The practical nurse (PN) reviews instructions for use of polyethylene glycol with a client scheduled for a colonoscopy. Which instruction should the PN include?

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: Peak and trough levels are relevant for drugs like vancomycin, not meloxicam, an NSAID. Meloxicam’s efficacy is assessed clinically via pain reduction, not blood levels, as it inhibits inflammation-causing prostaglandins, making this choice irrelevant for costochondritis management.

Choice B reason: Reassessing pain 30 minutes after meloxicam administration evaluates its effectiveness, as this NSAID reduces cyclooxygenase activity, decreasing prostaglandin-mediated pain and inflammation in costochondritis. Timely reassessment ensures adequate relief, guiding further interventions for breathing discomfort, making this the appropriate intervention.

Choice C reason: Involuntary lip and tongue movements are linked to antipsychotics causing tardive dyskinesia, not meloxicam. This NSAID does not affect neurological pathways causing movement disorders. Monitoring for this is irrelevant, as meloxicam’s primary risks are gastrointestinal, not neurological.

Choice D reason: Strict intake and output monitoring is unnecessary for meloxicam, which targets inflammation, not fluid balance. While long-term use may affect renal function, pain reassessment is more immediate for costochondritis, making this choice less relevant than evaluating therapeutic pain relief.