A nurse is obtaining a health history from a client. Which finding should the nurse identify as possible risk factors for iron deficiency anemia? Select all that apply

A.Teaching the client to practice deep breathing exercises is a preventive measure for respiratory complications but is completely inappropriate during an acute evisceration. Increased intra-abdominal pressure from deep breathing or coughing can further expel visceral organs through the surgical dehiscence. At this stage, the nurse must prioritize immediate surgical emergency protocols rather than routine postoperative education or respiratory hygiene.

B.Placing the client in a supine position with the hips and knees flexed reduces tension on the abdominal musculature and the surgical incision site. This specific positioning helps prevent further protrusion of the viscera by relaxing the abdominal wall and lowering intra-abdominal pressure. It is a critical first-aid intervention to stabilize the client while preparing for emergency surgical repair of the wound.

C.Covering the wound with a dry, adherent dressing is strictly contraindicated because it causes the delicate serosal surface of the protruding organs to stick to the gauze. This can lead to tissue trauma, ischemia, and necrosis when the dressing is eventually removed. The nurse should instead apply a sterile, non-adherent dressing moistened with warmed 0.9% sodium chloride to maintain tissue viability and moisture.

D.Carefully reinserting the intestines through the wound opening is an action that must never be performed by a nurse as it increases the risk of infection and organ injury. Attempting to push the viscera back into the peritoneal cavity can cause intestinal perforation or introduce pathogens into a sterile environment. The nurse's role is to protect the exposed tissue and keep it moist until a surgeon can perform the repair.

A.Gentamicin is an aminoglycoside antibiotic with a very high risk of nephrotoxicity, as it is primarily excreted unchanged by the kidneys. An increased serum creatinine indicates impaired glomerular filtration and a high risk for drug accumulation and further renal damage. The nurse must report this finding to prevent potential permanent kidney injury and to allow for appropriate dosage adjustments based on clearance.

B.While an increased serum sodium level, or hypernatremia, requires clinical attention, it is not a specific contraindication or a primary adverse effect associated with gentamicin therapy. Gentamicin does not directly interfere with sodium regulation or the endocrine mechanisms of water balance. The nurse should prioritize findings that suggest organ-specific toxicity related to the drug's known safety profile, such as renal dysfunction.

C.Decreased serum potassium can occur with various medications, but it is not a classic hallmark of aminoglycoside toxicity or a reason to withhold an initial dose of gentamicin. Hypokalemia would be more concerning if the patient were taking diuretics or digoxin. In the context of gentamicin, the most critical electrolyte disturbances are usually secondary to the renal tubular damage indicated by rising creatinine.

D.Increased blood glucose levels are typically associated with diabetes mellitus or corticosteroid use rather than aminoglycoside administration. Gentamicin does not affect insulin secretion, peripheral glucose uptake, or hepatic gluconeogenesis in a clinically significant manner. Therefore, while hyperglycemia is an important metabolic finding, it does not represent an immediate safety risk specifically tied to the administration of this antibiotic.