A nurse is monitoring a client who has diabetes mellitus and a glucose level of 384 mg/dl. (74 to 106 mg/dL). Which of the following findings should the nurse identify as an indication of metabolic acidosis?

Choice A Reason:
Refill the prescription every 12 months. This statement focuses on the frequency of prescription refills rather than guidance on the medication's use. While it's important to keep prescriptions up to date, this instruction doesn't directly relate to the administration or use of sublingual nitroglycerin for angina.
Choice B Reason:
Take a second tablet after 5 minutes for unrelieved chest pain. This advice is crucial because if the chest pain persists after the first tablet, taking a second tablet after 5 minutes (and seeking emergency medical assistance if pain persists after the second tablet) is part of the recommended protocol for managing unstable angina with sublingual nitroglycerin.
Choice C Reason:
Swallow the tablet whole with a glass of water. Sublingual nitroglycerin is designed to dissolve under the tongue, not to be swallowed. The medicine is absorbed through the blood vessels in the mouth to provide rapid relief for angina symptoms. Instructing the patient to swallow the tablet defeats the purpose of sublingual administration.
Choice D Reason:
Store the medication in the refrigerator. Nitroglycerin should generally be stored in a cool, dry place and away from direct sunlight, but refrigeration is not necessary. Storing it in the refrigerator might actually alter the medication's effectiveness or consistency, making it less reliable for quick absorption when needed during an angina episode.

Clamp the catheter tubing distal to the sampling port for 15 min. By clamping the tubing distal to the sampling port, it allows urine to accumulate in the tubing, ensuring that the urine specimen obtained is fresh and not from the stagnant urine that has been sitting in the tubing.

Wipe the sample port with an alcohol wipe and let the alcohol dry. Cleaning the sampling port with an alcohol wipe helps reduce the risk of introducing contaminants into the sample during collection, ensuring a more sterile procedure.

Attach a sterile needleless syringe to the sample port and aspirate the specimen. Using a sterile syringe prevents contamination and allows for the collection of a clean urine sample directly from the catheter tubing, maintaining the sterility of the specimen.

Empty the urine into a sterile container labeled with the client identifiers. Transferring the collected urine into a sterile container labeled with the client's identifiers ensures proper identification and handling of the specimen for laboratory analysis.

Document in the client's electronic medical record that the specimen was sent to the laboratory. Documenting in the client's medical record ensures that there is a clear record of the specimen collection, its handling, and its dispatch to the laboratory for analysis, maintaining proper documentation and continuity of care.