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: Performing weekly occult blood testing with gastric analysis is not typically required for managing IBD at home. While monitoring for blood in the stool can be important, weekly testing and gastric analysis are more invasive and usually performed under specific medical instructions rather than as a routine home care intervention.

Choice B reason: Discussing nutritional management with the inclusion of a high-protein, high-vitamin diet is crucial for patients with IBD. These patients often experience malnutrition due to poor absorption and increased nutritional needs during flare-ups. A high-protein, high-vitamin diet can help promote healing, maintain muscle mass, and prevent deficiencies. This intervention supports overall health and recovery.

Choice C reason: Leaving the ostomy site open to air for an hour each day when changing the appliance is not recommended. Ostomy sites need to be kept clean and protected to prevent infection and skin irritation. Instead, the focus should be on proper cleaning and secure application of the ostomy appliance.

Choice D reason: Instructing the patient and family on how to give medications through their G-tube is not relevant if the patient has an ostomy. A G-tube is used for feeding and medication administration in patients with impaired oral intake, which is not indicated in this scenario. The focus should be on ostomy care and management.

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.