A nurse is caring for a client who has a new prescription for mirtazapine. Which of the following medications should the nurse identify as a contraindication to the client's new prescription?

A. “Taking an HMG CoA reductase inhibitor”: HMG CoA reductase inhibitors, also known as statins, are used to lower cholesterol levels. While they can interact with many medications, they do not specifically predispose a client to developing digoxin toxicity.

B. “Having a prolapsed mitral valve”: A prolapsed mitral valve can lead to mitral valve regurgitation and potentially heart failure, but it does not specifically predispose a client to developing digoxin toxicity.

C. “Taking a high-ceiling diuretic”: This is the correct answer. High-ceiling diuretics, also known as loop diuretics, can cause electrolyte imbalances, particularly low potassium levels (hypokalemia). Digoxin toxicity is more likely to occur when potassium levels are low, as digoxin and potassium compete for the same binding sites in the body. Therefore, taking a high-ceiling diuretic can predispose a client to developing digoxin toxicity.

D. “Having a 10-year history of COPD”: While chronic obstructive pulmonary disease (COPD) can exacerbate heart failure symptoms, it does not specifically predispose a client to developing digoxin toxicity.

A) "You require TPN because your glucose is too high":
This statement does not accurately explain the purpose of TPN. TPN is not typically used to address high blood glucose levels; it is primarily used to provide essential nutrients to clients who cannot obtain adequate nutrition through oral or enteral routes due to conditions such as bowel obstruction, severe malabsorption, or impaired gastrointestinal function.

B) "You will receive TPN for the next 6 months":
The duration of TPN therapy varies depending on the client's condition and treatment plan. TPN is usually administered for a limited period until the client's nutritional status improves or alternative feeding methods can be initiated. Providing a specific duration without knowing the individual client's circumstances may be misleading.

C) "You require TPN because you have a low platelet count":
Low platelet count (thrombocytopenia) is not typically a direct indication for TPN. TPN is primarily used to provide essential nutrients to clients who cannot tolerate oral or enteral feeding due to gastrointestinal dysfunction or other conditions. While thrombocytopenia may affect the choice of vascular access for TPN administration, it is not the primary reason for initiating TPN.

D) "You will receive TPN through a central vein":
Correct. Total parenteral nutrition (TPN) is a form of nutrition therapy that involves delivering a nutritionally complete solution directly into the bloodstream via a central venous catheter. This method allows for the delivery of nutrients, including carbohydrates, proteins, fats, vitamins, and minerals, bypassing the digestive system entirely. It is essential for the nurse to include information about the route of administration to ensure the client understands the procedure and associated risks.