A nurse is reviewing the laboratory results of a client who is taking amitriptyline. Which of the following laboratory values should the nurse report to the provider?

Choice A Reason:
"I will check the client's INR before administering the heparin." is incorrect. Checking the client's INR (International Normalized Ratio) is essential, but it's more applicable for monitoring anticoagulants like warfarin, not heparin. Heparin's effect is typically monitored via activated partial thromboplastin time (aPTT) or anti-Xa levels, not INR.
Choice B Reason:
"I will aspirate before administering the heparin." Is incorrect. Aspirating before administering heparin injections is not necessary because the medication is given subcutaneously or intravenously and not into a blood vessel.
Choice C Reason:
"I will massage the site after injecting the heparin." Is incorrect. Massaging the site after injecting heparin could increase the risk of bruising or hematoma formation at the injection site. It's generally advised to avoid massaging the area after a heparin injection to prevent tissue trauma.
Choice D Reason:
"I will apply pressure for 1 minute after the injection." Is correct. Applying pressure to the injection site for about a minute after administering heparin helps reduce the risk of bleeding or hematoma formation, especially with subcutaneous injections. This practice aids in minimizing bleeding at the injection site.

Choice A Reason:
Hypomagnesemia is incorrect. Lithium therapy itself is not a direct cause of hypomagnesemia. While exercise can affect magnesium levels to some extent, it's not a primary electrolyte imbalance that is typically associated with lithium use or considered a significant concern specifically due to lithium.
Choice B Reason:
Hypocalcemia is incorrect. Similarly, lithium therapy is not a direct cause of hypocalcemia. Exercise can affect calcium metabolism, but it's not a primary electrolyte imbalance typically associated with lithium use or considered a significant concern specifically due to lithium.
When a client taking lithium begins a new exercise program, the nurse should primarily assess for the risk of:
Choice C Reason:
Hyponatremia is correct. Lithium can affect the body's regulation of sodium, and excessive sweating due to increased exercise can lead to sodium loss. This combination can potentially contribute to the development of hyponatremia (low sodium levels). Therefore, when a client on lithium starts a new exercise regimen that may induce sweating, monitoring for signs of hyponatremia becomes crucial. Symptoms of hyponatremia can include confusion, headaches, nausea, and in severe cases, seizures or coma.
Choice D Reason:
Hypokalemia is incorrect. Lithium itself does not commonly cause hypokalemia. Exercise can lead to potassium loss through sweating, but hypokalemia is not the primary electrolyte imbalance typically associated with lithium use or considered a significant concern specifically due to lithium.