Based on a client’s serum digoxin level, the client is diagnosed with digoxin toxicity. Which action should the nurse expect to implement?

Choice A reason:

Insomnia is a known side effect of St. John’s wort. While it can be bothersome, it does not typically require further instruction beyond standard advice on managing insomnia. Patients should be advised to take the medication earlier in the day to minimize sleep disturbances.

Choice B reason:

St. John’s wort can interact with hormonal contraceptives, reducing their effectiveness and increasing the risk of unintended pregnancy. This interaction occurs because St. John’s wort induces the enzymes that metabolize contraceptive hormones, leading to lower levels of these hormones in the body. Therefore, it is crucial to instruct the client to use an additional form of contraception to prevent pregnancy.

Choice C reason:

Sensitivity to the sun, or photosensitivity, is a documented side effect of St. John’s wort. Patients should be advised to use sunscreen and wear protective clothing when exposed to sunlight. While this side effect requires caution, it does not necessitate further instruction beyond these preventive measures.

Choice D reason:

Using hard candy to alleviate dry mouth is a common and effective strategy. St. John’s wort can cause dry mouth, and sucking on sugar-free hard candy can help stimulate saliva production. This advice is appropriate and does not require further instruction.

Choice A Reason:

Providing a PRN dose of antacid along with the scheduled medications is not the best option. Antacids can interfere with the absorption of other medications, including sucralfate and pantoprazole. Sucralfate works by forming a protective barrier on the ulcer site, and pantoprazole is a proton pump inhibitor that reduces stomach acid production. Adding an antacid could alter the effectiveness of these medications.

Choice B Reason:

Instructing the client to take the dose of sucralfate PO while eating breakfast is incorrect. Sucralfate should be taken on an empty stomach, typically one hour before meals, to ensure it can effectively coat the ulcer site and provide protection. Taking it with food can reduce its efficacy.

Choice C Reason:

Holding the dose of IV pantoprazole until the client has finished eating breakfast is not advisable. Pantoprazole is most effective when taken before meals, as it helps to reduce stomach acid production in anticipation of food intake. Delaying the dose could result in less effective acid suppression and increased discomfort for the patient.

Choice D Reason:

Administering both of the medications before breakfast as scheduled is the correct action. Sucralfate should be taken on an empty stomach to form a protective barrier on the ulcer site, and pantoprazole should be administered before meals to reduce stomach acid production. This timing ensures both medications work optimally to manage the patient’s peptic ulcer disease and alleviate symptoms like heartburn.