A nurse is reviewing laboratory values for a client who is receiving long-term NSAID therapy for rheumatoid arthritis. Which of the following values should the nurse report to the provider?
A. Total bilirubin 0.8 mg/dL
B. BUN 40 mg/dL
C. PaO2 90 mm Hg
D. Hematocrit 45%
The correct answer and explanation is:
The correct answer is B. BUN 40 mg/dL.
Explanation:
A nurse must carefully monitor laboratory values in clients receiving long-term therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) like those used in treating rheumatoid arthritis. NSAIDs can cause various adverse effects, especially on the renal system and gastrointestinal tract, which can be reflected in laboratory results.
- BUN (Blood Urea Nitrogen) 40 mg/dL:
The normal range for BUN is typically between 7 to 20 mg/dL, depending on the laboratory reference. A BUN level of 40 mg/dL is elevated, indicating possible kidney dysfunction or dehydration. NSAIDs can impair renal function by inhibiting prostaglandin production, which is important for maintaining adequate renal perfusion, particularly in the kidneys’ glomerulus. Elevated BUN levels are a warning sign of renal stress or potential kidney failure, especially in a patient on long-term NSAID therapy. Therefore, this result should be reported to the healthcare provider promptly. - Total bilirubin 0.8 mg/dL:
This value is within the normal reference range (typically 0.3 to 1.2 mg/dL). Bilirubin levels that are too high may indicate liver dysfunction, but a value of 0.8 mg/dL is normal and does not suggest any immediate concerns related to NSAID therapy. - PaO2 90 mm Hg:
PaO2 (partial pressure of oxygen) typically ranges from 75 to 100 mm Hg in a healthy adult. A PaO2 of 90 mm Hg is within the normal range and does not indicate any respiratory or oxygenation issues. NSAIDs do not generally affect oxygenation levels. - Hematocrit 45%:
Hematocrit levels for adults typically range between 38-50% for women and 40-54% for men. A hematocrit of 45% is within the normal range and does not indicate a problem. While NSAIDs can cause gastrointestinal bleeding, this value is not suggestive of such an issue.
In conclusion, the elevated BUN of 40 mg/dL is the most concerning value in this case and should be reported immediately to the healthcare provider.