A nurse is caring for a 55-year-old male client in an outpatient clinic.

Click to highlight the finding that requires immediate follow-up. To deselect a finding, click on the finding again.

A. Coughing up mucopurulent sputum
B. Joint pain
C. Anorexia
D. Night sweats
E. Purified protein derivative (PPD) test 11 mm
 

Choice A rationale

Magnesium levels within the normal range of 1.3 to 2.1 mEq/L do not directly indicate a therapeutic response to sodium polystyrene sulfonate. This medication is primarily used to exchange potassium ions for sodium ions in the gastrointestinal tract, thus lowering serum potassium. Magnesium homeostasis is regulated independently, often by renal excretion and dietary intake, and is not a direct target of this drug.

Choice B rationale

Calcium levels within the normal range of 9 to 10.5 mg/dL do not indicate a therapeutic response to sodium polystyrene sulfonate. This medication does not significantly impact calcium metabolism. Calcium regulation involves parathyroid hormone and vitamin D, and is separate from the ion-exchange mechanism of sodium polystyrene sulfonate.

Choice C rationale

Sodium levels within the normal range of 136 to 145 mEq/L, while desirable, do not directly indicate a therapeutic response to sodium polystyrene sulfonate. Although the medication exchanges potassium for sodium, leading to a potential increase in serum sodium, the primary therapeutic goal is potassium reduction, and a normal sodium level alone does not confirm this.

Choice D rationale

A potassium level of 4.8 mEq/L, which falls within the normal range of 3.5 to 5 mEq/L, indicates a therapeutic response to sodium polystyrene sulfonate. This medication functions as a cation-exchange resin, binding to potassium ions in the intestine and facilitating their excretion, thereby lowering elevated serum potassium levels to a safe range.

Choice A rationale

Aspartate aminotransferase (AST) is an enzyme primarily found in the liver, heart, and muscle. Elevated levels can indicate hepatocellular damage or cardiac muscle injury. While some medications can affect liver function, AST is not a primary monitoring parameter for methylprednisolone, which is a corticosteroid, unless specific hepatotoxicity is suspected or pre-existing liver conditions exist. Normal AST levels are typically 10-40 U/L.

Choice B rationale

Fibrin split products (FSPs) are indicators of fibrinolysis, the breakdown of fibrin clots. Elevated FSPs suggest active clotting and subsequent clot degradation, often seen in disseminated intravascular coagulation (DIC). Methylprednisolone, a corticosteroid, does not directly impact fibrinolysis or coagulation to warrant routine monitoring of FSPs as a primary concern. This test is not routinely indicated.

Choice C rationale

Blood urea nitrogen (BUN) measures the amount of nitrogen in the blood that comes from the waste product urea. Elevated BUN can indicate kidney dysfunction or dehydration. While corticosteroids can influence fluid balance, BUN is not a specific or primary laboratory value monitored for the direct effects of methylprednisolone therapy unless a pre-existing renal impairment is present. Normal BUN levels are typically 7-20 mg/dL.

Choice D rationale

Methylprednisolone, a glucocorticoid, significantly impacts carbohydrate metabolism by promoting gluconeogenesis and glycogenolysis, leading to increased blood glucose levels. This can induce hyperglycemia and even steroid-induced diabetes, particularly in predisposed individuals. Therefore, close monitoring of blood glucose is crucial to prevent and manage this common adverse effect. Normal fasting glucose is typically 70-99 mg/dL.