To prevent deep vein thromboses following knee replacement surgery, an adult male client is receiving daily subcutaneous enoxaparin. 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/mm² (150 to 400 × 10^9/L)]
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)]

Choice A reason:

Taking an initial respiratory rate is a necessary action to ensure safety during morphine administration, as morphine can cause respiratory depression, which is a potentially life-threatening side effect. The nurse should monitor the client's respiratory rate and oxygen saturation regularly and report any signs of respiratory distress or hypoxia to the physician. Therefore, choice A is correct.

Choice B reason:

Performing a 12-lead electrocardiogram is not a necessary action to ensure safety during morphine administration, as morphine does not have a significant effect on the cardiac rhythm or conduction. The nurse should monitor the client's heart rate and blood pressure regularly and report any signs of bradycardia, hypotension, or chest pain to the physician. Therefore, choice B is incorrect.

Choice C reason:

Suctioning the client to clear the airway is not a necessary action to ensure safety during morphine administration, as morphine does not cause excessive secretions or bronchospasm that would obstruct the airway. The nurse should assess the client's level of consciousness and gag reflex regularly and report any signs of sedation, confusion, or aspiration to the physician. Therefore, choice C is incorrect.

Choice D reason:

Having a manual resuscitation bag at the bedside is a necessary action to ensure safety during morphine administration, as morphine can cause respiratory depression that may require emergency intervention. The nurse should be prepared to administer oxygen and naloxone (an opioid antagonist) as ordered and perform rescue breathing or cardiopulmonary resuscitation if needed. Therefore, choice D is correct.

Choice E reason:

Asking the client about other medications she takes is a necessary action to ensure safety during morphine administration, as morphine can interact with other drugs that may enhance or reduce its effects or cause adverse reactions. The nurse should review the client's medication history and current medications and report any potential drug interactions or contraindications to the physician. Therefore, choice E is correct.

Choice F reason:

Restraining the client with soft restraints is not a necessary action to ensure safety during morphine administration, as morphine does not cause agitation or delirium that would warrant physical restraint. The nurse should provide a safe and comfortable environment for the client and report any signs of anxiety, hallucinations, or psychosis to the physician. Therefore, choice F is incorrect.

Choice A reason: Obtaining a hospital bed with side rails and an over-bed trapeze is not a necessary instruction for reducing the risk of injury for a client taking carbidopa-levodopa, which is a combination of two drugs that increase dopamine levels in the brain and improve motor function in patients with Parkinson's disease. A hospital bed may be helpful for patients with severe mobility impairment or bedridden status, but not for all patients with Parkinson's disease.

Choice B reason: Placing small rugs on smooth surfaces such as tile or wood floors is an incorrect instruction for reducing the risk of injury for a client taking carbidopa-levodopa, which is a combination of two drugs that increase dopamine levels in the brain and improve motor function in patients with Parkinson's disease. Small rugs can pose a tripping hazard and increase the risk of falls, especially for patients with impaired balance or coordination.

Choice C reason: Using caution when changing from a sitting to a standing position is a correct instruction for reducing the risk of injury for a client taking carbidopa-levodopa, which is a combination of two drugs that increase dopamine levels in the brain and improve motor function in patients with Parkinson's disease. Carbidopa-levodopa can cause orthostatic hypotension, which is a sudden drop in blood pressure when changing positions. This can cause dizziness, fainting, or falls. Patients should change positions slowly and carefully, and use support if needed.

Choice D reason: Ambulating using a four point cane or a walker with wheels is not a specific instruction for reducing the risk of injury for a client taking carbidopa-levodopa, which is a combination of two drugs that increase dopamine levels in the brain and improve motor function in patients with Parkinson's disease. The type of assistive device that is appropriate for each patient depends on their individual needs and abilities. Some patients may not need any device, while others may need different types of canes, walkers, or wheelchairs.