A diabetic client states he feels depressed, is complaining of chest pain, and has an open wound. Which of these complaints would require an immediate focused assessment?

Choice A reason: Fluid volume deficit is a condition in which the body loses more fluid than it gains, resulting in dehydration, hypotension, and electrolyte imbalances. It is not a complication of IV fluid therapy, but rather a reason for initiating it.

Choice B reason: Fluid volume excess is a condition in which the body retains more fluid than it needs, resulting in edema, hypertension, and heart failure. It is a potential complication of IV fluid therapy, especially in older adults who have reduced renal function and cardiac output. The nurse's assessment findings of crackles, shortness of breath, and jugular vein distention are indicative of fluid overload and pulmonary congestion.

Choice C reason: Speed shock is a systemic reaction that occurs when a substance is administered too rapidly into the bloodstream, causing adverse effects such as chest pain, dyspnea, hypotension, and cardiac arrest. It is not a complication of IV fluid therapy, but rather a risk associated with IV medication administration.

Choice D reason: Pulmonary embolism is a blockage of one or more pulmonary arteries by a blood clot, fat, or air, causing impaired gas exchange, chest pain, dyspnea, and hemoptysis. It is not a complication of IV fluid therapy, but rather a possible outcome of venous thromboembolism, which can be prevented by using anticoagulants and mechanical devices.

Choice A reason: An open wound is a concern for a diabetic client, as it can increase the risk of infection and delay the healing process. However, it does not require an immediate focused assessment, unless it is bleeding profusely, infected, or showing signs of tissue damage.

Choice B reason: Depression is a common complication of diabetes, as it can affect the client's mood, self-care, and adherence to treatment. However, it does not require an immediate focused assessment, unless the client is suicidal, psychotic, or unable to function.

Choice C reason: Chest pain is a symptom that can indicate a life-threatening condition, such as a heart attack, pulmonary embolism, or aortic dissection. It requires an immediate focused assessment, as it can compromise the client's cardiac and respiratory function and lead to death.

Choice D reason: Diabetes is a chronic condition that affects the client's blood glucose levels and can cause various complications, such as neuropathy, nephropathy, and retinopathy. However, it does not require an immediate focused assessment, unless the client is experiencing a hyperglycemic or hypoglycemic crisis.