A nurse is teaching a client who has osteoporosis about how to increase calcium in their diet. The nurse should instruct the client that which of the following foods is the best source of calcium?

A. Digoxin 0.125 mg PO daily: Hypokalemia increases the risk of digoxin toxicity because low potassium enhances the drug’s effects on cardiac cells. Administering digoxin without correcting potassium levels can lead to life-threatening arrhythmias, so the nurse should verify this prescription with the provider before giving the medication.

B. Strict intake and output: Monitoring fluid balance is appropriate for a client with heart failure but does not pose immediate safety risks related to potassium levels. This action is standard and does not require prescription verification.

C. Cardiac monitoring: Continuous cardiac monitoring is a safe and appropriate nursing intervention for a client with heart failure and hypokalemia. It does not require verification from the provider and is essential for early detection of arrhythmias.

D. Spironolactone 25 mg PO daily: Spironolactone is a potassium-sparing diuretic and can help correct hypokalemia. Administering this medication is generally safe in this context and does not require additional verification related to the low potassium level.

A. Bedtime: The client’s bedtime of 2330 has remained unchanged despite the shift in work hours, providing some stability to the circadian rhythm. A consistent bedtime typically supports sleep regulation rather than disrupting it. Although the new routine may affect sleep pressure, the bedtime is not the primary contributor to the new difficulties falling asleep.

B. Use of chronic devices: The client turns off their phone at 2230, limiting blue-light exposure well before bedtime. There is no indication of prolonged screen use or other electronic stimulation that would interfere with melatonin release. With the device turned off an hour before bed, this factor is unlikely to be influencing the client’s disrupted sleep.

C. Evening meal: The client now eats dinner late in the evening after a 1200–2000 work shift, placing the meal close to their 2330 bedtime. Eating late can increase gastrointestinal activity and delay the body’s transition into restful sleep, contributing to both difficulty falling asleep and nighttime awakenings.

D. Medication: The client’s medications ethinyl estradiol/desogestrel and ferrous sulphate have remained consistent for months without changes in timing or dosage. These medications are not known to disrupt sleep when taken as prescribed and do not coincide with the recent onset of nighttime symptoms.

E. Caffeine use: Although the client now drinks 2 to 3 cups of coffee, it is consumed early in the morning and remains outside the usual window in which caffeine impacts nighttime sleep. Morning intake allows adequate time for caffeine metabolism before bedtime. The timing makes it a less significant factor in the client’s difficulties initiating and maintaining sleep.

F. Exercise schedule: The client exercises immediately after a shift that ends at 2000, pushing vigorous activity close to bedtime. Late-evening exercise can increase sympathetic activity and core body temperature, which can interfere with the body’s ability to relax and initiate sleep.