A nurse is reviewing the laboratory results for a female client who is receiving furosemide and digoxin. Which of the following findings should the nurse recognize increases the client's risk for developing digoxin toxicity?

Rationale:
A. Bradypnea: Clients with end-stage kidney disease are more likely to experience Kussmaul respirations (rapid, deep breathing) as the body attempts to compensate for metabolic acidosis by exhaling excess carbon dioxide. Bradypnea is not a typical finding in renal failure and would indicate a different respiratory issue.

B. Oliguria: As kidney function declines, urine output decreases because the kidneys lose their ability to filter and excrete waste products effectively. Oliguria, or markedly reduced urine output, is a hallmark of end-stage renal disease and contributes to fluid overload.

C. Anemia: The kidneys normally produce erythropoietin, which stimulates red blood cell production. In end-stage kidney disease, decreased erythropoietin production leads to anemia, resulting in fatigue, pallor, and decreased oxygen-carrying capacity.

D. Hypotension: Clients with kidney failure often experience hypertension rather than hypotension due to fluid retention and activation of the renin-angiotensin-aldosterone system. Hypotension would be more characteristic of acute volume depletion, not chronic renal failure.

E. Edema: Impaired kidney function causes sodium and water retention, leading to fluid accumulation in tissues. Peripheral and periorbital edema are common manifestations of end-stage kidney disease due to reduced excretion of excess fluid.

Rationale:
A. "Did you tell your provider that your family doesn't agree with your decision?": While it’s appropriate for the provider to be aware of family concerns, this response diverts focus away from the client’s feelings and does not promote open communication. The nurse should first explore the client’s emotions and perspective before suggesting further discussion.

B. "You are making the same decision I would make.": This statement introduces the nurse’s personal opinion, which is nontherapeutic and shifts focus away from the client. It does not encourage expression of the client’s own values, beliefs, or reasoning behind her decision.

C. "You should get your family to agree with your decision before signing the consent.": The client’s consent is based on her own autonomy, not family approval. Suggesting she must gain their agreement undermines her right to make independent healthcare decisions.

D. "Your family disagrees with your decision?": This therapeutic, open-ended response encourages the client to share more about her family’s feelings and her own emotional experience. It demonstrates active listening, fosters trust, and allows the nurse to better understand and support the client’s perspective.