A patient with a history of heart failure is prescribed furosemide (Lasix). Several days after the aggressive diuretic therapy started, the patient began to exhibit confusion, tremors, muscle cramps, and nausea.
What does the nurse suspect?

This is because digoxin inhibits the Na-K-ATPase pump on the membrane of cardiac cells, which can cause extracellular potassium levels to rise.Hypokalemia (low potassium) caused by large dosages of diuretics may result in digoxin toxicity even at low serum digoxin levels.Digoxin toxicity can cause gastrointestinal, constitutional, and/or cardiovascular symptoms, as well as ECG changes such as signs of increased automaticity and atrioventricular node blockade.

Choice B is wrong because calcium 9.2 mg/dL is within the normal range of 8.5 to 10.5 mg/dL.Hypercalcemia (high calcium) can increase sensitivity to digoxin effects and lead to toxicity even with a lower concentration of serum digoxin, but this is not the case here.

Choice C is wrong because potassium 4.8 mEq/L is within the normal range of 3.5 to 5.0 mEq/L.

Hyperkalemia (high potassium) can also increase the risk of digoxin toxicity, but this is not the case here.

Choice D is wrong because calcium 10.3 mg/dL is within the normal range of 8.5 to 10.5 mg/dL.Hypercalcemia (high calcium) can increase sensitivity to digoxin effects and lead to toxicity even with a lower concentration of serum digoxin, but this is not the case here.

HDL stands for high-density lipoprotein, which is a type of cholesterol that carries excess cholesterol from other parts of the body back to the liver, where it can be removed.HDL cholesterol is often called the “good” cholesterol because it helps protect against heart disease by lowering the amount of plaque buildup in the arteries.Increasing HDL cholesterol levels can reduce the risk of cardiovascular disease in patients.

Choice A is wrong because increasing LDL cholesterol levels would have the opposite effect.

LDL stands for low-density lipoprotein, which is a type of cholesterol that carries cholesterol from the liver to other parts of the body, where it can accumulate in the walls of the arteries and form plaque.

LDL cholesterol is often called the “bad” cholesterol because it increases the risk of heart disease by narrowing and hardening the arteries.Decreasing LDL cholesterol levels can reduce the risk of cardiovascular disease in patients.

Choice C is wrong because increasing triglyceride levels would also increase the risk of cardiovascular disease.

Triglycerides are a type of fat (lipid) that circulates in the blood and provides energy for the body.

However, when triglycerides are too high, they can contribute to plaque formation in the arteries and inflammation of the pancreas.

High triglycerides are often associated with obesity, diabetes, metabolic syndrome, and low thyroid levels.Lowering triglyceride levels can reduce the risk of cardiovascular disease in patients.

Choice D is wrong because increasing intake of saturated fats would also increase the risk of cardiovascular disease.

Saturated fats are a type of fat that are solid at room temperature and are found mostly in animal products, such as meat, butter, cheese, and cream.

Saturated fats can raise both LDL and HDL cholesterol levels, but they also increase inflammation and oxidative stress in the body, which can damage the blood vessels and increase the risk of heart disease.Reducing intake of saturated fats and replacing them with unsaturated fats, such as olive oil, nuts, seeds, and fish, can reduce the risk of cardiovascular disease in patients.

The normal ranges for blood lipid levels are as follows:

• Total cholesterol: less than 200 mg/dL (5.2 mmol/L)

• LDL cholesterol: less than 100 mg/dL (2.6 mmol/L)

• HDL cholesterol: 40 mg/dL (1.0 mmol/L) or higher for men; 50 mg/dL (1.3 mmol/L) or higher for women

• Triglycerides: less than 150 mg/dL (1.7 mmol/L)