a nurse is caring for a client on a medical - surgical unit.
exhibit 1 exhibit 2 exhibit 3
nurses’ notes
day 1, 0800:
client admitted for monitoring after episode of loss of consciousness. medical history includes parkinson’s disease, hypertension, and atrial fibrillation.
1300:
client reports urinary frequency and burning since this morning.
1500:
urinalysis results indicate urinary tract infection.
day 3, 0930:
client reports that they just ate a bacon and egg sandwich, a carton of milk, and a can of grapefruit juice.
drag words from the choices below to fill in each blank in the following sentence.
the client is at risk for developing target 1 and target 2.
word choices
hypertensive crisis
levodopa toxicity
increased effect of warfarin
decreased effect of tetracycline
nifedipine toxicity

Question

a nurse is caring for a client on a medical - surgical unit.
exhibit 1  exhibit 2  exhibit 3
nurses’ notes
day 1, 0800:
client admitted for monitoring after episode of loss of consciousness. medical history includes parkinson’s disease, hypertension, and atrial fibrillation.
1300:
client reports urinary frequency and burning since this morning.
1500:
urinalysis results indicate urinary tract infection.
day 3, 0930:
client reports that they just ate a bacon and egg sandwich, a carton of milk, and a can of grapefruit juice.
drag words from the choices below to fill in each blank in the following sentence.
the client is at risk for developing target 1 and target 2.
word choices
hypertensive crisis
levodopa toxicity
increased effect of warfarin
decreased effect of tetracycline
nifedipine toxicity

Accepted Answer

# Brief Explanations:
1. Analyze the client's medical history and new developments: The client has Parkinson's (treated with levodopa), hypertension (maybe nifedipine), atrial fibrillation (warfarin), and a UTI (tetracycline? But UTI treatment and food interactions).
2. Grapefruit juice interaction: Grapefruit juice inhibits CYP3A4, which metabolizes nifedipine (CCB for hypertension) and warfarin? Wait, nifedipine is a calcium channel blocker, metabolized by CYP3A4. Grapefruit juice increases nifedipine levels (toxicity). For warfarin, vitamin K (from bacon/egg? No, bacon/egg has fat, milk has calcium, grapefruit juice—wait, warfarin's action is against vitamin K. But the food here: bacon and egg (maybe vitamin K? No, bacon is processed, egg has some, but grapefruit juice interaction with warfarin? Wait, no—grapefruit juice and warfarin: actually, warfarin is metabolized by CYP2C9, and grapefruit juice mainly affects CYP3A4. Wait, maybe the other drug: levodopa? No, levodopa is for Parkinson's. Wait, the client has a UTI, so maybe tetracycline? But tetracycline and milk: milk has calcium, which chelates tetracycline, decreasing its effect (decreased effects of tetracycline). Then, grapefruit juice and nifedipine: nifedipine is a CCB, grapefruit juice increases its levels (nifedipine toxicity). Wait, but the client's medical history: hypertension (nifedipine?), atrial fibrillation (warfarin), Parkinson's (levodopa), UTI (tetracycline? Or another antibiotic). Let's check the word choices:
- Target 1 and Target 2: Let's list the word choices: hypertensive crisis (unlikely, unless drug interaction causes high BP), levodopa toxicity (grapefruit juice? No, levodopa is metabolized by decarboxylase, not CYP3A4), increased effect of warfarin (grapefruit juice? Warfarin's metabolism: CYP2C9, and grapefruit juice doesn't affect that much. Wait, vitamin K: bacon and egg have some vitamin K, which would decrease warfarin's effect, but the choice is increased effect of warfarin—no. Decreased effects of tetracycline: milk (calcium) chelates tetracycline, so tetracycline's effect is decreased. Then, nifedipine toxicity: grapefruit juice increases nifedipine levels (since it inhibits CYP3A4, which metabolizes nifedipine). So the client ate grapefruit juice, milk, bacon/egg. So:
- Milk (calcium) + tetracycline (for UTI) → decreased effects of tetracycline (because calcium chelates tetracycline, reducing absorption).
- Grapefruit juice + nifedipine (for hypertension) → nifedipine toxicity (because grapefruit juice inhibits CYP3A4, increasing nifedipine levels).
Wait, but the sentence is "The client is at risk for developing [Target 1] and [Target 2]." So the two risks are:
1. Decreased effects of tetracycline (due to milk, which has calcium, chelating tetracycline, so the antibiotic is less effective, risking UTI not resolving).
2. Nifedipine toxicity (due to grapefruit juice, which inhibits CYP3A4, increasing nifedipine levels, leading to toxicity).
Alternatively, increased effect of warfarin: but warfarin and vitamin K (bacon/egg has vitamin K, which would decrease warfarin's effect, not increase). So that's out. Hypertensive crisis: if nifedipine toxicity, maybe hypotension, not hypertensive crisis. Levodopa toxicity: no. So the two choices are "decreased effects of tetracycline" and "nifedipine toxicity"? Wait, but the word choices are:
1. hypertensive crisis
2. levodopa toxicity
3. increased effect of warfarin
4. decreased effects of tetracycline
5. nifedipine toxicity

Wait, maybe I got it wrong. Let's re-examine the client's intake: Day 3, 0930: ate bacon and egg sandwich, milk, grapefruit juice.

- Milk (calcium) and tetracycline (antibiotic for UTI): calcium chelates tetracycline, so tetracycline's effect is decreased (decreased effects of tetracycline).
- Grapefruit juice and nifedipine (hypertension medication): grapefruit juice inhibits CYP3A4, which metabolizes nifedipine, so nifedipine levels increase → nifedipine toxicity.

So Target 1: decreased effects of tetracycline, Target 2: nifedipine toxicity? Or vice versa? Wait, the word choices are in the list. Let's check the options again. The client has a UTI (so on tetracycline, maybe), hypertension (nifedipine), atrial fibrillation (warfarin), Parkinson's (levodopa).

So the two risks are:
- Decreased effects of tetracycline (because milk (calcium) reduces tetracycline absorption)
- Nifedipine toxicity (because grapefruit juice increases nifedipine levels)

So the blanks should be filled with "decreased effects of tetracycline" and "nifedipine toxicity" (or the other way, but let's check the word choices). Wait, but the problem is to drag words, so the two correct choices are "decreased effects of tetracycline" and "nifedipine toxicity"? Wait, no, maybe the other way. Wait, maybe the first target is "decreased effects of tetracycline" (due to milk) and the second is "nifedipine toxicity" (due to grapefruit juice). Alternatively, maybe "increased effect of warfarin"—but warfarin and vitamin K: bacon and egg have vitamin K, which would decrease warfarin's effect, not increase. So that's out. Levodopa toxicity: no. Hypertensive crisis: no. So the correct two are "decreased effects of tetracycline" and "nifedipine toxicity". Wait, but the word choices are:

1. hypertensive crisis
2. levodopa toxicity
3. increased effect of warfarin
4. decreased effects of tetracycline
5. nifedipine toxicity

So the two blanks are filled with "decreased effects of tetracycline" (Target 1) and "nifedipine toxicity" (Target 2), or vice versa. But let's confirm:

- Milk (calcium) + tetracycline → decreased effects of tetracycline (choice 4)
- Grapefruit juice + nifedipine → nifedipine toxicity (choice 5)

Yes, that makes sense. So the client is at risk for developing decreased effects of tetracycline (because milk interferes with tetracycline) and nifedipine toxicity (because grapefruit juice increases nifedipine levels).
# Answer:
Target 1: decreased effects of tetracycline
Target 2: nifedipine toxicity

(Note: The order might depend on the sentence structure, but these are the two risks from the client's intake (milk with tetracycline, grapefruit juice with nifedipine) and medical history (hypertension, UTI).)

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