A nurse is caring for a client who has type 1 diabetes mellitus. The client reports that she is not feeling well. Which of the following findings should indicate to the nurse that the client is hypoglycemic? (Select all that apply.)

Rationale:
A. Serum albumin: Serum albumin is a key indicator of a client’s nutritional status, particularly protein intake and synthesis. Low albumin levels can reflect malnutrition, chronic illness, or liver dysfunction, while normal levels suggest adequate nutritional support and protein reserves.

B. Troponin level: Troponin is a cardiac biomarker used to diagnose myocardial injury or infarction. It is not related to nutrition and does not provide any information about the client’s dietary intake or protein status.

C. Serum sodium: Serum sodium reflects fluid and electrolyte balance rather than nutritional status. Abnormal sodium levels are typically associated with dehydration, fluid overload, or endocrine disorders, not with protein or calorie malnutrition.

D. Erythrocyte sedimentation rate: The erythrocyte sedimentation rate (ESR) is a nonspecific marker of inflammation and infection. It may rise with inflammatory conditions but does not provide direct information about a client’s nutritional health.

Rationale:
A. Pudendal block: A pudendal block is a safe and effective pain management option for a client who is fully dilated and pushing during the second stage of labor. It provides local anesthesia to the perineal area, reducing pain associated with delivery and episiotomy without affecting uterine contractions or the fetus.

B. Naloxone hydrochloride: Naloxone is not a pain medication; it is an opioid antagonist used to reverse the effects of opioid-induced respiratory depression. Administering naloxone at this stage would not relieve labor pain and is inappropriate unless needed for opioid reversal.

C. Spinal anesthesia: Spinal anesthesia is typically administered before the second stage of labor, such as for a cesarean birth. Administering it when the client is fully dilated and pushing could delay delivery and increase the risk of complications from sudden hemodynamic changes.

D. Butorphanol tartrate: Butorphanol is an opioid agonist-antagonist analgesic that can cause respiratory depression in the newborn if given too close to delivery. Since the client is already in the pushing stage, administering this medication poses a risk to the fetus and is therefore unsafe.