The nurse is reviewing the following laboratory results on the chart below of a client diagnosed with a small bowel obstruction. Based on the results, the nurse interprets that the client is experiencing which clinical problem?

Laboratory Results:

WBC	8.5
Hemoglobin	17g/dL
Hematocrit	54%
BUN	28mg/dL
Creatinine	1.1 mg/dL
Potassium	4.9 mEq/L

 

A. Administer amiodarone IV push followed by a continuous infusion: Amiodarone is part of the Advanced Cardiac Life Support (ACLS) algorithm for ventricular fibrillation (VF) or pulseless ventricular tachycardia, but it should only be given after confirming the rhythm and initiating basic life support steps, including pulse check.

B. Establish unresponsiveness and check the carotid pulse: The rhythm strip shows ventricular fibrillation, a life-threatening arrhythmia. However, before initiating advanced interventions such as defibrillation, the nurse must first confirm the client is unresponsive and pulseless, which is the correct initial action according to ACLS protocols.

C. Immediately defibrillate the client using the synchronous mode: Defibrillation is the correct treatment for VF, but it must be done in unsynchronized mode. Additionally, it is not appropriate to defibrillate until pulselessness is confirmed. Synchronized mode is used for rhythms like unstable SVT or atrial fibrillation not VF.

D. Initiate a rapid response call and increase the monitor’s sensitivity: A rapid response team is called for deteriorating patients who are still responsive. If the client is unresponsive and pulseless, a code blue or cardiac arrest protocol should be initiated, not just a rapid response. Monitor sensitivity adjustments are irrelevant in a confirmed life-threatening rhythm.

A. Have blood drawn weekly to check for high magnesium levels: Lisinopril, an ACE inhibitor, does not significantly affect magnesium levels. Regular monitoring is more important for potassium and renal function (BUN/creatinine), especially in heart failure patients, not magnesium.

B. Avoid the use of salt substitutes in your diet: Lisinopril is an ACE inhibitor. ACE inhibitors can cause potassium retention by reducing the production of aldosterone. Many salt substitutes contain high amounts of potassium chloride and combining the two may lead to hyperkalemia. Patients should be instructed to avoid these substitutes unless approved by their provider.

C. Notify your physician if a headache develops: Headache is a relatively common and usually mild side effect of lisinopril. It does not typically warrant discontinuation or immediate provider notification unless it's severe or persistent with other symptoms like dizziness or visual changes.

D. Take your heart rate daily when on this medication: Lisinopril does not significantly affect heart rate. Monitoring blood pressure is more relevant, as ACE inhibitors are antihypertensives. Heart rate monitoring is more critical with beta blockers or calcium channel blockers.