A nurse is obtaining a medical history from a client who is to start warfarin therapy and currently uses herbal supplements at home. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin?

Choice A reason: The extra letters after the name of the medication do not mean it is a stronger dose, but that it is a combination of two different medications. Metoprolol is a beta-blocker that lowers blood pressure and heart rate, while hydrochlorothiazide is a diuretic that reduces fluid retention and blood volume. The combination of these two medications may have a synergistic effect and lower blood pressure more effectively than either one alone.

Choice B reason: The client will have to do some things differently because it is not the same medication, but a combination of two medications. The client will have to monitor their blood pressure, weight, fluid intake, and electrolyte levels more closely, as the addition of hydrochlorothiazide may increase the risk of dehydration, hypotension, and hypokalemia. The client will also have to avoid alcohol, salt, and potassium supplements, as they may interact with the medication and affect its efficacy or safety.

Choice C reason: The client will still have to diet to lose weight, as the medication does not cause weight loss, but may cause weight gain due to fluid retention. The client will have to follow a healthy diet that is low in sodium, fat, and cholesterol, as these may worsen hypertension and increase the risk of cardiovascular complications. The client will also have to exercise regularly, as this may help lower blood pressure and improve overall health.

Choice D reason: The client may experience fewer side effects with the new medication, as the combination of metoprolol and hydrochlorothiazide may lower the dose and frequency of each medication, and reduce the adverse effects of each one. For example, metoprolol may cause fatigue, dizziness, or bradycardia, while hydrochlorothiazide may cause dry mouth, headache, or gout. The combination of these two medications may balance out these effects and improve the client's tolerance and compliance.

The Correct answer is A.

Choice A reason: Evaluating the client for nausea, vomiting, and anorexia is important because these are common signs of digoxin toxicity. Digoxin is a cardiac glycoside used to treat heart failure and certain arrhythmias, but it has a narrow therapeutic window. Toxicity can occur due to various factors, including renal insufficiency or drug interactions. Monitoring gastrointestinal symptoms like nausea, vomiting, and loss of appetite can help detect toxicity early.

Choice B reason: Withholding digoxin if the heart rate is above 100/min is not typically recommended. Digoxin has a negative chronotropic effect, meaning it can decrease heart rate. However, the decision to withhold medication usually depends on a heart rate that is too low (bradycardia), not high. The normal range for resting heart rate in adults is 60-100 beats per minute. Therefore, withholding digoxin for a heart rate above 100/min without other clinical justifications would not be appropriate.

Choice C reason: Measuring the apical pulse rate for 30 seconds before administration is not the standard practice. The apical pulse should be measured for a full minute to ensure accuracy, especially in clients with heart failure who are receiving digoxin. This is because digoxin can cause arrhythmias, and a shorter measurement period may not provide a true representation of the heart's rhythm.

Choice D reason: Instructing the client to eat foods that are low in potassium is incorrect. Clients taking digoxin should maintain a normal potassium level, as hypokalemia can increase the risk of digoxin toxicity. The normal serum potassium level is 3.5-5.0 mEq/L. Foods high in potassium can help maintain this balance and should not be avoided unless there is a specific clinical indication, such as hyperkalemia.