A nurse is reviewing the laboratory results of a client who has atrial fibrillation and a prescription for warfarin. After informing the provider that the INR is 2.5, the nurse should expect which of the following prescriptions?

Choice A Reason:
BUN 15 mg/dL (blood urea nitrogen) is incorrect. An elevated BUN level can indicate kidney dysfunction or dehydration, but it's not typically associated with azathioprine's adverse effects. Azathioprine is known to affect bone marrow, leading to decreased blood cell counts, rather than directly impacting kidney function.
Choice B Reason:
WBC 3,000/mm³ (low white blood cell count) is correct. Azathioprine is an immunosuppressive medication used to treat various conditions, including rheumatoid arthritis. One of its known adverse effects is bone marrow suppression, which can lead to decreased production of blood cells, including white blood cells (WBCs). A low WBC count (leukopenia) can increase the risk of infections due to compromised immune function, making it an important adverse effect to monitor in individuals taking azathioprine.
Choice C Reason:
Hct 45% (hematocrit) is incorrect. A hematocrit of 45% is within the normal range for both men and women. Azathioprine adverse effects usually manifest as blood cell-related issues (such as leukopenia) rather than directly impacting hematocrit levels.
Choice D Reason:
Platelets 250,000/mm³: Platelets within the range of 150,000 to 400,000/mm³ are considered normal. Azathioprine typically affects white blood cells more prominently than platelet counts.

Choice A Reason:
Hypomagnesemia is incorrect. Lithium therapy itself is not a direct cause of hypomagnesemia. While exercise can affect magnesium levels to some extent, it's not a primary electrolyte imbalance that is typically associated with lithium use or considered a significant concern specifically due to lithium.
Choice B Reason:
Hypocalcemia is incorrect. Similarly, lithium therapy is not a direct cause of hypocalcemia. Exercise can affect calcium metabolism, but it's not a primary electrolyte imbalance typically associated with lithium use or considered a significant concern specifically due to lithium.
When a client taking lithium begins a new exercise program, the nurse should primarily assess for the risk of:
Choice C Reason:
Hyponatremia is correct. Lithium can affect the body's regulation of sodium, and excessive sweating due to increased exercise can lead to sodium loss. This combination can potentially contribute to the development of hyponatremia (low sodium levels). Therefore, when a client on lithium starts a new exercise regimen that may induce sweating, monitoring for signs of hyponatremia becomes crucial. Symptoms of hyponatremia can include confusion, headaches, nausea, and in severe cases, seizures or coma.
Choice D Reason:
Hypokalemia is incorrect. Lithium itself does not commonly cause hypokalemia. Exercise can lead to potassium loss through sweating, but hypokalemia is not the primary electrolyte imbalance typically associated with lithium use or considered a significant concern specifically due to lithium.