A nurse is admitting a client who reports persistent nausea, vomiting, and weakness for three days. The client has dry oral mucous membranes, weak peripheral pulses, and decreased skin turgor. What additional assessment findings should the nurse identify as manifestations related to the fluid imbalance? (Select All That Apply)

Total urine output 45 mL during past 3 hours: Appropriate
Rationale: Epidural anesthesia can affect bladder function, leading to reduced urine output. A total urine output of 45 mL in 3 hours is low and should be reported as it might indicate urinary retention or decreased kidney function.
Nausea and vomiting: Inappropriate
Rationale: Nausea and vomiting are not typically a direct concern related to epidural anesthesia unless they are severe or persistent. These symptoms are more commonly associated with general anesthesia or postoperative complications, but they are not immediate concerns specific to epidural block.
Clear fluid leaking from insertion site: Appropriate
Rationale: Clear fluid leaking from the epidural insertion site could indicate cerebrospinal fluid leakage or other complications. This should be reported immediately to assess for potential complications such as an epidural hematoma or infection.
Severe headache: Appropriate
Rationale: A severe headache following an epidural block could be a sign of a post-dural puncture headache, which is a known complication of epidural anesthesia. It should be reported to the healthcare provider for further evaluation and management.
Left knee pain 3 out of 10: Inappropriate
Rationale: Pain at a level of 3 out of 10 is relatively mild and may be expected following surgery. While it is important to monitor and manage pain, this level of pain is not usually an immediate concern related to the epidural anesthesia unless other symptoms are present.

A. Fluid restriction: Fluid restriction is not indicated for high serum magnesium levels. It is generally used for conditions like heart failure or renal impairment, but not specifically for managing hypermagnesemia.
B. Furosemide (Lasix): This is the correct choice because furosemide is a diuretic that can help promote the excretion of excess magnesium through the urine. It is an appropriate treatment for hypermagnesemia, which is indicated by the elevated serum magnesium level.
C. Calcium carbonate (Tums): This option is incorrect as calcium carbonate is typically used to treat hypomagnesemia (low magnesium levels) or to bind excess phosphate, not to manage elevated magnesium levels.
D. Magnesium oxide (MagOx): This is not suitable because magnesium oxide would increase the magnesium level further, not decrease it. It is used to supplement magnesium in cases of deficiency, not to treat hypermagnesemia.