A nurse is caring for a client who is receiving an intravenous potassium infusion and who has a urine output of 10 mL/hr and a blood urea nitrogen of 50 mg/dL (10 to 20 mg/dL). Which of the following actions should the nurse take?

A. "I should expect drowsiness while taking this medication.": Aspirin does not typically cause drowsiness. Clients should be informed about other possible side effects, but fatigue is not a primary concern.

B. "I need to avoid consuming green, leafy vegetables while taking this medication.": Unlike warfarin, aspirin’s anticoagulant effect is not significantly influenced by dietary vitamin K intake. There is no need to avoid green, leafy vegetables while taking aspirin.

C. "I will take the aspirin daily on an empty stomach.": Taking aspirin on an empty stomach can increase the risk of gastrointestinal irritation and ulcers. It is generally recommended to take it with food or water to reduce stomach upset.

D. "I should notify my provider if I develop ringing in my ears.": Tinnitus can be an early sign of aspirin toxicity, especially with long-term use or higher doses. Notifying the healthcare provider if this occurs indicates proper understanding of the potential adverse effects.

Rationale for correct choices:

• Sodium 124 mEq/L: The client’s serum sodium is critically low, indicating severe hyponatremia, a known serious adverse effect of oxcarbazepine. Hyponatremia can lead to confusion, seizures, and potentially life-threatening neurological complications, requiring immediate provider follow-up and possible medication adjustment or discontinuation.
• Difficulty remembering medication times: Cognitive changes or confusion may indicate central nervous system effects of oxcarbazepine or complications from hyponatremia. This finding signals the need for urgent reassessment and intervention to prevent medication errors or toxicity.
• Nausea/vomiting: Persistent nausea and vomiting, especially after a recent dose increase, may be a sign of drug intolerance, early hyponatremia symptoms, or central nervous system effects. Immediate follow-up is necessary to prevent further complications and dehydration.

Rationale for Incorrect Choices:

• Mild headache: While headaches may occur with oxcarbazepine, the mild nature and recent onset are less urgent compared with severe hyponatremia and neurological symptoms.
• Vital signs (HR 86, BP 110/66, Temp 36.3° C, RR 16): These are slightly lower than baseline but not immediately concerning. The priority is lab abnormality and neurological changes.
• Hct 40%, Hgb 13 g/dL: These values remain within normal limits and do not require immediate intervention.
• Use of oral contraceptives: This is important for counseling because oxcarbazepine can reduce contraceptive efficacy, but it is not an urgent clinical finding compared to hyponatremia.