An adult with arthritis has been receiving treatment with naproxen and now reports ongoing stomach pain, increasing weakness, and fatigue. Which laboratory test should the nurse monitor?

Choice A reason: This is the correct answer because serum potassium, calcium, and phosphorus are laboratory results that should be closely monitored in a client who has end-stage renal disease (ESRD). ESRD is a chronic condition that causes irreversible loss of kidney function and accumulation of waste products and fluids in the body. Potassium is an electrolyte that regulates nerve and muscle function and cardiac rhythm. ESRD can cause hyperkalemia (high potassium levels) due to reduced excretion by the kidneys. Hyperkalemia can cause cardiac arrhythmias, muscle weakness, or paralysis. Calcium and phosphorus are minerals that maintain bone health and acid-base balance. ESRD can cause hypocalcemia (low calcium levels) due to impaired vitamin D metabolism and hyperphosphatemia (high phosphorus levels) due to reduced excretion by the kidneys. Hypocalcemia can cause muscle cramps, tetany, or seizures. Hyperphosphatemia can cause soft tissue calcification, bone pain, or fractures.

Choice B reason: Erythrocytes, hemoglobin, and hematocrit are laboratory results that are not as critical as serum potassium, calcium, and phosphorus in a client who has end-stage renal disease (ESRD). Erythrocytes are red blood cells that carry oxygen from the lungs to the tissues. Hemoglobin is a protein in erythrocytes that binds oxygen. Hematocrit is the percentage of blood volume that is occupied by erythrocytes. ESRD can cause anemia (low erythrocyte, hemoglobin, and hematocrit levels) due to reduced production of erythropoietin, a hormone that stimulates erythrocyte formation, by the kidneys. Anemia can cause fatigue, pallor, or shortness of breath.

Choice C reason: Leukocytes, neutrophils, and thyroxine are laboratory results that are not as relevant as serum potassium, calcium, and phosphorus in a client who has end-stage renal disease (ESRD). Leukocytes are white blood cells that fight infection and inflammation. Neutrophils are a type of leukocyte that respond to bacterial infection. Thyroxine is a hormone that regulates metabolism and growth. ESRD can cause leukopenia (low leukocyte levels) and neutropenia (low neutrophil levels) due to impaired immune function and increased susceptibility to infection. ESRD can also cause hypothyroidism (low thyroxine levels) due to reduced clearance of thyroid hormones by the kidneys. Hypothyroidism can cause weight gain, cold intolerance, or depression.

Choice D reason: Blood pressure, heart rate, and temperature are not laboratory results, but vital signs that should be monitored in a client who has end-stage renal disease (ESRD). Blood pressure is the force of blood against the walls of the arteries. Heart rate is the number of times the heart beats per minute. Temperature is the measure of body heat. ESRD can cause hypertension (high blood pressure) due to fluid overload and activation of the renin-angiotensin-aldosterone system, a hormonal pathway that regulates blood pressure and fluid balance. Hypertension can cause headache, chest pain, or stroke. ESRD can also cause tachycardia (high heart rate) due to anemia, fluid overload, or electrolyte imbalance. Tachycardia can cause palpitations, dizziness, or heart failure. ESRD can also cause fever (high temperature) due to infection or inflammation. Fever can cause chills, sweating, or delirium.

Choice A reason: Support stockings may help with peripheral edema, but they are not the priority intervention for this client. The client's low serum albumin level indicates malnutrition and increased risk of infection and poor wound healing.

Choice B reason: This is the correct answer because the client needs adequate protein intake to maintain serum albumin levels and prevent further complications. Complete proteins contain all nine essential amino acids that the body cannot synthesize and are found in animal sources such as meat, eggs, and dairy products.

Choice C reason: Evaluating patency of the AV graft is not the priority intervention for this client because the client is receiving peritoneal dialysis, not hemodialysis. The AV graft may be used in the future if peritoneal dialysis fails, but it is not an immediate concern.

Choice D reason: Instructing the client to follow fluid restriction amounts is important for peritoneal dialysis patients, but it is not the priority intervention for this client. The client's low serum albumin level indicates that fluid restriction alone is not sufficient to manage fluid balance and prevent edema.