Which intervention should the nurse implement to manage a client’s fluid and electrolyte balance?

Choice A reason: Diclofenac, an NSAID, can cause gastrointestinal bleeding, leading to anemia. Pale appearance and fatigue suggest blood loss. Reviewing hemoglobin levels is critical to confirm anemia, as low hemoglobin impairs oxygen delivery, exacerbating fatigue and requiring immediate intervention to address potential bleeding.

Choice B reason: Glucose levels are unrelated to diclofenac’s common side effects. Fatigue may occur in hypoglycemia, but diclofenac does not typically affect glucose metabolism. Pale appearance and fatigue are more indicative of anemia from NSAID-related bleeding, making hemoglobin a more urgent lab value to review.

Choice C reason: Total protein levels reflect nutritional status or liver function but are not directly linked to diclofenac’s side effects. Fatigue and pallor suggest anemia from gastrointestinal bleeding, a known NSAID risk. Hemoglobin is more critical to assess, as it directly correlates with the client’s symptoms.

Choice D reason: Sodium levels influence fluid balance but are not typically altered by diclofenac. Fatigue and pallor point to anemia from potential bleeding, not electrolyte imbalance. Hemoglobin review is prioritized, as diclofenac’s gastrointestinal side effects are more likely to cause blood loss than sodium disturbances.

Choice A reason: Gluten avoidance is specific to celiac disease, not Crohn’s, which involves autoimmune inflammation of the gut. Crohn’s dietary triggers vary individually, and gluten is not a universal issue. An elimination diet identifies specific triggers, making this response incorrect for Crohn’s management.

Choice B reason: Fluid restriction is not a primary limitation in Crohn’s disease, which often requires adequate hydration due to diarrhea. Restricting fluids could worsen dehydration. An elimination diet to identify trigger foods is more appropriate, as dietary management focuses on individual sensitivities, not fluid limits.

Choice C reason: An elimination diet identifies trigger foods causing Crohn’s flare-ups, as sensitivities vary. By systematically removing and reintroducing foods, patients pinpoint irritants like dairy or fiber, personalizing dietary management. This is the most effective approach, as Crohn’s lacks universal dietary restrictions, making it the correct response.

Choice D reason: Limiting calcium and iron is not standard for Crohn’s, as these nutrients are often deficient due to malabsorption. Supplementation may be needed. An elimination diet better addresses symptom triggers, as nutrient restriction could exacerbate deficiencies without targeting inflammatory food triggers.