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 A

Explanation

Erectile dysfunction drugs should not be used when a patient is taking nitrates.This is because both types of drugs cause blood vessels to dilate, which can lead to a dangerous drop in blood pressure. This can increase the risk of heart attack, stroke or fainting.

Choice B is wrong because alpha-adrenergic blockers are sometimes used together with nitrates to treat high blood pressure and angina. They work by relaxing the smooth muscles of the blood vessels, which lowers blood pressure and improves blood flow.

Choice C is wrong because calcium channel blockers are also used to treat high blood pressure and angina. They work by blocking the entry of calcium into the muscle cells of the heart and blood vessels, which reduces the force of contraction and relaxes the blood vessels.

Choice D is wrong because beta-adrenergic blockers are another class of drugs that can be used with nitrates to treat high blood pressure and angina. They work by blocking the effects of adrenaline on the heart and blood vessels, which slows down the heart rate and lowers blood pressure.

Normal ranges for blood pressure vary depending on age, gender and other factors, but generally they are between 90/60 mmHg and 120/80 mmHg for healthy adults.

A. Atorvastatin. B. Niacin. C. Gemfibrozil. D. Ezetimibe.

Correct Answer is A

Explanation

Atorvastatin is a type of statin, which are the most potent antilipidemic agents and have proven to lower the risk of myocardial infarction. Statins work by inhibiting an enzyme called HMG-CoA reductase, which is involved in the synthesis of cholesterol in the liver.By reducing the production of cholesterol, statins lower the levels of low-density lipoprotein (LDL) and triglycerides, and slightly increase the levels of high-density lipoprotein (HDL) in the blood.

Choice B, niacin, is wrong because niacin is not as effective as statins in lowering LDL and preventing cardiovascular events.Niacin is a water-soluble vitamin that can lower LDL and triglycerides, and increase HDL, but it can also cause flushing, itching, and liver toxicity.

Choice C, gemfibrozil, is wrong because gemfibrozil is a type of fibric acid derivative, which are mainly used to lower triglycerides and increase HDL, but have little effect on LDL.

Fibric acid derivatives work by activating a receptor called PPAR-alpha, which regulates the metabolism of lipids in the liver and muscle.Fibric acid derivatives can also increase the risk of gallstones and muscle damage.

Choice D, ezetimibe, is wrong because ezetimibe is a selective cholesterol absorption inhibitor, which blocks the absorption of dietary and biliary cholesterol in the intestine.Ezetimibe can lower LDL by about 15-20%, but it has not been shown to reduce the risk of myocardial infarction on its own.Ezetimibe is usually combined with a statin for better efficacy and safety.

Normal ranges for lipid levels are:

• Total cholesterol: less than 200 mg/dL

• LDL cholesterol: less than 100 mg/dL

• HDL cholesterol: more than 40 mg/dL for men and more than 50 mg/dL for women

• Triglycerides: less than 150 mg/dL

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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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Which drug class should not be used when a patient is taking nitrates?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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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?