A nurse is caring for a client who has diabetes insipidus and has had a urinary output of 3,000 mL in the past 12 hr. Which of the following medications should the nurse expect to administer to the client?

The nurse should first address the client's chest pain followed by the client's irregular heart rate.

Rationale:

Chest pain is the priority concern as it indicates an acute coronary event (ST-elevation myocardial infarction, STEMI). Immediate interventions such as oxygen, nitroglycerin, and pain management are required to reduce myocardial oxygen demand and prevent further cardiac damage.

Irregular heart rate must be addressed next, as tachycardia and arrhythmias can increase myocardial workload and worsen ischemia. Monitoring and possible antiarrhythmic interventions may be required to stabilize cardiac function.

Incorrect:

Troponin levels: Elevated troponin confirms myocardial injury but does not require immediate intervention; managing the ongoing ischemia is the priority.

Oxygen saturation: The client's oxygen saturation is 93% on room air, which is adequate. Oxygen therapy is not the first priority unless levels drop further.

Hyperlipidemia: While a cardiovascular risk factor, it is not an acute concern during an MI. Long-term management is necessary but not the immediate priority.

C-reactive protein: Elevated CRP indicates inflammation but does not require urgent intervention in the acute phase of MI.

A. Use fluticasone as needed for shortness of breath: Fluticasone is a corticosteroid used for long-term inflammation control in COPD, not for immediate symptom relief. Short-acting bronchodilators like albuterol are used for acute shortness of breath.

B. Limit fluid intake to 1 L per day: COPD clients benefit from adequate hydration (typically 2-3 L per day) to help thin mucus secretions and improve airway clearance. Restricting fluids can lead to thickened secretions and increased respiratory distress.

C. Avoid use of pursed-lip breathing: Pursed-lip breathing is encouraged for COPD clients to help reduce air trapping, improve oxygenation, and promote more effective exhalation. It is an essential technique for managing dyspnea.

D. Obtain a yearly influenza immunization: COPD clients are at higher risk of complications from respiratory infections. An annual influenza vaccine helps reduce the risk of severe illness and exacerbations, making it a crucial part of COPD management.