A nurse is caring for a client who has hepatic encephalopathy. Which of the following laboratory values should the nurse monitor?

Rationale:

A. “Our children can stay up as late as they prefer.” This statement reflects a permissive parenting style, where few rules are enforced and children have significant freedom. Parents in this style often avoid setting firm boundaries, which contrasts sharply with the strict control seen in authoritarian parenting.

B. “Our children are allowed to make their own choices.” This reflects an authoritative parenting style, which balances independence with guidance. Authoritative parents encourage decision-making while still providing consistent rules and support. This collaborative, approach differs significantly from the rigid and demanding nature of authoritarian parenting.

C. “We make decisions as a family.” This statement also aligns with authoritative parenting, which values communication, mutual respect, and shared problem-solving. Children’s input is considered, helping them develop confidence and reasoning skills. Such family-centered decision-making is not present in authoritarian households.

D. “We expect our children to do what we say without any questions.” Authoritarian parenting focuses on obedience, strict rules, and limited negotiation. Children are expected to comply without explanation, and parents often enforce discipline rigidly. This style places emphasis on control rather than communication.

Rationale:

A. Hemoglobin and hematocrit: The client’s hemoglobin (9.1 g/dL) and hematocrit (27%) are significantly below normal, indicating anemia, likely from gastrointestinal bleeding. This finding requires immediate follow-up to prevent further hemodynamic compromise and assess for ongoing blood loss.

B. Stool results: The client reports dark, tarry stool, which is indicative of melena and gastrointestinal bleeding. Positive hemoccult (if confirmed) further supports active bleeding. Prompt evaluation is necessary to identify the source and prevent severe anemia or shock.

C. Temperature: The client’s temperature is 37.5°C (99.5°F), which is mildly elevated but not critically high. It does not indicate an immediate life-threatening condition, though it should be monitored as part of ongoing assessment for infection.

D. WBC count: The WBC is 6,700/mm³, which is within normal limits. There is no indication of acute infection requiring immediate intervention at this time.

E. Respiratory rate: The respiratory rate of 18/min is within normal limits and does not require immediate follow-up.

F. Heart rate: The client’s heart rate is 118/min, which is tachycardic and may indicate hypovolemia from blood loss. Immediate monitoring and intervention are warranted to prevent cardiovascular compromise.

G. Blood pressure: The client’s blood pressure is 90/50 mm Hg, which is hypotensive. This may result from fluid loss due to bleeding and requires urgent assessment and stabilization to prevent shock.

H. Current medications: The client is taking high-dose ibuprofen (800 mg three times daily), a nonsteroidal anti-inflammatory drug (NSAID), which increases the risk of gastrointestinal bleeding and ulcer formation. This directly relates to the client’s presenting symptoms and requires immediate review and discontinuation.