hypokalemia by using a potassium-sparing diuretic along with a potassium-wasting diuretic.

A. Thiazide diuretic Hydrochlorothiazide. B. Osmotic diuretic Mannitol. C. Potassium sparing diuretic Aldactone. D. Loop diuretic Lasix.

Correct Answer is C

Explanation

This is because potassium sparing diuretics do not lower potassium levels in the blood, unlike some other types of diuretics. Potassium is an important electrolyte that helps regulate nerve and muscle functions, especially the heart. Low potassium levels can cause irregular heartbeats and other problems.Therefore, people who take diuretics should avoid foods that are high in potassium, such as bananas, oranges, tomatoes, and potatoes, unless they are taking potassium sparing diuretics.

Choice A is wrong because thiazide diuretics, such as hydrochlorothiazide, can cause low potassium levels in the blood and increase the risk of arrhythmias.

People who take thiazide diuretics may need to take potassium supplements or eat more potassium-rich foods.

Choice B is wrong because osmotic diuretics, such as mannitol, do not affect potassium levels in the blood.

They work by increasing the amount of water in the urine, but do not alter the electrolyte balance.

Osmotic diuretics are mainly used to treat brain swelling or glaucoma.

Choice D is wrong because loop diuretics, such as lasix, can also cause low potassium levels in the blood and increase the risk of arrhythmias.

People who take loop diuretics may also need to take potassium supplements or eat more potassium-rich foods.

Normal ranges for potassium in the blood are 3.5 to 5.0 millimoles per liter (mmol/L).

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A nurse in a provider’s office is monitoring blood electrolytes for four clients who take digoxin. Which of the following electrolyte values increases a client’s risk for digoxin toxicity?

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A nurse in a provider’s office is monitoring blood electrolytes for four clients who take digoxin.
Which of the following electrolyte values increases a client’s risk for digoxin toxicity?