A nurse is teaching a client who was recently diagnosed with type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?

Rationale:

A. Troponin level: Troponin is a cardiac biomarker used to detect myocardial injury or infarction. It is not an indicator of nutritional status and does not reflect protein levels or nutrient balance.

B. Serum albumin: Albumin is a plasma protein synthesized in the liver and commonly used as a marker of long-term nutritional status. Low levels may suggest protein-energy malnutrition or chronic illness affecting nutrient absorption or intake.

C. Erythrocyte sedimentation rate: ESR is a nonspecific marker of inflammation or infection. While chronic disease can indirectly affect nutrition, ESR does not directly assess nutrient levels or dietary sufficiency.

D. Serum sodium: Sodium levels reflect fluid balance and electrolyte status but are not indicators of nutritional status. They may be influenced by hydration, renal function, or hormonal imbalances, not by dietary protein intake.

Rationale for correct choices:

• Administer oxygen at 2 L/min via nasal cannula: The client's oxygen saturation has dropped to 92% on room air, indicating mild hypoxia. Supplemental oxygen should be administered to improve myocardial oxygenation and reduce ischemia while further interventions are being prepared.
• Administer sublingual nitroglycerin: Nitroglycerin is a first-line medication for chest pain caused by suspected myocardial ischemia. It promotes vasodilation, reduces myocardial oxygen demand, and provides symptom relief. Administering it promptly can help prevent further cardiac damage.

Rationale for incorrect choices:

• Request a prescription for an increase in statin medication: Although the client has hyperlipidemia, increasing the statin dose is not an immediate priority during an acute chest pain episode. Lipid management is important long-term but does not address the acute ischemic event.
• Prepare the client for cardiac catheterization: Cardiac catheterization may eventually be necessary, but it is not the nurse’s first action. The priority is to stabilize the client’s symptoms (oxygenation and pain) before preparing for any invasive diagnostic or therapeutic procedure.
• Check a STAT cardiac troponin: Troponin has already been obtained and is within normal limits at this point. While serial troponins may be needed later, immediate nursing priorities focus on symptom relief and oxygenation rather than repeating the test right away.
• Request a prescription for a beta-blocker: Beta-blockers may be used in the treatment of suspected myocardial infarction to reduce heart rate and myocardial oxygen demand. However, their initiation typically follows pain relief, oxygenation, and diagnostic confirmation, not as the first nursing action.