A nurse is reviewing the laboratory report for a client who has been taking sodium polystyrene sulfonate.
Which of the following findings indicates a therapeutic response to the medication?

Choice A rationale

Acyclovir is primarily excreted renally, and its metabolism can lead to crystal formation in the renal tubules, particularly if the client is dehydrated or the infusion is too rapid. Monitoring for an increase in creatinine (normal range 0.6-1.2 mg/dL) is crucial as it indicates decreased glomerular filtration rate and potential nephrotoxicity or acute kidney injury, necessitating dose adjustment or hydration.

Choice B rationale

Administering oxygen prophylactically is not a standard or scientifically indicated action for acyclovir administration. Acyclovir does not inherently cause respiratory depression or compromise oxygenation. Its primary adverse effects are typically related to renal function, central nervous system, or gastrointestinal system, not respiratory compromise.

Choice C rationale

While some antiviral medications can affect hematopoiesis, acyclovir is not commonly associated with significant decreases in hemoglobin (normal range 12-18 g/dL) and hematocrit (normal range 37-52%). These parameters are generally monitored in clients with pre-existing hematological conditions or those on long-term, high-dose therapy, but it's not a primary immediate concern for IV administration.

Choice D rationale

Administering acyclovir IV over 30 minutes is the recommended infusion duration. Rapid intravenous infusion can increase the risk of renal tubular damage and crystal formation, leading to nephrotoxicity. A slower infusion rate allows for proper dilution and minimizes the concentration of the drug in the renal tubules, thus protecting kidney function and reducing adverse effects.

• conditions. The client has dyspnea, tachycardia, and low oxygen saturation, suggesting acute illness or cardiovascular instability.
• Bumetanide, a loop diuretic, is contraindicated here as it may worsen hypovolemia and electrolyte imbalance. The client’s blood pressure is high but he is already showing signs of dehydration and electrolyte abnormalities (hypokalemia). Diuretics may exacerbate hypokalemia and hypotension later.
• Labetalol is anticipated for managing the acute hypertension (BP 160/98 mm Hg), especially with the client’s tachycardia and hypertensive urgency signs. It acts by blocking alpha and beta receptors to lower blood pressure safely.
• Oxygen is anticipated because the client’s oxygen saturation is 92% on room air with dyspnea and tachypnea; supplemental oxygen will improve tissue oxygenation and reduce hypoxia.
• Midodrine is contraindicated because it raises blood pressure via alpha-1 agonism; given the client’s elevated BP, it would worsen hypertension and increase cardiovascular risk.
• Calcium gluconate is contraindicated because the client’s calcium is within normal limits (10.3 mg/dL) and giving calcium unnecessarily can cause hypercalcemia or arrhythmias.
• Potassium supplementation is anticipated as the client has hypokalemia (2.8 mEq/L) on Day 2, which can cause arrhythmias and muscle weakness, requiring prompt correction.