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)]

Platelet count of 100,000/mm3 (100 x 10

Blood urea nitrogen (BUN) 20 mg/dL (7.) mmol/L).

Serum creatinine 1.0 mg/dL (88.4 μmol/L).

Hematocrit 45% (0.45 volume fraction).

Answer and Explanation

The Correct Answer is A

A. Platelet count of 100,000/mm³ (100 x 10^9/L): Enoxaparin is a low molecular weight heparin used to prevent deep vein thrombosis (DVT), and a low platelet count (thrombocytopenia) can be a serious adverse effect of anticoagulant therapy. A platelet count of 100,000/mm³ is below the normal range (150,000 to 400,000/mm³) and indicates potential thrombocytopenia, which could increase the risk of bleeding and may warrant immediate action.

B. Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L): This BUN level is at the upper limit of normal but does not typically require immediate action unless there are other symptoms or significant changes in kidney function.

C. Serum creatinine 1.0 mg/dL (88.4 μmol/L): This value is within the normal range for serum creatinine and does not indicate an immediate concern related to enoxaparin.

D. Hematocrit 45% (0.45 volume fraction): This hematocrit level is within the normal range and does not typically require immediate action.

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Correct Answer is A

Explanation

A. Serum creatinine level of 1.6 mg/dL (141 µmol/L), a blood urea nitrogen (BUN) of 20 mg/dL (7.1 mmol/L): Gentamicin is an aminoglycoside that is known for its nephrotoxic potential. Elevated serum creatinine and BUN levels are indicative of impaired kidney function, which warrants further investigation and possible intervention. This finding is significant because it may reflect kidney damage or reduced renal clearance of the drug.
B. Reports a sore mouth and three episodes of diarrhea that began this morning: While these symptoms are important and could suggest a possible adverse effect or secondary infection, they are not as immediately concerning in the context of gentamicin therapy as the potential for kidney damage indicated by elevated creatinine and BUN levels.
C. White blood count of 9,000/mm³ (9 x 10^9/L) and an oral temperature of 98.2°F (36.7°C) two hours ago: These values are within normal ranges and do not suggest an immediate concern related to gentamicin toxicity.
D. Urinary output of 400 mL of clear, amber-colored urine in the past eight hours: While monitoring urinary output is important, this level of output does not necessarily indicate a problem in the context of gentamicin therapy compared to elevated creatinine and BUN levels.

A. Assess the client for other indications of adverse effects of corticosteroid use. B. Advise the client that the medication should be stopped gradually rather than abruptly. C. Encourage the client to take the medication with food to decrease Gl distress. D. Review the client's dosing schedule to ensure he is taking the prescribed amount.

Correct Answer is B

Explanation

A. Assess the client for other indications of adverse effects of corticosteroid use: While important, this action does not address the immediate issue of stopping the medication safely.
B. Advise the client that the medication should be stopped gradually rather than abruptly: Corticosteroids should not be stopped suddenly due to the risk of adrenal insufficiency and withdrawal symptoms. Gradual tapering is necessary to safely discontinue the medication.
C. Encourage the client to take the medication with food to decrease GI distress: This can help manage GI symptoms but does not address the issue of safely discontinuing the medication.
D. Review the client's dosing schedule to ensure he is taking the prescribed amount: This is useful but does not resolve the problem of safely stopping the medication.

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Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

A male client reports to the nurse that he is experiencing gastrointestinal (GI) distress from a high dose of a corticosteroid and is planning to stop taking the medication. In response to the client's statement, which nursing action is most important for the nurse to Implement?

Correct Answer is B

Explanation

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