The nurse is continuing to care for the client.

The nurse is providing teaching about lithium to the client and the client's adult child. Select the 3 statements the nurse should include.

A. BUN 22 mg/dL (10 to 20 mg/dL): A slightly elevated BUN indicates mild renal impairment or dehydration but does not typically require withholding enoxaparin. Monitoring renal function is important, but this value alone is not a contraindication for anticoagulation.

B. WBC count 15,000/mm3 (5,000 to 10,000/mm3): An elevated WBC suggests possible infection or inflammation. While it may warrant further assessment, it does not directly increase the risk of bleeding and is not a reason to withhold enoxaparin.

C. Urine specific gravity 1.04 (1.005 to 1.03): A high specific gravity may indicate dehydration but is not a contraindication for enoxaparin administration. The medication can be given with caution while monitoring renal function and fluid status.

D. Platelets 80,000/mm3 (150,000 to 400,000/mm3): Thrombocytopenia significantly increases the risk of bleeding while on enoxaparin, which is an anticoagulant. Withholding the dose and notifying the provider is essential to prevent hemorrhagic complications and ensure safe management of the client.

A. Assess for bladder distention: A full bladder can prevent the uterus from contracting effectively, leading to a boggy fundus and increased risk of postpartum hemorrhage. Assessing and addressing bladder distention is the priority because it directly impacts uterine tone and hemorrhage prevention.

B. Apply supplemental oxygen via nonrebreather mask: Oxygen may be necessary if the client shows signs of hypoxia or shock, but it does not address the primary cause of a boggy uterus. The priority is to correct the underlying issue affecting uterine contraction.

C. Administer intramuscular methylergonovine: Methylergonovine is used to promote uterine contraction, but pharmacologic intervention should follow initial assessment to identify reversible causes such as bladder distention. Administering medication without assessment could overlook a correctable mechanical issue.

D. Analyze coagulation studies: Coagulation studies are important if bleeding persists or coagulopathy is suspected, but they are not the immediate priority in a client with a boggy fundus shortly after birth. Immediate interventions to promote uterine contraction take precedence.