A nurse is teaching an older adult client who has osteoporosis about ways to promote musculoskeletal health. Which of the following instructions should the nurse include?

Choice A rationale:
A warm left leg is a normal finding and does not require immediate intervention. Warmth indicates adequate circulation to the limb.
Choice B rationale:
A pedal pulse strength of 2 in the left leg indicates diminished pulse but does not require immediate intervention. The nurse should continue to monitor the pulse and report any significant changes to the healthcare provider.
Choice C rationale:
The client's report of pain in the foot of the left leg is an expected finding due to the fractured left femur. Pain is a subjective symptom, and the nurse should address the client's pain appropriately but not intervene immediately based on this finding.
Choice D rationale:
This is the correct choice. A capillary refill time of 3 seconds in the left foot suggests impaired circulation, which could be indicative of compartment syndrome or other circulation-related issues. The nurse should intervene immediately by notifying the healthcare provider to prevent further complications.

Choice A rationale:
The combination of widened QRS, frequent premature ventricular contractions (PVCs), and bradycardia (heart rate of 55/min) on telemetry monitoring suggests hyperkalemia. Elevated potassium levels in the blood can cause delayed repolarization of cardiac cells, leading to widened QRS complexes and PVCs. Bradycardia is another common manifestation of hyperkalemia.
Choice B rationale:
Hypocalcemia, characterized by low calcium levels in the blood, can lead to cardiac arrhythmias, but it typically presents with a prolonged QT interval rather than widened QRS complexes and PVCs.
Choice C rationale:
Hyperglycemia, which is high blood glucose levels, does not directly affect the electrocardiogram (ECG) parameters like QRS width or heart rate. It may have systemic effects, but it is not responsible for the ECG changes described in the scenario.
Choice D rationale:
Hypophosphatemia, or low levels of phosphate in the blood, can cause muscle weakness and may have systemic effects, but it is not associated with the specific ECG changes seen in hyperkalemia, such as widened QRS complexes and PVCs.