The nurse is administering SUBO 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/mm3 (150 to 400 x 109/L]] Creatinine [0.5 to 1.1 mg/dL (44 to 97 pmol/L)]

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

A. Phosphate: Calcium acetate is used primarily to manage hyperphosphatemia in patients with chronic kidney disease (CKD). It works by binding to dietary phosphate in the gut, preventing its absorption, which helps lower phosphate levels in the blood. A decrease in phosphate levels indicates that the calcium acetate is effectively controlling phosphate levels.
B. pH: While maintaining normal pH levels is important in CKD, calcium acetate does not directly affect blood pH. The primary role of calcium acetate is to manage phosphate levels rather than pH balance.
C. Calcium: Calcium acetate is a phosphate binder and does not primarily target calcium levels. It can influence calcium levels indirectly, but a decrease in calcium is not the direct measure of the medication's effectiveness. Instead, monitoring phosphate levels is more indicative of the medication’s effectiveness.
D. Potassium: Calcium acetate does not have a direct effect on potassium levels. It is specifically used to manage phosphate levels in CKD patients. Changes in potassium levels would not indicate the effectiveness of calcium acetate.

A. "I need to notify my healthcare provider if I lose my appetite or get nauseated." This statement shows understanding because loss of appetite and nausea can be symptoms of digoxin toxicity or side effects, and it is important to report these symptoms to a healthcare provider. Monitoring for such side effects is crucial when taking digoxin.
B. "I should take my furosemide only if I have shortness of breath or swelling in my feet." This statement is incorrect because furosemide, a diuretic, should be taken according to the prescribed schedule, not based on symptoms. It is used to manage fluid retention and symptoms of heart failure, and its use should not be dependent solely on the presence of symptoms.
C. "I need to check my blood pressure three times a day." While monitoring blood pressure is important, it is not specifically required for patients on digoxin and furosemide unless instructed by a healthcare provider. The focus should be more on monitoring for symptoms of drug side effects and electrolyte imbalances.
D. "If I lose more than one pound in a week, I should hold my next dose of furosemide." Weight loss can be a normal effect of furosemide due to fluid loss, and the decision to hold a dose should be based on specific medical advice and not solely on weight change.