A nurse is reinforcing teaching with a client who is at risk for hypertension. Which of the following risk reduction strategies should the nurse Include in the teaching?

Rationale:

 • Obtain IV access is the first priority because the client is showing signs of hypovolemic shock low blood pressure (76/45 mm Hg), tachycardia (HR 121/min), pale mucous membranes, and diaphoresis likely due to GI bleeding. Immediate vascular access is necessary for resuscitation and fluid administration.

 • Call the surgical suite to notify that the client is arriving STAT would delay essential stabilization. Transporting an unstable client without securing IV access and fluid resuscitation could worsen their condition and is unsafe.

 • Place the client in a supine position with feet elevated (modified Trendelenburg) might temporarily improve venous return, but it does not address the underlying fluid deficit. It is not a substitute for urgent fluid replacement via IV access.

 • Recheck the client's oxygen saturation is not a priority because the client already has a stable oxygen saturation of 98% on room air. The immediate threat is circulatory collapse, not hypoxia.

 • Prepare to administer IV fluids follows IV access to treat hypotension and restore circulating volume. IV fluids help stabilize hemodynamics while awaiting further interventions like endoscopy or blood transfusion if needed.

 • Transport the client for endoscopy is inappropriate at this moment because the client is hemodynamically unstable. Endoscopy is important but must be delayed until the client is stabilized.

 • Check the ECG may be useful if cardiac concerns arise due to hypotension or tachycardia, but it does not take precedence over immediate circulatory support in this scenario.

 • Check arterial blood gases would not provide data that immediately changes the management. The client's O2 saturation is normal, and ABGs are not needed to diagnose or treat hypovolemic shock due to GI bleeding.

Rationale:

A. "Prednisone can cause blood glucose levels to increase”: Prednisone is a corticosteroid that can increase blood glucose by promoting gluconeogenesis and reducing cellular glucose uptake. Monitoring glucose levels is important, especially in clients receiving moderate to high doses.

B. "Albuterol treatments can cause blood glucose levels to decrease.": Albuterol is more likely to cause mild hyperglycemia due to its beta-agonist activity, which can stimulate glycogenolysis. It does not typically cause a drop in blood glucose levels.

C. "Having COPD causes blood glucose levels to fluctuate.": COPD alone does not directly cause blood glucose fluctuations. However, glucose changes are more commonly influenced by treatments like corticosteroids rather than the disease itself.

D. "Older adults are at risk for developing type 1 diabetes mellitus.”: Type 1 diabetes is typically diagnosed in children and young adults due to autoimmune beta-cell destruction. Older adults are more at risk for type 2 diabetes, not type 1.