A client is currently prescribed pantoprazole, and the nurse is reviewing the client's labs (shown below). Which lab result is of most concern to the nurse?

Laboratory Test	Result	Normal Range
Sodium	146 mEq/dL	135-145 mEq/L
Calcium	8.2 mg/dL	8.4-10.2 mg/dL
Magnesium	1.2 mg/dL	1.6-2.2 mg/dL
Gastric pH	6	1-4

A) The client will remain free from visible bleeding, bruising, and signs of internal bleeding (tachycardia and hypotension) during this shift: This is the most appropriate outcome for the "Risk for bleeding" nursing diagnosis. Since both aspirin and warfarin are anticoagulants, they increase the client's risk of bleeding. The priority is to monitor for and prevent any signs of visible bleeding, bruising, or more serious internal bleeding, which could manifest as tachycardia or hypotension. This outcome directly addresses the client's safety by focusing on detecting and preventing bleeding complications.

B) The client will verbalize understanding of dietary restrictions while on warfarin and provide examples of foods that contain vitamin K during this shift: While this is an important goal for clients on warfarin (because vitamin K can interfere with the effectiveness of warfarin), it is not the most immediate concern in the context of the "Risk for bleeding" diagnosis. Dietary restrictions should be discussed but are not as time-sensitive or directly related to the prevention of bleeding in the short term, especially during this shift.

C) The client will state their pain level is less than 4 on a 0-10 pain scale during aspirin therapy: While managing pain is important, this outcome does not directly address the risk for bleeding associated with both aspirin and warfarin therapy. The priority nursing concern here is preventing bleeding, not pain management during aspirin therapy.

D) The client will remain free from any signs and symptoms of deep vein thrombosis (DVT): While preventing DVT is important for patients on anticoagulant therapy, the focus of this nursing diagnosis is on the risk of bleeding, not thrombosis. Therefore, this outcome is not as relevant to the immediate concerns related to the prescribed medications (aspirin and warfarin).

A) 1 x soft bowel movement: This is the correct answer. Psyllium is a bulk-forming laxative that helps to relieve constipation by absorbing water into the stool, making it easier to pass. A therapeutic effect of psyllium would be the client experiencing a soft bowel movement, indicating the medication has helped to regulate the client's bowel movements and relieve constipation.

B) Gastric pH 2 (Normal pH: 1-4): While this is a normal gastric pH range, it is not related to the therapeutic effect of psyllium. Psyllium works in the gastrointestinal tract to promote bowel regularity, not to alter gastric pH. The pH measurement of gastric contents is not a relevant indicator of the medication's effectiveness.

C) 500 ml of urine output: This finding is not related to the therapeutic effect of psyllium. Psyllium is intended to address bowel function, not urine output. Adequate urine output should be monitored, but it is not the expected outcome for a patient taking psyllium.

D) Blood glucose: 95 (Normal Fasting Blood Glucose: 60-120): While a normal blood glucose level is important, it is not relevant to the action of psyllium. Psyllium does not have a direct effect on blood glucose levels, so a normal blood glucose result is not indicative of a therapeutic effect of the medication.