A nurse is caring for a client who is receiving heparin therapy. If the client requires a reversal of the effects of heparin, which of the following medications should the nurse expect the provider to prescribe?

• Blood pressure. The client's blood pressure dropped from 104/56 mm Hg to 80/46 mm Hg, indicating worsening hypotension. This suggests fluid volume depletion due to ongoing diarrhea and possible sepsis from Clostridium difficile infection. Hypotension is the priority concern as it can lead to shock and organ dysfunction if not addressed immediately. The nurse should anticipate fluid resuscitation with IV fluids to restore circulatory volume.
• Hgb level. The client's hemoglobin is 17 g/dL, which is elevated compared to normal values (12-16 g/dL). This suggests hemoconcentration, likely due to dehydration from severe diarrhea rather than an actual increase in red blood cell count. While this is concerning, the immediate priority is addressing hypotension before evaluating hemoglobin further.
• Temperature. The client has a persistent fever of 38.9°C (102°F), which indicates an active Clostridium difficile infection. While fever management is important, hypotension takes priority because it can lead to hypoperfusion and organ failure. Antipyretic medications and infection control measures can be initiated after stabilizing blood pressure.
• Potassium level. The client's potassium is 3.1 mEq/L, which is below the normal range (3.5-5.0 mEq/L). Diarrhea leads to potassium loss, increasing the risk of cardiac arrhythmias and muscle weakness. After stabilizing the client’s blood pressure, potassium replacement is critical to prevent life-threatening hypokalemia-related complications such as cardiac dysrhythmias.
• Abdominal findings. The client has a soft, distended abdomen with hyperactive bowel sounds and watery stools with mucus, consistent with Clostridium difficile infection. While these findings confirm the diagnosis, the more urgent issues of hypotension and electrolyte imbalances must be addressed first before further gastrointestinal assessment.
• Hct level. The hematocrit is elevated (48%), which aligns with hemoconcentration from dehydration. However, fluid resuscitation will help correct this, making it a secondary concern after addressing blood pressure and potassium levels.

A. "Limit potassium-containing foods in your diet." Long-term prednisone use can lead to hypokalemia (low potassium levels) due to its mineralocorticoid effects, which increase potassium excretion. Clients on chronic corticosteroid therapy may actually need to consume potassium-rich foods to help maintain electrolyte balance, rather than restricting them.

B. "Withhold prednisone for 48 hours prior to receiving contrast dye." There is no general recommendation to withhold prednisone before contrast dye administration. However, clients on long-term steroid therapy may require stress-dose steroids if undergoing procedures that could trigger an adrenal crisis. Withholding prednisone without provider guidance could increase the risk of adrenal insufficiency.

C. "Measure your blood glucose levels periodically." Prednisone can cause hyperglycemia by increasing insulin resistance and promoting gluconeogenesis. Clients, especially those with diabetes or at risk for metabolic syndrome, should monitor blood glucose levels regularly to detect potential steroid-induced diabetes. Adjustments in diet or medication may be needed based on blood glucose trends.

D. "Take prednisone on an empty stomach." Taking prednisone on an empty stomach can increase the risk of gastrointestinal irritation, ulcers, and gastritis. It should be taken with food or milk to help reduce stomach irritation and minimize gastrointestinal side effects. Clients should be advised to follow this guideline to prevent discomfort and potential complications.