The nurse is caring for an adult client who is taking digoxin. Which laboratory value should be reported to the healthcare provider immediately?

Reference Range:
Sodium [Adult 136 to 145 mEq/L (136 to 145 mmol/L)]
Digoxin level (0.8 to 2.0 ng/mL (0.6 to 13 nmol/L)]
Potassium (K+) [Adult: 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L)]
Creatinine [0.5 to 1.1 mg/dL (44 to 97 μmol/L)]

Digoxin level of 1.1 ng/mL (1.4 nmol/L).

Creatinine level of 0.8 mg/dL (70.72 μmol/L).

Potassium level of 3.2 mEq/L (3.2 mmol/L).

Sodium level of 135 mEq/L (135 mmol/L).

Answer and Explanation

The Correct Answer is C

A. Digoxin level of 1.1 ng/mL (1.4 nmol/L):
A digoxin level of 1.1 ng/mL is within the therapeutic range (0.8 to 2.0 ng/mL). While it is important to monitor digoxin levels, this value does not indicate an immediate concern.

B. Creatinine level of 0.8 mg/dL (70.72 μmol/L):
A creatinine level of 0.8 mg/dL is within the normal range (0.5 to 1.1 mg/dL) and does not indicate any renal impairment or immediate issue.

C. Potassium level of 3.2 mEq/L (3.2 mmol/L):
A potassium level of 3.2 mEq/L is below the normal range (3.5 to 5.0 mEq/L). Hypokalemia can increase the risk of digoxin toxicity and arrhythmias, making this an urgent issue that should be reported to the healthcare provider immediately.

D. Sodium level of 135 mEq/L (135 mmol/L):
A sodium level of 135 mEq/L is slightly below the normal range (136 to 145 mEq/L), but it is not as critical as a significantly abnormal potassium level in the context of digoxin use. While it should be monitored, it is less urgent compared to the potassium level.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Explore what the client means by the drug "is not working":
The first step in addressing the client's concern is to understand their perception of how the medication is performing. This involves exploring their specific symptoms, any changes they've noticed, and their expectations of the medication. This understanding will help guide further assessment and intervention.

B. Determine if the client is taking the medication before meals:
Carbidopa-levodopa is typically recommended to be taken on an empty stomach to optimize absorption. While this is important for effective medication use, addressing the client's perception of the drug's effectiveness takes priority to identify whether there is an issue with their treatment regimen or if other factors are influencing their response.

C. Evaluate the client for signs of dyskinesia:
Dyskinesia, or involuntary movements, can be a side effect of long-term use of carbidopa-levodopa, but evaluating for these signs should follow the initial exploration of the client's concerns. If the client believes the medication is ineffective, it’s crucial first to clarify what symptoms they are experiencing before assessing for specific side effects.

D. Ask if the client's morning voids are dark colored:
Dark-colored urine is not directly related to the effectiveness of carbidopa-levodopa. This assessment is less relevant compared to understanding the client's overall experience with the medication and symptoms. Addressing the client’s concern about the medication’s effectiveness should be the priority.

A. Adding the herb can decrease the need for corticosteroids. B. Ingestion of St. John's Wort can reduce the client's intake of sodium. C. St. John's Wort can decrease plasma concentrations of cyclosporine. D. The client probably used this herb to treat depression.

Correct Answer is C

Explanation

A) Adding the herb can decrease the need for corticosteroids: There is no substantial evidence that St. John’s Wort affects the need for corticosteroids. Its primary interactions are with medications metabolized by the liver, particularly cyclosporine, rather than affecting corticosteroid requirements directly.

B) Ingestion of St. John's Wort can reduce the client's intake of sodium: St. John’s Wort does not impact sodium intake. Its known interactions are with drugs, particularly those metabolized by the liver, rather than affecting dietary intake or sodium levels.

C) St. John's Wort can decrease plasma concentrations of cyclosporine: St. John’s Wort is a potent inducer of cytochrome P450 enzymes, which can lead to decreased plasma levels of cyclosporine, an immunosuppressant crucial for preventing graft rejection. This interaction can result in subtherapeutic levels of cyclosporine and increase the risk of graft rejection.

D) The client probably used this herb to treat depression: While it is true that St. John’s Wort is commonly used for its antidepressant effects, this is not the most significant concern in the context of a renal transplant. The primary issue is its interaction with cyclosporine, which can significantly impact transplant outcomes.

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Naxlex Comprehensive Predictor Exams

The nurse is assessing a client who was recently diagnosed with Parkinson's disease and is taking carbidopa-levodopa. The client is concerned that the medication is not working. Which intervention should the nurse implement first?

Correct Answer is A

Explanation

Correct Answer is C

Explanation

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