A nurse assesses a client with a brain tumor. Which new assessment finding would alert the nurse to urgently communicate with the healthcare provider? (Select all that apply.)

Choice A reason: Calculating the dosage in milligrams is necessary, but it cannot be done until the client’s weight is converted to kilograms. Since the order is based on mg/kg, the first step must be to determine the weight in kilograms.

Choice B reason: Converting the client’s weight to kilograms is the first and most essential step. The client weighs 98 lb. Step 1: 98 ÷ 2.2 = 44.5 kg. This conversion provides the basis for calculating the correct dose in mg/kg. Without this step, the dosage calculation would be inaccurate.

Step-by-step dosage calculation (for clarity):
Step 1: Convert weight to kilograms → 98 ÷ 2.2 = 44.5 kg.
Step 2: Multiply by ordered dose → 44.5 × 15 mg = 667.5 mg.
Step 3: Determine concentration → 250 mg ÷ 5 mL = 50 mg/mL.
Step 4: Divide required dose by concentration → (667.5 ÷ 50) = 13.35 mL.
Step 5: Round to nearest whole number → 13 mL.

Thus, the nurse should administer 13 mL of cefadroxil suspension after completing all steps.

Choice C reason: Rounding the amount to the nearest whole number is done at the final stage of calculation, after determining the exact dose in milliliters. It is not the first step and should only be performed once the precise dose is calculated.

Choice D reason: Calculating the dosage in milliliters is also necessary, but it comes after determining the dose in milligrams. Since the available concentration is 250 mg/5 mL, the nurse must first know the required mg dose before converting it to mL.

Choice A reason: A hematocrit of 40% is within the normal range for adult females (generally 36–46%). This value indicates adequate red blood cell mass and oxygen-carrying capacity, so it does not require immediate notification to the surgeon.

Choice B reason: A potassium level of 3.8 mEq/L is within the normal range (3.5–5.0 mEq/L). Potassium is critical for cardiac and neuromuscular function, but this value does not pose a risk for surgery and does not require urgent reporting.

Choice C reason: A creatinine level of 0.9 mg/dL is normal (0.6–1.3 mg/dL). This indicates adequate renal function, which is important for medication metabolism and fluid balance during surgery. Since the value is normal, it does not require notification.

Choice D reason: A WBC count of 20,000/mm³ is significantly elevated, indicating possible infection or severe inflammatory response. Surgery should not proceed in the presence of untreated infection because it increases the risk of postoperative complications such as sepsis, poor wound healing, and prosthetic joint infection. This abnormal result requires immediate notification to the surgeon.