The nurse is administering subcutaneous enoxaparin to a client following knee replacement surgery to prevent a deep vein thrombosis. Which laboratory result requires immediate action by the nurse?

Reference Range:

Hematocrit [42% to 52% (0.42 to 0.52 volume fraction)]

Platelets [150,000 to 400,000/mm (150 to 400 x 10L)

Creatinine (0.5 to 1.1 mg/dL (44 to 97 μmol/L)]

Blood Urea Nitrogen (BUN) [10 to 20 mg/dl (3.6 to 7.1 mmol/L)]

A) Tamsulosin is typically administered once daily, not on a twice-weekly dosing schedule. Instructing the client to adhere to the prescribed dosing frequency is essential for maintaining therapeutic blood levels of the medication and optimizing its effectiveness in managing urinary retention associated with benign prostatic hyperplasia (BPH).

B) While the timing of medication administration can impact its effectiveness, taking tamsulosin early in the day versus later in the day may not significantly affect its therapeutic action. The key consideration with tamsulosin is to maintain consistency in timing to ensure a steady plasma concentration of the drug.

C) Instructing the client to stand and sit up slowly is crucial because tamsulosin, as an alpha-blocker, can cause orthostatic hypotension, especially when first starting the medication or when increasing the dosage. By advising the client to change positions slowly, the nurse helps prevent falls and dizziness, which are common side effects associated with sudden drops in blood pressure.

D) Reducing daily fluid intake is not advisable, especially for a client with urinary retention. Maintaining adequate hydration is essential for overall health and urinary function. Tamsulosin works by relaxing the smooth muscles of the prostate and bladder neck, facilitating urine flow, but it does not directly affect fluid intake requirements.

Therefore, the most important instruction for the nurse to provide is to stand and sit up slowly to minimize the risk of orthostatic hypotension and associated complications.

A) Bronchitis: Methylphenidate, a central nervous system stimulant, is not contraindicated in clients with bronchitis. While caution may be warranted in individuals with respiratory conditions due to potential stimulant effects, bronchitis alone does not necessitate specific precautions or contraindications for methylphenidate use.

B) Diabetes mellitus: Methylphenidate use does not typically pose significant risks for individuals with diabetes mellitus. While stimulant medications may affect appetite and blood glucose levels, they are not contraindicated in clients with diabetes. Monitoring blood glucose levels may be prudent, but it is not the primary concern when reviewing the medical record before administering methylphenidate.

C) Hypertension: Reviewing the medical record for hypertension is essential before administering methylphenidate. Stimulant medications like methylphenidate can increase heart rate and blood pressure, potentially exacerbating hypertension or cardiovascular conditions. Clients with uncontrolled hypertension may require dose adjustments or alternative treatments to mitigate cardiovascular risks associated with methylphenidate use.

D) Hypercholesterolemia: Methylphenidate is not contraindicated in clients with hypercholesterolemia. While stimulant medications may have minor effects on lipid profiles, they are not typically considered significant enough to warrant specific precautions or contraindications in individuals with hypercholesterolemia.