A nurse is reviewing the BUN result of a client who is taking cyclosporine following a kidney transplant. Which of the following laboratory studies should the nurse recognize as another renal function study that should be monitored?

Rationale:
A. "Placement of the catheter is confirmed by a CT scan.": Catheter placement is not routinely confirmed by CT scan. Instead, correct placement of a central venous catheter is verified by a chest X-ray immediately after insertion to ensure proper tip location.

B. "You will be under general anesthesia for this procedure.": General anesthesia is not required for placement of a nontunneled percutaneous central venous catheter. The procedure is typically performed using local anesthesia and aseptic technique at the bedside.

C. "The provider will wear a mask while performing the procedure.": The provider wears a mask, sterile gown, gloves, and cap as part of strict sterile technique during insertion to prevent catheter-related bloodstream infections.

D. "Your head will be elevated as high as possible while the catheter is inserted.": The client’s head is not elevated during insertion. Instead, a flat or slight Trendelenburg position is used to distend neck veins and reduce the risk of air embolism.

Rationale for Correct Choices

• Endometritis: The client’s postpartum course—cesarean delivery, prolonged rupture of membranes, and postpartum Day 3 fever—places her at high risk for endometritis, a uterine infection. Signs include uterine tenderness, boggy fundus, and foul-smelling lochia.

• Uterus and lochia assessment: The firm but tender uterus with boggy areas and moderate dark brown, foul-smelling lochia are classic indicators of endometritis. These assessment findings directly reflect the infection within the uterine cavity and help guide immediate intervention.

Rationale for Incorrect Choices

• Mastitis: While the client reports firm, warm breasts with nipple discomfort, these symptoms alone without localized redness, unilateral involvement, or systemic malaise are not sufficient to diagnose mastitis. The uterine and lochia findings are more indicative of endometritis.

• Postpartum hemorrhage: Although uterine atony can cause bleeding, the client’s fundus is firm after massage and the lochia is moderate, making hemorrhage less likely at this point. Hemoglobin remains within normal limits, further reducing the likelihood of acute postpartum hemorrhage.

• Fever: Fever is a symptom rather than a diagnosis. While present (38.2° C), it supports the presence of infection but does not specify which type, so it is not the best standalone choice for the evidence used to identify the condition.

• Elevated WBC (markedly 33,000/mm3) confirm a systemic infection, it is a general sign of infection that could apply to any source (e.g., wound or mastitis). The assessment of the uterus and lochia specifically localizes the infection to the reproductive tract.