The nurse should monitor the client for clinical manifestations of digoxin toxicity if the laboratory report reflects a serum:

Choice A reason: This is the most concerning result for the nurse. Creatinine is a waste product of muscle metabolism that is filtered by the kidneys and excreted in the urine. A high creatinine level indicates impaired kidney function, which can be a complication of hypertension. The normal range of creatinine is 0.6 to 1.2 mg/dL for men and 0.5 to 1.1 mg/dL for women. A creatinine level of 3.2 mg/dL is more than twice the upper limit of normal and suggests severe kidney damage.

Choice B reason: This is not a concerning result for the nurse. Potassium is an electrolyte that is essential for the function of nerves and muscles, especially the heart. The normal range of potassium is 3.5 to 5.0 mEq/L. A potassium level of 3.4 mEq/L is slightly below the normal range, but not enough to cause serious problems. A low potassium level can be caused by diuretics, vomiting, diarrhea, or excessive sweating. The nurse should monitor the client's potassium level and symptoms, and advise the client to eat foods that are high in potassium, such as bananas, oranges, potatoes, and tomatoes.

Choice C reason: This is not a concerning result for the nurse. Hemoglobin is a protein in the red blood cells that carries oxygen to the tissues. The normal range of hemoglobin is 13.5 to 17.5 g/dL for men and 12.0 to 15.5 g/dL for women. A hemoglobin level of 12.8 g/dL is within the normal range for women and slightly below the normal range for men, but not enough to cause significant anemia. A low hemoglobin level can be caused by blood loss, iron deficiency, or bone marrow disorders. The nurse should assess the client's history, diet, and symptoms, and check for other signs of anemia, such as pallor, fatigue, and shortness of breath.

Choice D reason: This is not a concerning result for the nurse. Blood urea nitrogen (BUN) is a waste product of protein metabolism that is filtered by the kidneys and excreted in the urine. A high BUN level indicates impaired kidney function or dehydration. The normal range of BUN is 7 to 20 mg/dL. A BUN level of 20 mg/dL is at the upper limit of normal, but not enough to indicate serious kidney problems. The nurse should ensure that the client is well hydrated and monitor the client's urine output and specific gravity.

Choice A reason: The client requires additional teaching if they state that they can have aspirin for pain after the bone marrow aspiration. Aspirin is a drug that inhibits platelet aggregation and increases the risk of bleeding. ¹ The client should avoid aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) for at least 48 hours after the procedure. ² The client should use acetaminophen or another pain reliever that does not affect blood clotting.

Choice B reason: The client does not require additional teaching if they state that the nurse will check the puncture site at least every 4 hours after the procedure. This is a correct statement, as the nurse should monitor the site for signs of bleeding, infection, or hematoma. ² The nurse should also apply pressure and a sterile dressing to the site and instruct the client to keep it dry and clean for 24 hours.

Choice C reason: The client does not require additional teaching if they state that they will have some pain that is similar to a toothache. This is a correct statement, as the client may experience mild to moderate pain at the site of the aspiration, which may radiate to the hip or back. ² The pain usually subsides within a few hours or days.

Choice D reason: The client does not require additional teaching if they state that they understand that this is a sterile procedure. This is a correct statement, as the bone marrow aspiration is performed under sterile conditions to prevent infection. ² The nurse should wear gloves, gown, mask, and eye protection and use a sterile needle, syringe, and antiseptic solution.