Level: Advanced
Difficulty: Hard
Subtopic: Renal and cardiac diet patterns
NCLEX: A 58-year-old client after a stroke is being evaluated for nursing care related to renal and cardiac diet pattern…
Nutrition Basic Care and Comfort
Case Study
A 58-year-old client after a stroke is being evaluated for nursing care related to renal and cardiac diet patterns. The nurse reviews this trend: INR increasing from 2.0 to 4.5 without active bleeding. Which interpretation and action are most appropriate?
Question
A. Ignore the trend because one data point can be explained later.
B. Treat a single value without comparing it with baseline, symptoms, or benchmarks.
C. Wait for a critical value or sentinel event before taking any nursing action.
D. Interpret the trend in context, compare it with baseline or benchmarks, and take the safest indicated action.
B. Treat a single value without comparing it with baseline, symptoms, or benchmarks.
C. Wait for a critical value or sentinel event before taking any nursing action.
D. Interpret the trend in context, compare it with baseline or benchmarks, and take the safest indicated action.
Rationale
Correct answer: D. Interpret the trend in context, compare it with baseline or benchmarks, and take the safest indicated action.
Rationale: Trend questions require comparison with baseline, symptoms, risk, and benchmarks. Safe nursing action begins before a preventable event becomes critical.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Trend questions require comparison with baseline, symptoms, risk, and benchmarks. Safe nursing action begins before a preventable event becomes critical.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.