Which laboratory results should the nurse closely monitor in a client who has end-stage renal disease (ESRD)?

Choice A reason: Providing diet low in phosphorus is not a relevant intervention for a client with cirrhosis of the liver. Phosphorus is a mineral that helps maintain bone health and acid-base balance. Cirrhosis of the liver does not affect phosphorus levels, but it can cause low calcium levels due to impaired vitamin D metabolism. The nurse should provide a diet high in calcium and vitamin D to prevent osteoporosis and fractures.

Choice B reason: This is a correct answer because noting signs of swelling and edema is an important intervention for a client with cirrhosis of the liver. Cirrhosis of the liver is a chronic condition that causes scarring and damage to the liver tissue, impairing its function and blood flow. This can lead to portal hypertension, which is increased pressure in the portal vein that carries blood from the digestive organs to the liver. Portal hypertension can cause fluid accumulation in the abdomen (ascites) and legs (peripheral edema). The nurse should assess the client's weight, fluid intake and output, abdominal girth, and extremity circumference.

Choice C reason: Increasing oral fluid intake to 1,500 mL daily is not a suitable intervention for a client with cirrhosis of the liver. Fluid intake should be individualized based on the client's fluid status, electrolyte levels, and urine output. Increasing fluid intake may worsen fluid retention and electrolyte imbalance in clients with cirrhosis of the liver. The nurse should restrict fluid intake to 1,000 to 1,500 mL daily or as prescribed by the healthcare provider.

Choice D reason: This is a correct answer because monitoring abdominal girth is an essential intervention for a client with cirrhosis of the liver. Abdominal girth is a measurement of the circumference of the abdomen at the level of the umbilicus. It reflects the amount of fluid in the peritoneal cavity, which can increase due to portal hypertension and hypoalbuminemia in clients with cirrhosis of the liver. The nurse should measure and record abdominal girth daily or more frequently as indicated.

Choice E reason: This is a correct answer because reporting serum albumin and globulin levels is a significant intervention for a client with cirrhosis of the liver. Albumin and globulin are types of proteins that are synthesized by the liver and have various functions in the body, such as maintaining fluid balance, transporting hormones and drugs, and fighting infections. Cirrhosis of the liver can cause low albumin levels due to reduced synthesis and increased loss through ascites or urine. Low albumin levels can cause edema, malnutrition, and increased risk of infection. Cirrhosis of the liver can also cause high globulin levels due to chronic inflammation or immune response. High globulin levels can indicate autoimmune diseases, infections, or malignancies. The nurse should monitor and report serum albumin and globulin levels as they reflect liver function and overall health status.

Choice A reason: Explaining to the client that the dosage has been changed is not a safe action because it may not be true. The nurse should not assume that the prescribed dosage is correct or different from the previous one without verifying it with the healthcare provider or the medication record.

Choice B reason: This is the correct answer because withholding the medication until the dosage can be confirmed is a prudent action that ensures patient safety and avoids medication errors. The nurse should compare the prescribed dosage with the client's previous dosage and consult with the healthcare provider or the pharmacist if there is any discrepancy or doubt.

Choice C reason: Informing him that he may refuse the medication and documenting whether or not he takes it is not a responsible action because it does not address the issue of dosage discrepancy. The nurse should respect the client's right to refuse medication, but should also educate him about the benefits and risks of taking or not taking it. The nurse should also try to resolve any barriers or concerns that may affect the client's adherence to medication.

Choice D reason: Telling him to take the medication then verifying the dosage at the next healthcare team meeting is not a timely action because it may cause harm or complications to the client. The nurse should not administer any medication without checking its accuracy and appropriateness for the client. The nurse should also report and document any medication incidents as soon as possible.