A nurse is caring for a client in the emergency department.

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Nurses notes:

1400:

Client admitted to the medical-surgical unit at 1200 today. Alert and orientated x4, heart and lung sounds clear. Client urinating 100 mL/hour. Client is tolerating soft diet and oral fluids. Bowel sounds are hyperactive in all 4 quadrants. Bilateral pedal pulses 2+. Blood glucose 310 mg/dL (74 to 106 mg/dL)

Vital signs:

1400:

Temperature 36.8° C (98.2 F)

Pulse rate 84/min

Respiratory rate 16/min

Blood pressure 106/76 mm Hg

Oxygen saturation 96% on room air

A. Anticipate client to be prepped for cardiac catheterization.
The client is presenting with signs and symptoms indicative of acute myocardial infarction (MI), including chest pain radiating to the left arm, nausea, diaphoresis, tachycardia, and abnormal diagnostic results such as elevated troponin and myoglobin levels. The 12-lead electrocardiogram (ECG) showing ST segment elevation and T wave changes is also suggestive of an acute MI. Cardiac catheterization is commonly used to diagnose and treat acute coronary syndrome, particularly if there is a suspicion of a blockage in the coronary arteries. This is the most appropriate intervention at this time.
B. Assist with a continuous heparin infusion.
Heparin is often used in the management of acute coronary syndrome to prevent further clot formation. However, it is not the first action the nurse should take without a provider's prescription. Heparin may be indicated depending on the clinical scenario and provider's orders, but it should not be administered without a specific prescription.
C. Encourage the client to ambulate.
Encouraging ambulation is contraindicated in this situation. The client is likely experiencing an acute MI, and ambulation could increase myocardial oxygen demand, worsening the condition. Rest and monitoring are essential in this phase of care.
D. Anticipate an increased dosage of metoprolol.
Metoprolol is a beta-blocker that may be used to control heart rate and reduce myocardial oxygen demand in the setting of an MI. However, the dosage adjustment should be based on the provider's orders and the client's hemodynamic status. The nurse should monitor the client closely for signs of bradycardia or hypotension, which could necessitate adjusting the dosage, but this is not the immediate action.
E. Obtain a prescription for client to be NPO.
The client is likely to require diagnostic tests and possibly interventions such as cardiac catheterization or surgery. In preparation for these procedures, the client should be NPO (nothing by mouth) to reduce the risk of aspiration and to ensure that the client is ready for potential interventions. However, this is not the first action but should be anticipated soon after assessment.
F. Request a prescription for an antibiotic.
An antibiotic is not indicated at this time as there is no evidence of infection in the client's presentation. The focus should be on managing the acute myocardial infarction, not treating an infection.

A. Mannitol is the medication of choice for managing increased intracranial pressure (ICP). It is an osmotic diuretic that reduces ICP by drawing fluid out of the brain and into the bloodstream, which is then excreted by the kidneys. This helps to decrease cerebral edema and improve cerebral perfusion.

B. Chlorpromazine is an antipsychotic medication and is not used to treat increased ICP. It may be used for other conditions, such as agitation or nausea, but not for ICP management.

C. Dobutamine is a positive inotropic medication used to increase cardiac output in conditions such as heart failure, but it is not indicated for increased ICP.

D. Propranolol is a beta-blocker used to manage hypertension or anxiety, but it does not directly address the underlying issues of increased ICP.