An adult client is admitted with AIDS and oral candidiasis manifested by several painful mouth ulcers. The nurse delegates oral care to the unlicensed assistive personnel (UAP) and discusses how to assist the client. Which instruction should the nurse provide the UAP?

Choice A reason: Monitoring urine output assesses fluid status but does not directly prevent hypernatremia, which results from excess sodium or water loss. Reducing dietary sodium intake is more proactive, as urine output is a secondary indicator, making this instruction less effective for management.

Choice B reason: Using salt tablets after exercise is dangerous, as they increase sodium intake, worsening hypernatremia. This condition requires sodium reduction and water replacement, making this instruction harmful, as it exacerbates elevated serum sodium levels, risking neurological complications.

Choice C reason: Reviewing food labels for sodium content is critical, as hypernatremia results from high sodium intake or water loss. Limiting dietary sodium prevents further elevation of serum sodium, protecting against cerebral edema or seizures, making this the most effective discharge instruction.

Choice D reason: Drinking water when thirsty helps hydration but is reactive and insufficient for hypernatremia, which requires proactive sodium reduction. Thirst may be impaired in some patients, and dietary sodium control is more direct, making this instruction less comprehensive than label review.

Choice A reason: Hemoglobin is critical to review, as diclofenac, an NSAID, can cause gastrointestinal bleeding, leading to anemia. Pale appearance and fatigue suggest blood loss, reducing oxygen-carrying capacity. Low hemoglobin confirms anemia, necessitating intervention to prevent further complications, making this the priority laboratory value.

Choice B reason: Serum creatinine monitors renal function, as diclofenac may cause nephrotoxicity, but pale appearance and fatigue point to anemia from bleeding, not renal issues. Renal effects are less immediate than blood loss, making hemoglobin more urgent to assess in this context.

Choice C reason: Blood glucose is irrelevant, as diclofenac does not significantly affect glucose metabolism. Pale appearance and fatigue are classic anemia symptoms, not hypoglycemia, making hemoglobin the priority over glucose, which does not explain the client’s presentation in rheumatoid arthritis.

Choice D reason: Liver enzymes monitor hepatotoxicity, a diclofenac side effect, but pale appearance and fatigue suggest anemia from gastrointestinal bleeding, not liver dysfunction. Hemoglobin directly addresses the likely cause, making it more critical than liver enzymes for immediate evaluation.