A nurse is preparing to care for a patient who is receiving digoxin. When screening for potential adverse effects from this drug, the nurse will review which of this patient’s laboratory results?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Serum electrolytes. When a patient is receiving digoxin, monitoring serum electrolyte levels, particularly potassium, is crucial. This is because digoxin toxicity can occur in the presence of hypokalemia, which can potentiate its effects on the heart and lead to serious adverse effects like arrhythmias. Therefore, reviewing serum electrolytes helps the nurse assess the patient's risk for digoxin toxicity and take appropriate actions to prevent harm. Option A) Albumin is not directly related to digoxin therapy monitoring. Option B) Blood urea nitrogen (BUN) and creatinine are mainly used to assess kidney function and are not specific to digoxin monitoring. Option C) Hepatic enzymes are more relevant when monitoring drugs that are metabolized in the liver, not digoxin which is primarily excreted by the kidneys. Educationally, this question highlights the importance of understanding the specific monitoring parameters required for patients receiving digoxin. It emphasizes the need for nurses to be vigilant in assessing laboratory values that directly impact the safety and effectiveness of medication therapy, ultimately improving patient outcomes.

Correct Answer: B

Rationale: In older adult patients, hepatic function often decreases due to age-related changes, impacting the metabolism of oral medications that undergo extensive first-pass metabolism. The correct answer, option B, stating that the interval between doses should be increased, is appropriate because the decreased hepatic function may prolong the metabolism of medications, necessitating a longer time between doses to prevent potential toxicity. Option A, using a higher dose with the same time schedule, is incorrect as this could lead to an increased risk of adverse effects or toxicity in older adults due to the compromised metabolism. Option C, stating no change is necessary, is also incorrect because age-related changes in hepatic function can indeed affect drug metabolism. Option D, reducing the interval between doses, is not advisable as it may result in higher drug concentrations in the bloodstream, increasing the risk of adverse effects. In an educational context, it is crucial for nurses to understand how age-related changes in hepatic function can impact drug metabolism in older adult patients. They must be able to recognize the need for dosage adjustments based on individual patient factors to ensure medication safety and efficacy in this population. By choosing the correct dosing adjustments, nurses can help prevent medication-related complications and improve patient outcomes.

Correct Answer: D

Rationale: Estrogen therapy (ET) is primarily beneficial for suppressing menopausal symptoms like hot flashes and preventing bone loss (not reversing osteoporosis). It does not protect against coronary heart disease—studies show increased risks of stroke and breast cancer—and EPT (estrogen/progestin) is not safer, especially as progestin increases breast cancer risk. Option D correctly identifies the main benefits of ET, aligning with evidence-based teaching.

Correct Answer: A

Rationale: To delay her period during the honeymoon, the patient can skip the inert (placebo) pills and immediately start a new pack of active pills, extending the cycle safely for up to four cycles with her existing 28-day supply. Discontinuing OCs (B), switching to extended-cycle products (C), or adding DMPA (D) isn’t necessary given her current stock, making option A the simplest solution.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Metoprolol may mask signs of hypoglycemia, so you need to monitor your blood glucose closely. Explanation: Metoprolol, a beta-blocker, can mask the typical signs and symptoms of hypoglycemia such as tachycardia and tremors. This can lead to a delay in recognizing and treating low blood sugar levels in patients with diabetes, particularly those taking insulin like NPH insulin. Therefore, it is crucial for the patient to monitor their blood glucose levels regularly to catch any potential hypoglycemic episodes promptly. Why the other options are wrong: A) Metoprolol has no effect on diabetes mellitus or on your insulin requirements. - This is incorrect as metoprolol can indeed affect blood glucose levels in patients with diabetes. B) Metoprolol interferes with the effects of insulin, so you may need to increase your insulin dose. - This is incorrect; metoprolol does not directly interfere with insulin's effects. D) Metoprolol may potentiate the effects of the insulin, so the dose should be reduced. - This is incorrect as metoprolol masking hypoglycemic symptoms does not mean the insulin dose should be reduced. Educational context: Understanding the potential interactions between medications is vital for healthcare professionals to ensure patient safety. In the case of patients with diabetes, it is essential to educate them about how certain medications, like metoprolol, can impact their blood glucose levels and the importance of closely monitoring for signs of hypoglycemia. This knowledge empowers patients to take an active role in managing their condition and prevents potentially dangerous situations.