The nurse is caring for a patient who was admitted to the medical unit with a diagnosis of heart failure and has a history of hyperparathyroidism. The nurse reviews the following lab results in the chart below. Which order by the healthcare provider (HCP) will the nurse clarify/question?

• Brain (B-Type) Natriuretic Peptide: 210 pg/mL
• Potassium: 4.7 mg/dL
• Calcium: 14.1 mg/dL
• Sodium: 139 mEq/L
• BUN: 25 mg/dL
• Creatinine: 1.1 mg/dL

Choice A reason:

• Normal blood pressure may indicate improved hydration, but deep respirations (often seen in metabolic acidosis or DKA) suggest that the patient is still experiencing distress. This combination does not reliably signal effective treatment for HHS.

Choice B reason:

• Increased alertness shows that the patient’s mental status is improving, reflecting better cerebral perfusion and hydration.
• A normal heart rhythm indicates that potassium levels are stable (thanks to the potassium chloride in the IV fluids) and that the insulin therapy is not causing dangerous shifts.
• Together, these findings are the best indicators that the treatment is effective.

Choice C reason:

• A high urine specific gravity reveals that the urine is still concentrated, which means dehydration persists.
• Although the temperature is normal, the continued dehydration is not consistent with effective treatment of HHS.

Choice D reason:

• A blood glucose of 250 mg/dL suggests that hyperglycemia is being corrected; however, persistent disorientation indicates that the patient’s mental status has not improved, meaning that the treatment has not fully resolved the critical aspects of HHS.

Thus, Choice B (Increased alertness, normal heart rhythm) is the best indicator of effective treatment.

Choice A reason: The order to administer Hydrochlorothiazide should be clarified because thiazide diuretics can increase calcium levels, which could worsen hypercalcemia in a patient with a history of hyperparathyroidism.

Choice B reason: Monitoring intake and output and daily weights are essential for managing fluid balance in heart failure patients and do not need clarification.

Choice C reason: Administering Calcitonin helps lower calcium levels, which is appropriate for treating hypercalcemia in a patient with hyperparathyroidism.

Choice D reason: Preparing the patient for possible hemodialysis may be necessary if the patient's kidney function deteriorates, especially with elevated BUN and creatinine levels.