A nurse is caring for a client who is taking tamoxifen to treat breast cancer. The nurse should identify which of the following manifestations as an adverse effect of this medication?

Saw palmetto is a natural herbal supplement that may help reduce the symptoms of benign prostate hypertrophy (BPH) by inhibiting the enzyme 5- alpha-reductase, which converts testosterone to dihydrotestosterone (DHT), a hormone that stimulates prostate growth. Some studies have shown that saw palmetto can improve urinary flow and reduce nocturia in men with BPH.

Choice Ais wrong because black cohosh is a plant that contains phytoestrogens, which are compounds that mimic estrogen in the body.Black cohosh is mainly used for menopausal symptoms in women, such as hot flashes and mood swings.

Choice Bis wrong because garlic has no proven effect on BPH. Garlic may have some benefits for cardiovascular health and immune system, but it does not affect prostate size or function.It has no effect on BPH and may even worsen it by altering the hormonal balance.

Choice C is wrong because feverfew is a herb that has anti-inflammatory and anti-migraine properties.

It may help prevent or treat headaches, arthritis, and allergies, but it has no effect on BPH or urinary symptoms.

Taking a high-ceiling diuretic predisposes this client to developing digoxin toxicity because it can cause hypokalemia (low blood potassium level), which increases the sensitivity of the heart to digoxin. Digoxin is a medicine that is used to treat heart failure or arrhythmias (abnormal heart rhythms) by increasing cardiac contractility and controlling the heart rate. Digoxin toxicity happens when there is too much digoxin in the body and it becomes harmful, causing symptoms such as nausea, vomiting, headache, confusion, vision disturbance, and irregular heartbeat.

Choice A is wrong because taking an HMG CoA reductase inhibitor (also called a statin) does not increase the risk of digoxin toxicity.

Statins are lipid-lowering medications used to prevent coronary heart disease by blocking an enzyme involved in cholesterol synthesis.

Statins do not affect the blood potassium level or the sensitivity of the heart to digoxin.

Choice B is wrong because having a 10-year history of COPD (chronic obstructive pulmonary disease) does not increase the risk of digoxin toxicity. COPD is a lung condition that causes breathing difficulties and chronic inflammation.

COPD does not affect the blood potassium level or the sensitivity of the heart to digoxin.

Choice D is wrong because having a prolapsed mitral valve does not increase the risk of digoxin toxicity.

A prolapsed mitral valve is a condition where the valve between the left atrium and left ventricle of the heart does not close properly, allowing some blood to leak back into the atrium.

A prolapsed mitral valve does not affect the blood potassium level or the sensitivity of the heart to digoxin.