A client sustained a left femur fracture 3 hours ago. Initial vital signs and assessment were within normal limits with the exception of left leg pain.

The nurse re-assesses the client and documents the following:

• Temp: 37.2 C Pain: 7/10-chest 5/10 left leg.
• Pulse: 110 bpm
• Respirations: 40 breaths per min, labored 02 saturation: 88%
• Neuro: A&O x 3. Anxious Skin: Petechiae to neck and anterior chest.

Based on this assessment, which action is appropriate at this time?

A 3% saline solution is a hypertonic solution used to increase serum sodium levels in cases of severe hyponatremia. However, it can lead to fluid overload and pulmonary edema. The presence of crackles throughout both lung fields indicates the accumulation of fluid in the lungs, which is a serious adverse outcome.

The patient's radial pulse rate of 105 beats/min is within a normal range and does not directly indicate an adverse effect of the saline infusion.

The presence of sediment and blood in the patient's urine may be unrelated to the 3% saline infusion and could indicate other issues such as urinary tract infection or kidney injury.

An increase in blood pressure from 66/50 to 122/74 mmHg is an expected effect of a hypertonic solution like 3% saline, as it can cause an increase in intravascular volume. While the increase in blood pressure is significant, it does not represent an adverse outcome specific to the infusion itself.

Hemoglobin A1C is a blood test that provides an average blood glucose level over the past 2-3 months. Regular monitoring of A1C levels helps to assess the effectiveness of lifestyle modifications and treatment plans and guides adjustments in management if necessary.

Daily exercise is another essential aspect of managing pre-diabetes. Regular physical activity helps improve insulin sensitivity, promotes weight management, and reduces the risk of developing type 2 diabetes. The nurse should educate patients on the importance of incorporating physical activity into their daily routine and provide recommendations on suitable exercise types and durations.

While other options may be relevant for patients with diabetes, they are not specifically tailored to pre-diabetes, which is a condition where blood glucose levels are higher than normal but not yet meeting the criteria for diabetes.

Hypoglycemia and injection site infection are more relevant concerns for individuals with diabetes who require insulin or other medications to manage their blood sugar levels. Increasing carbohydrate intake and administering insulin are not appropriate recommendations for pre-diabetes management, as they can contribute to elevated blood glucose levels.