A nurse is caring for a client who experienced a lacerated spleen and has been on bedrest for several days. The nurse auscultates decreased breath sounds in the lower lobes of both lungs. The nurse should realize that this finding is most likely an indication of which of the following conditions?

A. "I will feel less hungry during meals while I am taking orlistat": Orlistat works by blocking the absorption of dietary fat in the intestines rather than suppressing appetite. Therefore, it does not typically reduce hunger during meals.
B. "I will eat a no-fat diet to prevent side effects from the medication": Orlistat can cause gastrointestinal side effects such as oily stools, fecal incontinence, and flatulence, particularly when consumed with high-fat meals. While reducing fat intake can help minimize these side effects, it is not necessary to eliminate fat entirely from the diet. The statement is partially correct but not the best response indicating full understanding.
C. "I will stop taking orlistat and call my doctor if my urine gets darker in color": Dark urine can indicate liver problems, which are a potential side effect of orlistat. Therefore, it is crucial for the client to monitor for this symptom and contact their healthcare provider if it occurs. This response indicates that the client understands the potential adverse effects of the medication.
D. "I will take my dose of orlistat every morning an hour before breakfast": Orlistat is typically taken with meals or up to one hour after eating. Taking it on an empty stomach before breakfast is not recommended.

A. Notify the client's provider: This option might be considered if there are signs of postpartum hemorrhage, such as excessive bleeding, signs of shock, or a boggy uterus that does not respond to massage. However, in this scenario, the fundus is midline and firm, which indicates appropriate uterine contraction. Therefore, notifying the provider at this point may not be necessary.
B. Encourage the client to empty her bladder: Encouraging the client to empty her bladder is always important in the postpartum period, as a full bladder can impede uterine contraction. However, the presence of lochia rubra and small clots along with a midline and firm fundus suggests that uterine involution is progressing well. While encouraging the client to empty her bladder is appropriate, it may not be the priority in this situation.
C. Increase the frequency of fundal massage immediately: Fundal massage is typically performed to promote uterine involution and prevent postpartum hemorrhage. However, in this scenario, the fundus is already midline and firm, indicating adequate contraction. Increasing the frequency of fundal massage unnecessarily could cause discomfort to the client and is not indicated based on the current assessment findings.
D. Document the findings and continue to monitor the client: This is the most appropriate action at this time. The presence of lochia rubra and small clots along with a midline and firm fundus suggests that the uterus is involuting properly. Documenting the findings allows for accurate documentation of the client's condition and continued monitoring for any changes or developments. If the client's condition changes or if there are signs of postpartum hemorrhage, further action, such as notifying the provider, can be taken.