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?

Hypokalemia is a condition where the blood potassium level is too low, which can cause muscle weakness, arrhythmias, and other problems. Diuretics are drugs that increase urine output and help remove excess fluid from the body. Some diuretics, such as loop diuretics, also cause potassium loss in the urine.To prevent hypokalemia, a combination of diuretics may be prescribed, such as a loop diuretic with a potassium-sparing diuretic or a thiazide diuretic. These combinations help balance the potassium level while still removing sodium and water.

Choice A is wrong because they are not a part of the initial diuretic therapy.Combination diuretic therapy is usually reserved for patients who have resistant edema or hypertension that does not respond to monotherapy.

Choice C is wrong because they do not boost the blood-pressure-lowering effect of other medications.Diuretics can lower blood pressure by reducing blood volume and relaxing blood vessels, but they are not used to enhance the effect of other antihypertensive drugs.

Choice D is wrong because they do not have fewer side effects when used in a drug combination.Combination diuretic therapy can increase the risk of electrolyte imbalances, such as hyponatremia, hypokalemia, hypomagnesemia, and metabolic alkalosis.It can also cause hypotension, dehydration, and worsening renal function.Therefore, combination diuretic therapy should be used with caution and close monitoring.

Normal ranges for blood potassium level are 3.5 to 5.0 mmol/L or 3.5 to 5.0 mEq/L.Normal ranges for blood sodium level are 135 to 145 mmol/L or 135 to 145 mEq/L.

Normal ranges for blood pressure are less than 120/80 mm Hg for normal, 120-129/less than 80 mm Hg for elevated, 130-139/80-89 mm Hg for stage 1 hypertension, and 140 or higher/90 or higher mm Hg for stage 2 hypertension.

Bile acid-binding resins are cholesterol-lowering agents that bind to bile acids in the intestine and prevent their reabsorption. This reduces the amount of bile acids available for cholesterol synthesis in the liver, which lowers the levels of LDL cholesterol in the blood. However, bile acids are also needed for the absorption of fat-soluble vitamins A, D, E, and K.Therefore, patients taking bile acid-binding resins may require supplements of these vitamins to prevent deficiency.

Choice A is wrong because nicotinic acid, or niacin, is a B vitamin that can lower cholesterol by limiting the production of fats in the liver.It does not affect the absorption of fat-soluble vitamins.

Choice B is wrong because nitroglycerin is not a cholesterol-lowering agent, but a vasodilator that relaxes the blood vessels and improves blood flow.It has no effect on fat-soluble vitamin absorption.

Choice D is wrong because beta blockers are not cholesterol-lowering agents, but drugs that lower blood pressure and heart rate by blocking the effects of adrenaline.They have no effect on fat-soluble vitamin absorption.