A client who received a renal transplant two weeks ago is experiencing a rapid and sudden decrease in urine output in the catheter. Which assessment(s) should the practical nurse (PN) complete before notifying the charge nurse? Select all that apply.

Choice A reason: Flushed, hot skin is not directly related to the client's CBC results. This symptom can indicate various conditions, such as fever, inflammation, or an allergic reaction, but it does not specifically correlate with the lab findings provided. The client's WBC count, hemoglobin, hematocrit, and basophils are within normal ranges, and the most significant abnormality is the low platelet count.
Choice B reason: Hives, or urticaria, are typically associated with allergic reactions and not directly related to the client's CBC results. While a low platelet count can sometimes be associated with immune-mediated conditions, hives are not a primary symptom of thrombocytopenia (low platelet count). The main concern with a low platelet count is the increased risk of bleeding and bruising.
Choice C reason: Inelastic turgor is a sign of dehydration or poor skin elasticity, often seen in conditions such as severe dehydration or malnutrition. The client's CBC results do not indicate dehydration or issues with skin turgor. The hemoglobin and hematocrit levels are within normal ranges, suggesting that the client's overall fluid status is likely stable.
Choice D reason: Bruising is the most relevant finding to assess for in a client with a low platelet count (thrombocytopenia). Platelets play a crucial role in blood clotting, and a low platelet count increases the risk of bleeding and easy bruising. The client's platelet count of 98,000/mm³ (98 x 10⁹/L) is below the normal range, which predisposes them to bruising and potential bleeding complications. It is important for the practical nurse to assess for signs of bruising and bleeding and to monitor the client closely for any further complications.

Choice A reason: Palpating the client's neck gently is important in assessing thyroid function, as it can help detect the presence of thyroid enlargement or nodules. However, this action does not confirm the presence of exophthalmos, which is characterized by the protrusion of the eyeballs. Neck palpation is useful for evaluating thyroid size and consistency but does not provide information about eye-related symptoms.
Choice B reason: Measuring the client's vital signs, including heart rate, blood pressure, and temperature, is essential in monitoring the overall health and metabolic status of a client with hyperthyroidism. Hyperthyroidism can lead to increased heart rate, elevated blood pressure, and other systemic effects. However, measuring vital signs does not confirm the presence of exophthalmos. While vital signs provide important information about the client's condition, they do not address specific eye symptoms.
Choice C reason: Compressing the client's pretibial area is typically performed to assess for pretibial myxedema, which is another possible manifestation of hyperthyroidism, particularly in Graves' disease. Pretibial myxedema is characterized by thickening and swelling of the skin on the lower legs. However, this action does not confirm the presence of exophthalmos. It is important to assess for both pretibial myxedema and exophthalmos in clients with hyperthyroidism, but they require different examination techniques.
Choice D reason: Observing the client's face and eyes is the correct action to confirm the presence of exophthalmos. Exophthalmos is the abnormal protrusion of the eyeballs and is a common feature of Graves' disease, a type of hyperthyroidism. By carefully examining the client's face and eyes, the practical nurse can look for signs of eye protrusion, lid retraction, and other related symptoms. This focused assessment helps in identifying exophthalmos and determining the extent of the condition, which is essential for appropriate management and treatment.