A nurse is monitoring a client following a thoracentesis.
The nurse should identify which of the following manifestations as a complication and contact the provider immediately?

Choice A rationale

1 cup of canned black beans is an excellent source of non-heme iron. Iron is a crucial component of hemoglobin synthesis, which is essential for oxygen transport in red blood cells. Increasing dietary iron intake helps to replenish iron stores and alleviate fatigue associated with iron deficiency anemia.

Choice B rationale

8 oz whole milk provides calcium and vitamin D but is a poor source of iron. In fact, calcium can sometimes interfere with iron absorption, making it an unsuitable choice for a client specifically aiming to increase iron intake to combat iron deficiency anemia.

Choice C rationale

1.5 oz raisins provide some iron, but the quantity is relatively small compared to other iron-rich foods. While a healthy snack, it would not be the primary recommendation for a client requiring significant iron replenishment due to fatigue from anemia.

Choice D rationale

8 oz black tea contains tannins, which are compounds known to inhibit the absorption of non-heme iron from plant-based foods. Therefore, consuming black tea with meals would counteract efforts to increase iron levels and is not recommended for iron deficiency anemia.

The nurse is evaluating the client’s response to the prescribed medications. The client’s HDL level and blood pressure indicate an improvement in the client’s condition.

Rationale for correct answers:

HDL level (High-Density Lipoprotein):
HDL is the "good" cholesterol that helps remove excess cholesterol from blood vessels. Normal target HDL is >45 mg/dL in men. The client’s HDL increased from 25 mg/dL to 60 mg/dL, reflecting significant improvement in lipid profile, indicating effective response to lipid-lowering therapy.

Blood pressure:
The client’s blood pressure decreased from 180/88 mm Hg (stage 2 hypertension) to 138/70 mm Hg, which is much closer to the recommended target of <140/90 mm Hg for general hypertension control. This reflects a positive response to antihypertensive treatment.

Rationale for incorrect options:

A. Potassium level:
Today's potassium is 5.3 mEq/L, slightly above the normal range (3.5–5.0 mEq/L). Although not yet critical, this mild hyperkalemia may warrant monitoring, especially if the patient is on potassium-sparing agents like ACE inhibitors or ARBs.

B. Weight:
The client’s weight increased from 86 kg to 90 kg, which is not desirable. Weight gain can negatively impact both blood pressure and lipid control. Ideally, weight should decrease or remain stable.

C. Heart rate:
The heart rate dropped from 96/min to 58/min. While not necessarily dangerous, a low heart rate (bradycardia) could be a side effect of certain antihypertensives (e.g., beta-blockers). It's not a direct indicator of improved cardiovascular health.

D. Pulse oximetry:
Oxygen saturation changed slightly from 97% to 95%, both within normal limits (normal is >94%). No respiratory complaints are present, so this change is not clinically significant.

F. Pedal findings:
No peripheral edema is noted, but this is a neutral finding rather than an improvement. The absence of edema is expected in a stable patient and does not directly reflect medication effectiveness.

Take-home points:

• Improved HDL and blood pressure are key indicators of effective antihypertensive and lipid-lowering therapy.
• Slightly elevated potassium may suggest medication side effects and requires monitoring.
• Weight gain may counteract benefits of therapy and should be addressed in lifestyle counseling.
• Bradycardia and mild hyperkalemia should prompt review of medication types and dosages.