A charge nurse is reviewing morning laboratory reports for clients on the unit. The charge nurse should recognize that which result requires reporting to the provider?

A. A fasting glucose level of 78 mg/dL is within the normal glycemic reference range of 70 to 110 mg/dL for an adult client. In a client with diabetes, this value indicates effective metabolic control and does not signal an acute hypoglycemic or hyperglycemic crisis. The nurse should continue to monitor the client and follow the established medication and dietary plan without needing an urgent provider notification. B. A hemoglobin level of 11.5 g/dL is slightly below the standard adult reference range but is frequently observed and tolerated in the immediate postoperative period. Minor blood loss during surgery or hemodilution from intravenous fluid administration can cause this expected drop. Unless the client exhibits symptomatic anemia, such as tachycardia or hypotension, this value does not represent a clinical emergency requiring immediate reporting. C. An international normalized ratio (INR) of 5.2 is significantly above the typical therapeutic range of 2.0 to 3.0 for a client on warfarin therapy. This supratherapeutic level places the client at an extreme risk for spontaneous, life-threatening hemorrhage and requires immediate provider notification for dose adjustment or vitamin K administration. The nurse must also assess the client for any occult or overt signs of bleeding. D. A blood urea nitrogen (BUN) of 19 mg/dL is within the normal clinical reference range of 10 to 20 mg/dL for a healthy adult. This result indicates that the client’s kidneys are effectively filtering nitrogenous waste and that the current intravenous fluid rate is maintaining adequate renal perfusion. There is no evidence of dehydration or renal insufficiency that would necessitate a change in the medical management or a report.