A nurse is assessing a client who has heart failure and is taking digoxin. Which of the following findings should the nurse identify as an early indication of medication toxicity?

Choice A Reason:
Giving the prescribed dose of clindamycin is not appropriate due to the reported penicillin allergy, which increases the risk of an allergic reaction.
Choice B Reason:
Obtain a prescription for an alternative antibiotic is correct. Given the client's reported allergy to penicillin, which is in the same antibiotic class as clindamycin (both are antibiotics that belong to the beta-lactam group), there is a higher risk of cross-reactivity and potential allergic reaction. Therefore, it's important to avoid administering clindamycin in such cases and seek an alternative antibiotic that does not have a similar chemical structure to penicillin to prevent an allergic reaction.
Choice C Reason:
Premeditating the client with epinephrine before administering the antibiotic is not a standard practice in this context. Epinephrine is used to treat severe allergic reactions but is not used as a preventive measure before administering antibiotics.
Choice D Reason:
Administering the clindamycin using a desensitization schedule might be an option in certain situations under the guidance of an allergist or immunologist, but it's not typically performed by nurses and requires a specific protocol and expertise in managing drug allergies. Obtaining an alternative antibiotic is a more appropriate and immediate action to avoid the risk of an allergic reaction in this scenario.

Choice A Reason:
Hypokalemia is correct. Hydrochlorothiazide is a thiazide diuretic that promotes the excretion of sodium and water in the kidneys, leading to increased urine production. However, it can also cause the loss of potassium (hypokalemia) as a side effect. Hypokalemia can manifest with symptoms such as muscle weakness, fatigue, irregular heart rhythms, and muscle cramps.
Choice B Reason:
Hypermagnesemia is incorrect. Hydrochlorothiazide typically promotes the loss of magnesium rather than causing elevated magnesium levels.
Choice C Reason:
Hypernatremia is incorrect. Hydrochlorothiazide is more likely to cause a decrease in sodium levels (hyponatremia) rather than an increase (hypernatremia).
Choice D Reason:
Hypocalcemia is incorrect. Hydrochlorothiazide can cause increased excretion of calcium but it's not a common adverse effect compared to the loss of potassium (hypokalemia).