A client is admitted for observation with reports of progressively increasing fatigue over the past month and a brief episode of dizziness that occurred today. The client has a history of heartburn and indigestion that is self-treated with ibuprofen and antacids. Which assessment finding should the nurse report immediately to the healthcare provider?

Reference Range:

Guaiac stool [negative]

Hemoglobin (14 to 18 g/dl. (140 to 180 g/L)]

Hematocrit [42% to 52% (0.42 to 0.52 volume fraction)]

Gastric Acid pH (1.5 to 3.5)

Positive guaiac of stool.

Hematocrit 42% (0.42 volume fraction).

Gastric pH 2.0.

Hemoglobin 13 g/dL (130 g/L).

Answer and Explanation

The Correct Answer is A

A) Positive guaiac of stool:
A positive guaiac test indicates the presence of occult (hidden) blood in the stool, which may suggest gastrointestinal bleeding. Given the client’s history of heartburn, indigestion, and self-treatment with ibuprofen and antacids, gastrointestinal irritation or ulceration may be occurring, leading to bleeding. Gastrointestinal bleeding can cause fatigue, dizziness, and other symptoms. Therefore, it is essential to report this finding immediately to the healthcare provider for further evaluation and management.

B) Hematocrit 42% (0.42 volume fraction):
A hematocrit level within the reference range (42% to 52%) is considered normal. While a slight decrease in hematocrit may indicate anemia, it is not an urgent finding that requires immediate reporting. The client’s hematocrit level of 42% is within the normal range, so it does not warrant immediate concern.

C) Gastric pH 2.0:
A gastric pH of 2.0 falls within the normal range (1.5 to 3.5) for gastric acid pH. This finding indicates normal gastric acidity and does not suggest an acute problem that requires immediate reporting to the healthcare provider.

D) Hemoglobin 13 g/dL (130 g/L):
A hemoglobin level of 13 g/dL is slightly below the lower end of the reference range (14 to 18 g/dL) but does not indicate a critical condition requiring immediate intervention. While it may suggest mild anemia, it is not an urgent finding that necessitates immediate reporting to the healthcare provider.

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Correct Answer is B

Explanation

A) Avoid taking the medication on an empty stomach:
While it’s generally recommended to take lithium carbonate with food or milk to minimize gastrointestinal side effects, taking it on an empty stomach does not pose a significant risk. Therefore, it is not the most crucial instruction to emphasize to the client.

B) Maintain a fluid intake of 1,500 to 3,000 mL per day:
This instruction is crucial because lithium can cause dehydration, especially if the client becomes dehydrated due to increased sweating or decreased fluid intake. Adequate fluid intake helps maintain stable lithium levels in the blood and reduces the risk of toxicity. Emphasizing the importance of maintaining hydration is essential for clients taking lithium.

C) Report fluctuations in weight to the healthcare provider:
Weight fluctuations can indicate changes in fluid balance or other metabolic effects of lithium. While it’s important for the client to report changes in weight, this instruction is not as critical as ensuring adequate fluid intake, which directly affects lithium levels and toxicity risk.

D) Keep medication fliers for frequent review and reference:
While it’s helpful for clients to have medication information for reference, this instruction is more about general medication adherence and education rather than a specific requirement related to lithium carbonate.

A. Platelets. B. Osmolality. C. Glucose D. Calcium

Correct Answer is B

Explanation

A) Platelets:
Platelet levels are not directly affected by antidiuretic hormone (ADH) administration or diabetes insipidus. Platelet monitoring is important in assessing clotting function but is not specifically related to the management of diabetes insipidus or ADH therapy.

B) Osmolality:
This is the correct answer. Osmolality refers to the concentration of solutes in the blood and is a critical parameter to monitor in clients receiving ADH therapy for diabetes insipidus. ADH regulates water reabsorption in the kidneys, thereby affecting blood osmolality. Monitoring serum osmolality helps assess the effectiveness of ADH therapy in maintaining fluid balance and preventing excessive urine output.

C) Glucose:
While glucose monitoring is important in clients with diabetes mellitus, it is not directly related to diabetes insipidus or ADH therapy. Diabetes insipidus is characterized by excessive thirst and urination due to inadequate ADH production or response, which does not involve glucose metabolism.

D) Calcium:
Calcium levels are not typically affected by ADH therapy or diabetes insipidus. Monitoring calcium levels is important in conditions such as hyperparathyroidism or hypoparathyroidism but is not directly relevant to the management of diabetes insipidus.

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Naxlex Comprehensive Predictor Exams

The nurse is providing medication teaching to a client with bipolar disorder who receives a prescription for lithium carbonate. Which instruction should the nurse emphasize with the client?

Correct Answer is B

Explanation

When caring for a client with diabetes insipidus who is receiving an antidiuretic hormone intranasally, who serum laboratory test is most important for the nurse to monitor',

Correct Answer is B

Explanation

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