The nurse reviews the most current laboratory results for assigned clients. Which finding is the highest priority for the nurse to report to the health care provider?

Question

Quizplus · Accepted Answer

The American Society for Parenteral and Enteral Support (ASPEN) recommends 140-180 mg/dL (7.8-10.0 mmol/L) as the target range for glucose control in clients receiving nutritional support. Hypoglycemia (serum glucose <70 mg/dL [3.9 mmol/L]) can be due to slowing the rate of the infusion. Although it occurs less frequently in clients receiving total parenteral nutrition (TPN) than hyperglycemia (serum glucose >180 mg/dL [10.0 mmol/L]) does, hypoglycemia can lead to life-threatening complications (eg, seizures, nervous system dysfunction). Therefore, the serum glucose of 68 mg/dL (3.8 mmol/L) is the laboratory finding of highest priority for the nurse to report to the health care provider (HCP). (Option A) A CD4⁺ cell count of 500/mm³ (0.5 × 10⁹/L) in a client with HIV who is receiving oral fluconazole (Diflucan) to treat oral candidiasis is within normal limits (500-1,200/mm³ [0.5-1.2 × 10⁹/L]) and does not need to be reported to the HCP. (Option B) A hemoglobin A_1C (HbA_1c) of 7.3% in a client with type 2 diabetes who is receiving IV levofloxacin to treat pneumonia is not exceptionally high; the recommended goal is <7%. A bacterial infection causes physiologic stress and increased serum glucose. This increases insulin requirements but would not affect the current HbA_1c level, as it reflects glucose control over a 2-3 month period. Therefore, this finding is not the highest priority for the nurse to report to the HCP. (Option C) Heparin can lead to thrombocytopenia. However, a platelet count of 148,000/mm³ (148 × 10⁹/L) is just below normal limits (150,000-400,000/mm³ [150-400 × 10⁹/L]). Therefore, this finding does not need to be reported to the HCP. Educational objective: The recommended target serum glucose range for clients receiving nutritional support is 140-180 mg/dL (7.8-10.0 mmol/L). The nurse should monitor a client receiving TPN for hyperglycemia (serum glucose >180 mg/dL [10.0 mmol/L]) and hypoglycemia (serum glucose <70 mg/dL [3.9 mmol/L]). Hypoglycemia places the client at risk for life-threatening complications (eg, seizures, nervous system damage).

The Nurse Reviews the Most Current Laboratory Results for Assigned