The nurse identifies that the goal of decreasing the cardiac workload for a client receiving atenolol 25 mg PO BID for unstable angina is met when the client has:

Choice A Reason
Urine negative for ketones is a normal finding and does not typically indicate an acute problem. Ketones in the urine can be a sign of uncontrolled diabetes or starvation, but their absence is expected in a well-nourished individual who is not in a state of diabetic ketoacidosis.

Choice B Reason
Sodium at 135 mg/dL and Potassium at 3.5 mEq/L are within normal ranges. The normal range for serum sodium is approximately 135-145 mEq/L, and for serum potassium, it is around 3.5-5.0 mEq/L. These values do not indicate an immediate concern for the patient with urosepsis.

Choice C Reason
A BUN of 34 mg/dL and Creatinine of 4.2 mg/dL are concerning. The normal range for BUN is approximately 6-20 mg/dL, and for Creatinine, it is about 0.6-1.2 mg/dL for males and 0.5-1.1 mg/dL for females. Elevated levels of BUN and Creatinine indicate impaired kidney function, which can be a complication of urosepsis and the nephrotoxic effects of gentamicin and vancomycin.

Choice D Reason
A white blood cell count of 12,000/mm³ is slightly elevated, which may be expected in a patient with an infection such as urosepsis. The normal range is approximately 4,500-11,000 WBCs/mm³. While this should be monitored, it does not require immediate reporting unless there is a significant change or it is outside the patient's baseline.

Choice a reason:
Assessing capillary refill and the color of the extremity is essential for determining the vascular status of the limb. A normal capillary refill time is less than 2 seconds and indicates good blood flow. The color should be consistent with the rest of the body, without pallor or cyanosis, which could indicate compromised circulation.

Choice b reason:
Checking pedal pulses is another critical aspect of assessing vascular integrity. The presence of strong and equal pulses in both feet suggests that the blood supply to the lower extremities is not compromised.

Choice c reason:
While the ACE wrap and Velcro boot are part of the postoperative management to provide support and protection to the affected limb, and hanging weights might be used for traction, these are not part of the physiological assessment of the extremity.

Choice d reason:
Monitoring pin sites for signs of infection, such as redness, swelling, or discharge, is crucial in a client with ORIF. Infection can lead to complications that may affect the healing process and the integrity of the fixation.

Choice e reason:
Evaluating the temperature, sensation, and movement of toes helps in assessing for potential nerve damage or compartment syndrome. Any changes in these parameters should be reported immediately as they may signify serious complications.