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?

This range of systolic blood pressure is classified as stage 1 hypertension according to the American College of Cardiology and the American Heart Association. Stage 1 hypertension is when blood pressure consistently ranges from 130 to 139 systolic or 80 to 89 mm Hg diastolic.At this stage of high blood pressure, health care professionals are likely to prescribe lifestyle changes and may consider adding blood pressure medication based on your risk of atherosclerotic cardiovascular disease, or ASCVD, such as heart attack or stroke.

Choice A is wrong because 140 to 159 is the range for stage 2 hypertension, which is more severe than stage 1.

Stage 2 hypertension is when blood pressure consistently is 140/90 mm Hg or higher.At this stage of high blood pressure, health care professionals are likely to prescribe a combination of blood pressure medications and lifestyle changes.

Choice C is wrong because 110 to 119 is the range for normal blood pressure.

Normal blood pressure is when systolic blood pressure is less than 120 mm Hg and diastolic blood pressure is less than 80 mm Hg.If your results fall into this category, stick with heart-healthy habits like following a balanced diet and getting regular exercise.

Choice D is wrong because 120 to 139 is not a valid range for systolic blood pressure.

It includes two different categories: elevated and stage 1 hypertension.

Elevated blood pressure is when readings consistently range from 120-129 systolic and less than 80 mm Hg diastolic.People with elevated blood pressure are likely to develop high blood pressure unless steps are taken to control the condition.Stage 1 hypertension, as explained above, is when systolic blood pressure ranges from 130 to 139 or diastolic blood pressure ranges from 80 to 89.

The normal range for systolic blood pressure is less than 120 mm Hg.The normal range for diastolic blood pressure is less than 80 mm Hg.

Diuretics are drugs that increase the amount of urine and salt (sodium) excreted by the kidneys. They are used to treat high blood pressure, heart failure, and edema (fluid retention). However, some diuretics can cause low levels of potassium in the blood (hypokalemia), which can lead to muscle weakness, cramps, and arrhythmias. To prevent this, a combination of diuretics acting on different parts of the kidney (such as a loop diuretic and a thiazide diuretic) may be prescribed.This way, the potassium-sparing effect of one diuretic can balance the potassium-wasting effect of the other, while still achieving a net sodium loss.

Choice A is wrong because they are not a part of the initial diuretic therapy.Combination diuretic therapy is usually reserved for patients who are resistant to or intolerant of monotherapy.

Choice C is wrong because little follow up is not needed after the initial treatment.Patients on combination diuretic therapy require close monitoring of their blood pressure, electrolytes, renal function, and weight to avoid adverse effects such as dehydration, hyponatremia, hypotension, and worsening renal function.

Choice D is wrong because they do not increase the risk of hypokalemia.As explained above, combination diuretic therapy aims to reduce the risk of hypokalemia by using a potassium-sparing diuretic along with a potassium-wasting diuretic.

Normal ranges for serum potassium are 3.5 to 5.0 mmol/L and for serum sodium are 135 to 145 mmol/L.