The nurse reviews the serum laboratory results of assigned clients. Which results are most important to report to the health care provider? Select all that apply.

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Potassium-sparing diuretics (eg, spironolactone, triamterene, eplerenone), ACE inhibitors (eg, lisinopril, ramipril), and angiotensin II receptor blockers (eg, losartan, valsartan, candesartan) cause hyperkalemia. Therefore, these should be held in clients with underlying hyperkalemia (Option D). Aminoglycosides (eg, gentamicin, tobramycin, amikacin) are used to treat serious infections. The nurse should monitor renal function and peak and trough levels, and report an elevated creatinine level (>1.3 mg/dL [115 µmol/L]) to the health care provider as it is a major adverse effect that can indicate reversible nephrotoxicity. An adjustment in the dose and dosing interval may be required (Option E). (Option A) Neutropenia (decreased neutrophil count) increases a client's susceptibility to infection. Filgrastim (Neupogen) is used to increase the neutrophil count in clients with certain malignancies and in those undergoing chemotherapy. Neutropenia is expected in this client and is not the most important result to report. (Option B) Acute osteomyelitis, an infection of the bone, is characterized by local and systemic manifestations of infection (eg, leukocytosis - white blood cell count >11,000/mm³ [11.0 x 10⁹/L], increased erythrocyte sedimentation rate, fever) and involves long-term antibiotic therapy. This is expected and is not the most important result to report. (Option C) Acute pancreatitis is an acute inflammation of the pancreas, characterized by abdominal pain and elevated levels of amylase and lipase, which are digestive enzymes produced by the pancreas. The pain is treated with opioids (eg, hydromorphone, fentanyl). Morphine can also be used; worsening pancreatitis due to an increase in sphincter of Oddi pressure has not been proven in studies. Elevated lipase level is expected and is not the most important result to report. Educational objective: ACE inhibitors (eg, lisinopril, ramipril) and angiotensin II receptor blockers ("sartans") can cause hyperkalemia (potassium >5.0 mEq/L [5.0 mmol/L]). Aminoglycosides (eg, tobramycin, gentamicin, amikacin) can cause nephrotoxicity.

The Nurse Reviews the Serum Laboratory Results of Assigned Clients