A nurse is reinforcing teaching with a client following an upper gastrointestinal series using barium contrast. Which of the following instructions should the nurse include?

Choice A Reason:
The ammonia level of 55 mcg/dL falls within the normal range of 10 to 80 mcg/dL. Ammonia is a byproduct of protein metabolism and is converted to urea by the liver before being excreted by the kidneys. Elevated levels can indicate liver dysfunction, but in this case, the value does not warrant concern.

Choice B Reason:
A bilirubin level of 1.0 mg/dL is at the upper limit of the normal range, which is 0.3 to 1.0 mg/dL. Bilirubin is produced during the normal breakdown of red blood cells and is processed by the liver. While this value is at the higher end, it is not abnormal and does not require reporting to the provider unless there are symptoms of jaundice or other clinical signs of liver disease.

Choice C Reason:
The platelet count of 60,000/mm³ is significantly below the normal range of 150,000 to 450,000/mm³. Platelets are crucial for blood clotting, and a low count, known as thrombocytopenia, can increase the risk of bleeding, especially concerning in the context of an invasive procedure like a liver biopsy. This value should be reported to the provider as it may necessitate a change in the biopsy plan or require intervention to address the low platelet count.

Choice D Reason:
An AST level of 34 units/L is at the upper boundary of the normal range. AST is an enzyme found in high amounts in the liver, heart, and muscles, and it is released into the bloodstream when any of these tissues are damaged. While this value is at the upper limit, it is not elevated and typically would not need to be reported unless there are other indicators of liver injury or the patient is symptomatic.

Choice A Reason:
A backboard is not typically required at the bedside for a client with a seizure disorder. It is primarily used in situations where spinal immobilization is necessary, such as after a traumatic injury.

Choice B Reason:
Suction equipment is essential for a client with a seizure disorder. During or after a seizure, the client may experience difficulties with secretions or vomit, which can lead to aspiration. Suctioning helps to clear the airway and prevent aspiration pneumonia.

Choice C Reason:
Wrist restraints are not recommended for clients with seizures because they can cause injury if the client has a seizure. Instead, the focus should be on preventing falls and protecting the head during a seizure.

Choice D Reason:
Padded tongue blades are not advised and should never be used in a client with a seizure disorder. There is a risk of causing oral injury or choking if the client bites down on the tongue blade during a seizure.