After administering oral doses of calcitriol and calcium carbonate to a client with hypoparathyroidism, the nurse notes that the client's total calcium level is 14 mg/dL (3.5 mmol/L). Which action should the nurse implement?

Choice A reason: Measuring the client's urinary output is not the most appropriate action for the nurse to take. Although urinary output is an important indicator of renal function, it is not related to the color change of the urine. The nurse should monitor the client's fluid balance as part of the routine care, but it is not a priority.

Choice B reason: Explaining the color change is normal is the most appropriate action for the nurse to take. Carbidopa/levodopa can cause the urine to become dark brown or black, which is a harmless side effect. The nurse should reassure the client that this is not a sign of a serious problem and does not affect the effectiveness of the medication.

Choice C reason: Obtaining a specimen for a urine culture is not the most appropriate action for the nurse to take. A urine culture is used to diagnose a urinary tract infection (UTI), which is characterized by symptoms such as dysuria, frequency, urgency, and hematuria. The color change of the urine due to carbidopa/levodopa is not indicative of a UTI. The nurse should obtain a urine culture only if the client has signs or symptoms of a UTI.

Choice D reason: Encouraging an increase in oral intake is not the most appropriate action for the nurse to take. Although adequate hydration is important for the client's health, it is not related to the color change of the urine. The nurse should encourage the client to drink enough fluids to prevent dehydration, but it is not a priority.

Choice A reason: This is not the action that the nurse should implement. Determining Glasgow Coma Scale score is a method of assessing the level of consciousness and neurological function of the client, but it is not a priority intervention in this situation. The client's respiratory rate and oxygen saturation are more critical indicators of the client's condition and the need for immediate action. The nurse should assess the Glasgow Coma Scale score as part of the ongoing evaluation, but it is not the first action.

Choice B reason: This is not the action that the nurse should implement. Initiating cardiopulmonary resuscitation (CPR) is a lifesaving procedure that is performed when the client has no pulse and no breathing, but it is not indicated in this situation. The client has a respiratory rate of 4 breaths/minute, which is very low, but not absent. The client also has an oxygen saturation of 75%, which is very low, but not incompatible with life. The nurse should provide oxygen therapy and ventilatory support to the client, but not CPR.

Choice C reason: This is not the action that the nurse should implement. Preparing to assist with chest tube insertion is a procedure that is done to drain air or fluid from the pleural space and restore lung expansion, but it is not relevant in this situation. The client's respiratory depression is caused by the opioid overdose, not by a pneumothorax or a pleural effusion. The nurse should monitor the client's chest x-ray and lung sounds, but not prepare for chest tube insertion.

Choice D reason: This is the action that the nurse should implement. Administering a second dose of naloxone is the most appropriate and effective intervention in this situation. Naloxone is an opioid antagonist that reverses the effects of opioids, such as respiratory depression, sedation, and hypotension. However, naloxone has a shorter duration of action than most opioids, and it may require repeated doses to maintain the reversal. The nurse should administer a second dose of naloxone if the client's respiratory rate and oxygen saturation do not improve or worsen after the first dose. The nurse should also monitor the client for signs of opioid withdrawal, such as agitation, nausea, or pain.