The practical nurse (PN) is reviewing morning laboratory values for a female adult client. Which findings indicate abnormal values that should be reported to the healthcare provider? Select all that apply.

Reference Range:

• White Blood Cell (WBC) [5,000 to 10,000/mm3 (5 to 10 x 109/L)]
• Hemoglobin (Hgb) [12 to 16 g/dL (120 to 160 g/L)]
• Hematocrit (Hct) [37% to 47% (0.37 to 0.47 volume fraction)]
• Potassium (K+) [3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L)]
• Sodium [136 to 145 mEq/L (136 to 145 mmol/L)]

Rationale:

A. Measure and record the abdominal girth: Measuring abdominal girth provides objective data on abdominal distention, which can indicate constipation, obstruction, or fluid accumulation. This baseline measurement is essential for monitoring changes over time and assessing the severity of bowel irregularity.

B. Determine the client's usual bowel patterns: Understanding the client’s normal frequency, consistency, and characteristics of bowel movements helps differentiate between chronic variations and acute changes, guiding appropriate nursing interventions for constipation or other gastrointestinal issues.

C. Auscultate the abdomen for bowel sounds: Listening for bowel sounds allows the nurse to evaluate intestinal motility. Hyperactive, hypoactive, or absent bowel sounds can provide clues about underlying gastrointestinal function and guide the next steps in management.

D. Obtain a prescription for an enema or suppository: Administering an enema or suppository should only occur after assessment and clinical judgment, and with a healthcare provider’s prescription. It is not the first action in data collection and evaluation of bowel function.

E. Evaluate the client's dietary intake and eating patterns: Dietary habits, including fiber and fluid intake, significantly influence bowel regularity. Assessing these patterns helps identify contributing factors to constipation and guides non-pharmacologic interventions to promote bowel health.

Rationale:

A. Assess level of consciousness: Level of consciousness provides information about neurologic status but does not directly address absent peripheral pulses. While important in overall assessment, it does not help determine the presence or adequacy of blood flow to the extremity.

B. Obtain a doppler stethoscope: Using a Doppler device allows the PN to detect blood flow when a pulse is not palpable by touch. This is a standard follow-up action for assessing peripheral perfusion, particularly in older adults or clients with edema, obesity, or vascular disease that can make palpation difficult.

C. Measure the blood pressure: Blood pressure measurement provides systemic perfusion data but does not identify localized arterial flow to a specific extremity. A normal blood pressure does not rule out peripheral vascular compromise in the foot.

D. Elevate both feet on a pillow: Elevating the extremities may improve venous return but does not aid in locating or confirming an absent dorsalis pedis pulse. This is not effective for evaluating arterial perfusion at the site of concern.