The nurse should monitor the client for clinical manifestations of digoxin toxicity if the laboratory report reflects a serum:

Choice A reason: Decreased hair is most likely a hereditary condition and nail changes are related to fungus is not the statement that describes the cause of this finding. This statement is not based on evidence and does not explain the relationship between peripheral vascular disease and the observed changes in the legs and feet.

Choice B reason: A blood clot may be forming and the client needs immediate intervention is not the statement that describes the cause of this finding. This statement is an alarmist and inaccurate interpretation of the finding. A blood clot would cause more acute and severe symptoms, such as pain, swelling, redness, and warmth in the affected area.

Choice C reason: Decreased oxygen to the tissues causes changes in hair growth and nail texture is the statement that describes the cause of this finding. This statement is based on the pathophysiology of peripheral vascular disease, which is a chronic condition that reduces the blood flow to the extremities due to atherosclerosis or inflammation of the blood vessels. The reduced blood flow leads to tissue ischemia and necrosis, which can manifest as hair loss, thickening and yellowing of the nails, skin ulcers, and gangrene.

Choice D reason: Depending on the client's age, the findings may be normal is not the statement that describes the cause of this finding. This statement is a vague and dismissive response that does not address the underlying problem of peripheral vascular disease. The findings are not normal for any age group and require further assessment and intervention.

Choice A reason: The client had an allergic reaction to losartan, a drug that belongs to the class of angiotensin II receptor blockers (ARBs). ¹ Anaphylaxis is a severe and potentially life-threatening allergic reaction that can cause swelling of the lips, tongue, throat, and face, as well as difficulty breathing, low blood pressure, and shock. ² The client needs immediate medical attention and treatment with oxygen, fluids, and epinephrine. ³

Choice B reason: The client did not have an expected side effect of the medication. Losartan is used to treat high blood pressure and heart failure by blocking the action of angiotensin II, a hormone that causes blood vessels to constrict and retain salt and water. ¹ Some common side effects of losartan include dizziness, headache, fatigue, cough, and nausea. ⁴ Anaphylaxis is not a common or expected side effect of losartan, but a rare and serious adverse reaction.

Choice C reason: The client should not have a prescription change to enalapril. Enalapril is another drug that lowers blood pressure and heart failure, but it belongs to the class of angiotensin-converting enzyme (ACE) inhibitors. ⁵ ACE inhibitors and ARBs have similar mechanisms of action and effects, but they differ in how they block the angiotensin system. However, both classes of drugs can cause allergic reactions and anaphylaxis in some people, especially those who have a history of allergy to either drug. The client should avoid both ACE inhibitors and ARBs and use another type of blood pressure medication.

Choice D reason: The client should not avoid taking the medication with food. Food does not affect the absorption or effectiveness of losartan. ⁴ The client can take the medication with or without food, as directed by the provider. However, the client should avoid grapefruit and grapefruit juice, as they can interact with losartan and increase the risk of side effects.