A nurse is collecting data from a client who has bipolar disorder. The nurse should identify that which of the following findings places the client at an increased risk for injury due to mania?

A. Prepare the client for a barium enema: A barium enema is a diagnostic imaging procedure used to evaluate structural abnormalities in the colon, but it is not the immediate priority when a client on warfarin reports blood in stools. The focus should first be on assessing coagulation status and risk of bleeding.

B. Prepare the client for a colonoscopy: Colonoscopy allows direct visualization of the colon to identify sources of bleeding, but performing an invasive procedure in a client on anticoagulation without assessing clotting parameters first increases the risk of severe hemorrhage. Immediate evaluation of anticoagulation levels is safer.

C. Request an aPTT level: Activated partial thromboplastin time (aPTT) is used to monitor heparin therapy, not warfarin. Checking aPTT would not provide accurate information about the client’s anticoagulation status or bleeding risk with warfarin therapy.

D. Request an INR level: The international normalized ratio (INR) is the standard laboratory test for monitoring warfarin therapy. An elevated INR indicates increased anticoagulation and a higher risk of bleeding. Assessing the INR provides critical information to guide interventions such as dose adjustment or vitamin K administration.

A. Collect 2 mL of sputum in an emesis basin: Sputum should be collected directly into a sterile container, not an emesis basin, to prevent contamination and ensure accurate culture results. Using a nonsterile basin can introduce oral flora and compromise the validity of the specimen.

B. Instruct the client to rinse with an antiseptic mouthwash prior to specimen collection: Antiseptic mouthwash can kill microorganisms in the oral cavity and potentially reduce the yield of pathogenic organisms in the sputum culture. Clients should rinse with plain water instead to reduce contamination without affecting the specimen.

C. Swab the oropharynx with a sterile swab: Swabbing the oropharynx collects saliva and mucosal cells rather than lower respiratory secretions, which may not accurately represent the causative pathogen in pneumonia or other lower respiratory infections. A deep cough specimen is preferred.

D. Refrigerate the specimen until the time of transport to the laboratory: Sputum specimens should be stored in a refrigerator if there is any delay in transport to the laboratory. Refrigeration slows bacterial overgrowth, preserves the integrity of the specimen, and ensures accurate culture and sensitivity results.