A nurse is caring for an older adult client who has confusion and weakness. The client has an elevated hematocrit (Hct) of 53%, an elevated blood urea nitrogen (BUN) of 25 mg/dL, and an elevated urine specific gravity of 1.032.Which of the following actions should the nurse contribute to the client's plan of care? (Select all that apply).

Choice A rationale An elevated Hct (normal ≈ 36%-50%), elevated BUN (normal 8-20 mg/dL), and high urine specific gravity (normal 1.005-1.030) are all indicative of volume depletion or dehydration. Monitoring intake and output precisely quantifies the fluid balance, which is crucial for determining the degree of deficit and evaluating the effectiveness of rehydration therapy. Choice B rationale The client's confusion and weakness are potential symptoms of dehydration, as reduced intravascular volume can impair cerebral perfusion and electrolyte imbalances can disrupt nerve and muscle function. Regularly checking orientation provides an essential ongoing assessment of the client's neurological status and the effectiveness of fluid replacement. Choice C rationale The client's lab values and symptoms strongly suggest dehydration, which requires increased fluid intake, not restriction. Fluid restriction would exacerbate the existing hypovolemia, further worsening the elevated Hct, BUN, and specific gravity, potentially leading to renal compromise and worsening confusion. Choice D rationale Dehydration often leads to orthostatic hypotension due to reduced circulating blood volume. Instructing the client to sit briefly before standing allows time for baroreceptor reflexes to compensate for the positional change, preventing a sudden drop in blood pressure and minimizing the risk of a fall. Choice E rationale Daily weights provide a highly sensitive and objective measure of fluid status changes. A rapid change in body weight, especially in the context of dehydration and hypovolemia, directly reflects the magnitude of fluid loss or gain, making it a critical parameter for monitoring the effectiveness of interventions.