A nurse is reviewing the prescriptions for a client who is pregnant and is taking digoxin. Which of the following actions should the nurse take to best evaluate the client's medication adherence?

Explanation

Choice A Reason:

WBC count 11,000/mm3 (5,000 to 10,000/mm3) is incorrect. A slightly elevated white blood cell (WBC) count within the range of 11,000/mm3 may be indicative of a mild infection or inflammation, which is common during pregnancy due to physiological changes in the immune system. However, this finding alone is not significantly abnormal and may not require immediate reporting unless accompanied by clinical signs or symptoms of infection.

Choice B Reason:

Fasting blood glucose 180 mg/dL (74 to 106 mg/dL) is correct. During pregnancy, it is essential to monitor blood glucose levels as gestational diabetes mellitus (GDM) can develop, leading to adverse outcomes for both the mother and the fetus. A fasting blood glucose level of 180 mg/dL is significantly higher than the normal range during pregnancy (74 to 106 mg/dL) and is indicative of hyperglycemia.

Choice C Reason:

Hematocrit 37% (37% to 47%) is incorrect. A hematocrit level of 37% falls within the normal range for pregnancy (37% to 47%) and is not significantly abnormal. This finding indicates the proportion of red blood cells in the blood and is typically lower during pregnancy due to hemodilution, which is a normal physiological adaptation to pregnancy.

Choice D Reason:

Creatinine 0.9 mg/dL (0.5 to 1 mg/dL) is incorrect. A serum creatinine level of 0.9 mg/dL falls within the normal range for pregnancy (0.5 to 1 mg/dL). Creatinine levels reflect kidney function, and this result suggests that the client's renal function is within normal limits. Therefore, it does not require immediate reporting unless there are other concerning clinical signs or symptoms.

Explanation

Choice A Reason:

"When was the last time you ate meat?" This question is not relevant for a client who adheres to a vegan diet, as they abstain from consuming meat or animal products.

Choice B Reason:

"How much protein do you eat in a day?" Assessing the client's protein intake is essential because protein is a critical component of a healthy diet, especially during pregnancy. Since the client adheres to a vegan diet, obtaining an understanding of their protein intake is particularly important, as plant-based protein sources may require more careful planning to ensure adequate intake. Adequate protein intake is vital for supporting maternal tissue growth, blood volume expansion, and fetal development.

Choice C Reason:

"Are you taking a Vitamin C supplement?" While vitamin C is important, especially for individuals following a vegan diet to aid in the absorption of non-heme iron from plant-based sources, it may not be the primary concern when assessing overall dietary intake. Additionally, vitamin C supplementation may not be necessary if the client consumes a varied diet rich in fruits and vegetables.

Choice D Reason:

"Have you considered eating shellfish?" This question is not appropriate for a client who adheres to a vegan diet, as shellfish are animal products and are not consumed in a vegan diet. Instead, the focus should be on assessing the client's intake of plant-based protein sources.