The nurse is administering sevelamer during lunch to a client with chronic kidney disease (CKD). The client asks the nurse to bring the medication later. The nurse should describe which action of sevelamer as an explanation for taking it with meals?

Choice A reason: Platelet count of 100,000/mm³ (100 x 10^9/L) is below the normal range and indicates thrombocytopenia, which is a decrease in the number of platelets in the blood. Thrombocytopenia can increase the risk of bleeding and bruising, and can be a serious adverse effect of enoxaparin. This laboratory result requires immediate action by the nurse, such as notifying the prescriber, monitoring for signs of bleeding, and withholding the next dose of enoxaparin.

Choice B reason: Hematocrit 45% (0.45 volume fraction) is within the normal range and does not indicate any problem with the client's red blood cells or oxygen-carrying capacity.

Choice C reason: Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) is within the normal range and does not indicate any problem with the client's kidney function or hydration status.

Choice D reason: Serum creatinine 1.0 mg/dL (88.4 μmol/L) is within the normal range and does not indicate any problem with the client's kidney function or muscle metabolism.

Choice A reason: Apical pulse rate of 50 beats/minute requires nursing intervention prior to the administration of digoxin, which is a medication that slows down and strengthens the heartbeat. Digoxin can cause bradycardia, which is a slow heart rate below 60 beats/minute. Bradycardia can lead to inadequate blood flow and oxygen delivery to the body. The nurse should withhold the dose of digoxin and notify the prescriber if the apical pulse rate is below 60 beats/minute.

Choice B reason: Irregular apical pulse rhythm does not require nursing intervention prior to the administration of digoxin, which is a medication that treats arrhythmias, which are irregular heart rhythms. Digoxin can correct or prevent some types of arrhythmias, such as atrial fibrillation or flutter. The nurse should monitor the apical pulse rhythm and report any changes to the prescriber, but it is not a reason to withhold the dose of digoxin.

Choice C reason: Presence of a systolic heart murmur does not require nursing intervention prior to the administration of digoxin, which is a medication that improves the pumping function of the heart. A systolic heart murmur is a sound that occurs when the heart contracts and blood flows through a narrow or leaky valve. Digoxin can reduce the symptoms of heart failure, such as shortness of breath, fatigue, and edema, which may be associated with a systolic heart murmur. The nurse should document the presence and characteristics of the heart murmur, but it is not a reason to withhold the dose of digoxin.

Choice D reason: Apical pulse heard best at the pulmonic site does not require nursing intervention prior to the administration of digoxin, which is a medication that affects the electrical activity and contractility of the heart. The apical pulse is the heartbeat heard at the apex of the heart, which is located at the fifth intercostal space on the left midclavicular line. The pulmonic site is located at the second intercostal space on the left sternal border, where the sound of blood flow through the pulmonary valve can be heard. The nurse should listen to the apical pulse at the correct location, but it is not a reason to withhold the dose of digoxin.