A nurse is caring for a client who is taking lithium and reports starting a new exercise program. The nurse should assess the client for which of the following electrolyte imbalances?

Choice A Reason:
Serum osmolarity 310 mOsm/L is incorrect. Serum osmolarity measures the concentration of particles in the blood. While an elevated serum osmolarity might indicate dehydration, it's not a direct indicator of the effectiveness of treatment. It signifies the concentration of solutes in the blood rather than reflecting hydration improvement after treatment.
Choice B Reason:
Serum hematocrit 55%m is incorrect. Elevated hematocrit levels can occur in dehydration because of hemoconcentration (an increase in the concentration of red blood cells due to reduced fluid volume). However, similar to serum osmolarity, while it can indicate dehydration, it doesn't specifically reflect the effectiveness of treatment.
To determine effective treatment of dehydration, the nurse should consider the laboratory values that reflect hydration status:
Choice C Reason:
Urine specific gravity 1.020 is correct. Urine specific gravity measures the concentration of solutes in the urine, indicating the kidneys' ability to concentrate urine. A higher specific gravity (typically above 1.020) suggests more concentrated urine, which can indicate dehydration. As hydration improves, the urine becomes less concentrated, so a decrease in urine specific gravity toward the normal range (around 1.010-1.020) indicates effective rehydration and improved kidney function in retaining fluids.
Choice D Reason:
BUN 28 mg/dL is incorrect. Blood urea nitrogen (BUN) levels can also rise in dehydration due to reduced kidney perfusion. However, like serum osmolarity and hematocrit, while it can indicate dehydration, it doesn't directly show the effectiveness of treatment or the improvement in hydration status after treatment.

Choice A Reason:
Remove duplicate medications of different dosages from the reconciliation is incorrect. Removing duplicate medications with different dosages from the reconciliation is indeed essential. However, the primary focus during transfer is to compare the current medication list with the new regimen to avoid omissions or discrepancies in the transition process.
Choice B Reason:
Compare the current list of medications to medications the client will receive after transform is correct. Comparing the current list of medications, the client is taking to the medications they are expected to receive after transfer is crucial for ensuring a seamless transition of care. This process helps identify discrepancies, potential interactions, or changes in the medication regimen between settings, ensuring the continuity and accuracy of medication administration.
Choice C Reason:
Omit over-the-counter medications from the at-home medication list is incorrect. Over-the-counter medications should ideally be included in the medication reconciliation process to provide a comprehensive overview of all medications the client is taking, including potential interactions with prescribed medications.
Choice D Reason:
Include medications the client received in the acute setting but will no longer need after transfer is incorrect. The reconciliation process should aim to update the medication list to reflect the client's current and future medication needs accurately. Including medications, the client received in the acute setting but won't need after transfer might introduce unnecessary medications into the new regimen. These should be communicated but not included in the ongoing medication list.