While caring for a client with full-thickness burns covering 40% of the body, the nurse observes purulent drainage from the wounds. Before reporting this finding to the health care provider, the nurse should evaluate which laboratory value?

Choice A reason: Clear, dark amber-colored urine is not an assessment finding that indicates progress toward the desired effect of this treatment plan, because it may suggest dehydration, which can worsen the client's condition. The client with cirrhosis and hepatic failure may have fluid retention, electrolyte imbalance, and renal impairment, which can affect the urine output, color, and concentration. The nurse should monitor the client's fluid intake and output, urine specific gravity, and serum creatinine and blood urea nitrogen levels, and report any abnormalities to the doctor.

Choice B reason: Improved level of consciousness is an assessment finding that indicates progress toward the desired effect of this treatment plan, but it is not the most specific one. The client with cirrhosis and hepatic failure may have hepatic encephalopathy, which is a neuropsychiatric syndrome caused by the accumulation of ammonia and other toxins in the brain, due to the impaired liver function. This can cause changes in the level of consciousness, mental status, and behavior, such as confusion, lethargy, or coma. The nurse should assess the client's mental status using tools such as the Glasgow Coma Scale or the West Haven Criteria, and administer medications such as lactulose or rifaximin, as prescribed by the doctor, to reduce the ammonia levels. However, the level of consciousness can also be affected by other factors, such as hypoxia, hypoglycemia, or infection, and it is not directly related to the low sodium diet or the albumin infusions.

Choice C reason: Prothrombin time within normal limits is an assessment finding that indicates progress toward the desired effect of this treatment plan, but it is not the most specific one. The client with cirrhosis and hepatic failure may have coagulopathy, which is a bleeding disorder caused by the reduced synthesis of clotting factors, such as prothrombin, by the damaged liver. This can increase the risk of bleeding and hemorrhage, especially from the esophageal varices, which are dilated veins in the lower esophagus that can rupture due to portal hypertension, a complication of cirrhosis. The nurse should monitor the client's coagulation status using tests such as prothrombin time, international normalized ratio, and activated partial thromboplastin time, and administer blood products or vitamin K, as ordered by the doctor, to correct the coagulation defects. However, the prothrombin time can also be affected by other factors, such as anticoagulant therapy, vitamin K deficiency, or liver transplantation, and it is not directly related to the low sodium diet or the albumin infusions.

Choice D reason: Decreased abdominal girth is the most specific assessment finding that indicates progress toward the desired effect of this treatment plan, because it reflects the reduction of ascites, which is the accumulation of fluid in the peritoneal cavity, due to portal hypertension and hypoalbuminemia, common features of cirrhosis and hepatic failure. The low sodium diet and the albumin infusions are interventions that can help to decrease the fluid retention and increase the oncotic pressure, which can draw the fluid back into the blood vessels and reduce the ascites. The nurse should measure the client's abdominal girth daily, using a tape measure at the level of the umbilicus, and record the results. The nurse should also monitor the client's weight, edema, and abdominal discomfort, and report any signs of spontaneous bacterial peritonitis, such as fever, abdominal pain, or leukocytosis, to the doctor.

Choice A reason: White blood cell count and pulse rate are not the most important information about the client that the nurse should tell the healthcare provider, because they are not directly related to the AAA or the low back pain. White blood cell count is a measure of the immune system activity, and it may be elevated in cases of infection or inflammation, but it is not specific to AAA. Pulse rate is a measure of the heart rate, and it may be increased in cases of anxiety, pain, or shock, but it is not indicative of AAA.

Choice B reason: Hematocrit and blood pressure are the most important information about the client that the nurse should tell the healthcare provider, because they are directly related to the AAA and the low back pain. Hematocrit is a measure of the percentage of red blood cells in the blood, and it may be decreased in cases of bleeding or anemia, which can occur if the AAA ruptures or leaks. Blood pressure is a measure of the force of the blood against the walls of the arteries, and it may be increased in cases of hypertension or stress, which can worsen the AAA or cause it to rupture. The nurse should monitor the client's hematocrit and blood pressure closely and report any changes to the healthcare provider.

Choice C reason: Calcium level and skin condition are not the most important information about the client that the nurse should tell the healthcare provider, because they are not directly related to the AAA or the low back pain. Calcium level is a measure of the amount of calcium in the blood, and it may be abnormal in cases of bone disorders, kidney disorders, or parathyroid disorders, but it is not relevant to AAA. Skin condition is a general term that can describe the appearance, texture, color, or temperature of the skin, and it may be altered in cases of infection, allergy, or injury, but it is not specific to AAA.

Choice D reason: Serum amylase and level of consciousness are not the most important information about the client that the nurse should tell the healthcare provider, because they are not directly related to the AAA or the low back pain. Serum amylase is a measure of the amount of amylase, an enzyme that digests starch, in the blood, and it may be elevated in cases of pancreatitis, gallstones, or intestinal obstruction, but it is not associated with AAA. Level of consciousness is a measure of the client's mental status, alertness, and responsiveness, and it may be impaired in cases of brain injury, stroke, or coma, but it is not indicative of AAA.