To prevent deep vein thromboses following knee replacement surgery, an adult male client is receiving daily subcutaneous enoxaparin. Which laboratory result requires immediate action by the nurse?

Reference Range:
Hematocrit [42% to 52% (0.42 to 0.52 volume fraction)]
Platelets [150,000 to 400,000/mm² (150 to 400 × 10^9/L)]
Creatinine [0.5 to 1.1 mg/dL (44 to 97 μmol/L)]
Blood Urea Nitrogen (BUN) [10 to 20 mg/dL (3.6 to 7.1 mmol/L)]

Choice A reason: Eliminating use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, is an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that stabilizes mood and prevents manic episodes. NSAIDs can increase the blood levels of lithium and cause toxicity, which can manifest as nausea, vomiting, tremors, confusion, or seizures.

Choice B reason: Monitoring blood glucose levels daily is not an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that does not affect the blood sugar levels or the risk of diabetes. Blood glucose levels may be important for the general health of the client, but they are not related to lithium therapy.

Choice C reason: Notifying healthcare provider prior to dental procedures is not an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that does not interact with local anesthetics or antibiotics that may be used during dental procedures. However, the client should inform the dentist about their medical history and medications, as a precaution.

Choice D reason: Avoiding consuming all foods that contain iodine is not an instruction that the nurse should provide to the client who is taking lithium carbonate, which is a medication that does not interfere with the thyroid function or the metabolism of iodine. Iodine is an essential nutrient that is found in many foods, such as seafood, dairy products, eggs, and iodized salt. Avoiding iodine can cause deficiency and lead to goiter or hypothyroidism.

Choice A: Printing an electrocardiogram strip is not a priority in this situation. The client is not responsive and has a low respiratory rate, which indicates a possible overdose of morphine. The nurse should focus on reversing the effects of the opioid and maintaining the client's airway and circulation.

Choice B: Providing rescue breaths with a manual ventilation bag is a correct and urgent action. It can supply oxygen to the client until naloxone takes effect and restore normal breathing.

Choice C: Giving naloxone 2 mg intravenously is a correct and urgent action. Naloxone is an opioid antagonist that can block the effects of morphine and reverse respiratory depression.

Choice D: This can help increase the patient’s oxygen levels, which may be low due to the decreased respiratory rate.

Choice E: Performing chest compressions is not a correct or urgent action. It is only indicated if the client has no pulse or signs of life. It can also cause harm if the client has a heartbeat.

Choice F: Calling for rapid response is a correct and urgent action. Rapid response is a team of health care professionals that can assist in emergency situations and provide advanced care.