The laboratory findings for a client with chronic kidney disease (CKD) include elevated blood urea nitrogen (BUN) and serum creatinine levels. The client reports feeling fatigued and is unable to concentrate during the morning assessments. Based on these findings, which action should the nurse implement?

Step-by-step Calculation:

1. We need to find the volume (in mL) of teriparatide that contains the desired dose of 60 mcg.
2. Set up the proportion:

dose (mcg) / concentration (mcg/mL) = volume (mL)

1. Fill in the known values:
   • Dose (mcg): 60 mcg (as given in the problem)
   • Concentration (mcg/mL): 750 mcg/2.4 mL (from the medication label)
2. Solve for the volume:
   • Multiply both sides of the proportion by the concentration to isolate the volume on the left:
   • dose (mcg) = volume (mL) concentration (mcg/mL)
   • Substitute the known values:
   • 60 mcg = volume (mL) (750 mcg / 2.4 mL)
3. Calculate the volume:
   • Divide both sides by the concentration to solve for the volume:
   • volume (mL) = 60 mcg / (750 mcg / 2.4 mL)
   • Simplify:
   • volume (mL) = (60 mcg 2.4 mL) / 750 mcg
   • volume (mL) = 0.192 mL (approximately)
4. Rounding (optional): The problem specifies rounding to the nearest tenth. Since 0.192 is closer to 0.2 than 0.1, the rounded volume is:
5. volume (mL) = 0.2 mL (rounded to one decimal place)

Therefore, the nurse should administer 0.2 mL of teriparatide.

A. Demonstrating how to palpate the popliteal pulse is not a suitable alternative for measuring blood pressure when the client cannot be measured in the arms or legs. Palpating peripheral pulses does not provide accurate blood pressure measurements.

B. Advising the UAP to document the last blood pressure obtained is insufficient because it does not address the need for current blood pressure monitoring. Documentation of past
measurements does not provide real-time information about the client's hemodynamic status.

C. Estimating the blood pressure by assessing the pulse volume of the client's radial pulses is a reasonable alternative when traditional blood pressure measurement sites are inaccessible. Although not as accurate as traditional methods, assessing the strength of peripheral pulses can provide valuable information about perfusion and blood pressure status.

D. Documenting why the blood pressure cannot be accurately measured is important for record- keeping but does not address the need for ongoing blood pressure monitoring or provide an alternative method for assessment.