At the start of the shift, the practical nurse (PN) reviews a client’s medication administration record and notes that a client has a new prescription for a diuretic to be administered at bedtime. Which action should the PN take?

Choice A reason: Digoxin toxicity can cause visual disturbances, like seeing yellow halos, due to its effect on retinal cone cells. The client’s comment about a yellow uniform suggests this side effect. Evaluating for toxicity, including checking serum digoxin levels, is critical, as toxicity can lead to life-threatening arrhythmias.

Choice B reason: Withholding furosemide and forcing fluids is inappropriate, as the client’s visual symptom points to digoxin toxicity, not furosemide-related issues. Furosemide causes diuresis, but no evidence suggests dehydration here. This choice does not address the likely digoxin-induced visual disturbance.

Choice C reason: Assuming the client is joking ignores a potential digoxin toxicity symptom. Visual changes, like yellow-tinted vision, are serious and require investigation, not dismissal. Administering medications without evaluation risks exacerbating toxicity, making this choice unsafe and incorrect.

Choice D reason: Additional potassium-rich foods are unnecessary, as the client is already receiving potassium chloride. The visual symptom suggests digoxin toxicity, not hypokalemia. Potassium levels may influence digoxin toxicity, but the priority is evaluating digoxin’s effects, not dietary intervention.

Choice A reason: Avoiding grapefruit juice is correct, as it inhibits CYP3A4, an enzyme metabolizing itraconazole, potentially increasing drug levels and toxicity. This shows understanding, as grapefruit juice can alter the drug’s pharmacokinetics, leading to adverse effects. No additional instruction is needed for this statement.

Choice B reason: Taking itraconazole with antacids reduces its absorption, as it requires an acidic stomach environment for optimal bioavailability. Antacids neutralize gastric acid, decreasing drug efficacy. This statement indicates a misunderstanding, necessitating further instruction to ensure effective antifungal treatment.

Choice C reason: Monitoring stool color changes is reasonable, as itraconazole can cause hepatotoxicity, potentially altering stool appearance due to liver dysfunction. This shows awareness of side effects, requiring no additional instruction, as it aligns with monitoring for adverse hepatic effects.

Choice D reason: Reporting breathing difficulty is appropriate, as itraconazole may rarely cause pulmonary side effects or exacerbate heart failure. This indicates understanding of serious adverse effects, requiring no further instruction, as it reflects vigilance for critical symptoms needing medical attention.