A male client reports to the on-call clinic nurse that he took two tablets of 10 mg lisinopril by mouth two hours ago and his skin now feels flushed. He reports a history of stable angina, but denies experiencing any chest pain at the moment or recently. Which action should the nurse take?

Choice B reason: Erythrocytes, hemoglobin, and hematocrit are laboratory results that are not as critical as serum potassium, calcium, and phosphorus in a client who has end-stage renal disease (ESRD.. Erythrocytes are red blood cells that carry oxygen from the lungs to the tissues. Hemoglobin is a protein in erythrocytes that binds oxygen. Hematocrit is the percentage of blood volume that is occupied by erythrocytes. ESRD can cause anemia (low erythrocyte, hemoglobin, and hematocrit levels) due to reduced production of erythropoietin, a hormone that stimulates erythrocyte formation, by the kidneys. Anemia can cause fatigue, pallor, or shortness of breath.

Choice C reason: Leukocytes, neutrophils, and thyroxine are laboratory results that are not as relevant as serum potassium, calcium, and phosphorus in a client who has end-stage renal disease (ESRD.. Leukocytes are white blood cells that fight infection and inflammation. Neutrophils are a type of leukocyte that respond to bacterial infection. Thyroxine is a hormone that regulates metabolism and growth. ESRD can cause leukopenia (low leukocyte levels) and neutropenia (low neutrophil levels) due to impaired immune function and increased susceptibility to infection. ESRD can also cause hypothyroidism (low thyroxine levels) due to reduced clearance of thyroid hormones by the kidneys. Hypothyroidism can cause weight gain, cold intolerance, or depression.

Choice D reason: Blood pressure, heart rate, and temperature are not laboratory results, but vital signs that should be monitored in a client who has end-stage renal disease (ESRD.. Blood pressure is the force of blood against the walls of the arteries. Heart rate is the number of times the heart beats per minute. Temperature is the measure of body heat. ESRD can cause hypertension (high blood pressurE. due to fluid overload and activation of the renin-angiotensin-aldosterone system, a hormonal pathway that regulates blood pressure and fluid balance. Hypertension can cause headache, chest pain, or stroke. ESRD can also cause tachycardia (high heart ratE. due to anemia, fluid overload, or electrolyte imbalance. Tachycardia can cause palpitations, dizziness, or heart failure. ESRD can also cause fever (high temperaturE. due to infection or inflammation. Fever can cause chills, sweating, or delirium.

The correct answer is A. Flushed, peeling skin

Choice A reason: Flushed, peeling skin is a classic sign of scarlet fever, which is a condition that can arise from Streptococcal pharyngitis. Scarlet fever is characterized by a red rash that can cover most of the body and may lead to the skin peeling. This symptom is a direct reaction to the toxins produced by the Streptococcal bacteria.

Choice B reason: Red bumps across the chest could be indicative of many conditions and are not specifically characteristic of the reaction to toxins produced by Streptococcal bacteria. While a rash is common in scarlet fever, it typically starts on the face or neck and spreads to the rest of the body, rather than presenting as isolated red bumps.

Choice C reason: A white coating on the tongue, often referred to as “strawberry tongue,” is indeed associated with scarlet fever. However, it is not the clearest indication of a reaction to the toxins. The white coating usually precedes the strawberry-like appearance, where the tongue becomes red and bumpy.

Choice D reason: While a high fever is a symptom of scarlet fever, it is not specific to the reaction to toxins from Streptococcal bacteria, as many infections can cause high fevers. The term “protracted” suggests a prolonged fever, which could be seen in various conditions.