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Client who is experiencing hallucinations and extreme anxiety after the use of marijuana: Hallucinations and anxiety are distressing but generally not life-threatening effects of marijuana use. These symptoms can be managed with reassurance and a calm environment once physical safety is ensured.

Client with a history of alcohol use complaining of insomnia and diaphoresis: These symptoms suggest early alcohol withdrawal, which can progress to serious complications like seizures or delirium tremens if untreated. However, at this stage, the client's symptoms are mild and not immediately life-threatening.

Client who has a respiration rate of 14 after overdosing on oxycodone (OxyContin): Although opioid overdose can cause respiratory depression, a rate of 14 indicates adequate ventilation for now. The client should still be closely monitored, but there is no immediate evidence of respiratory failure.

Dyspepsia: Dyspepsia, or indigestion, is a common symptom associated with peptic ulcer disease rather than a complication. It often presents as epigastric discomfort, bloating, or nausea, which are expected findings in this condition and not indicative of worsening disease.

Gastric cancer: Chronic peptic ulcer disease, especially those related to H. pylori infection, can increase the long-term risk of gastric cancer. However, cancer is a delayed sequela rather than an acute complication, so it is not the immediate priority for monitoring during hospitalization.

Large bowel obstruction: Large bowel obstruction is unrelated to peptic ulcer disease, as ulcers occur in the stomach or duodenum, not the large intestine. Monitoring for obstruction symptoms such as abdominal distention or absence of bowel movements would not be relevant to this client’s current diagnosis.

Abdominal arteriogram: An abdominal arteriogram is used primarily to evaluate blood vessels for aneurysms, occlusions, or bleeding sources, not to diagnose gastric disorders. It would not provide useful information regarding mucosal integrity or the presence of ulcers in clients with dyspepsia.

Magnetic resonance imaging (MRI): MRI is effective for assessing soft tissue and organ structure but has limited utility in diagnosing gastric mucosal diseases. It cannot provide the direct visualization or biopsy capability needed to confirm conditions like gastritis or peptic ulcer disease.

Nuclear medicine scan: A nuclear medicine scan is sometimes used to evaluate gastric emptying or detect gastrointestinal bleeding, but it lacks the precision to identify mucosal lesions or ulcerations. It is therefore not the first-line diagnostic test for clients presenting with frequent gastric pain and dyspepsia.

“I should drink wine occasionally instead of every night”: Reducing alcohol consumption is appropriate since alcohol irritates the gastric mucosa and can worsen gastritis. Occasional, moderate intake may be tolerated, but complete avoidance is preferable during healing.

“I should decrease my intake of caffeinated drinks, especially coffee”: Caffeine stimulates gastric acid secretion, aggravating gastritis symptoms and delaying mucosal recovery. Recognizing the need to limit coffee and other caffeinated beverages demonstrates correct understanding of preventive self-care measures.

“I will take acetaminophen instead of aspirin when I have a headache”: Aspirin is a known gastric irritant that can worsen gastritis and cause ulcer formation. Choosing acetaminophen, which has minimal gastric irritation, reflects correct understanding of medication safety.

White blood cell count: 11,000/mm³ (11 × 10³/µL): A mildly elevated WBC count may indicate an inflammatory or infectious process but is not immediately critical. It should be monitored, but it does not alone signal acute tissue hypoperfusion or imminent shock unless accompanied by other abnormal findings.

Sodium: 150 mEq/L (150 mmol/L): This indicates mild hypernatremia, which may result from dehydration or fluid loss. Although it warrants correction, it is not an urgent indicator of shock. The focus would be on assessing fluid balance and adjusting IV therapy as needed.

Creatinine: 0.9 mg/dL: This is within normal range and reflects adequate renal perfusion. Stable creatinine levels indicate that the kidneys are still being adequately supplied with blood, suggesting no immediate compromise in circulatory function at this time.

“The wound was stapled together after an infection was cleared up”: Wounds that are closed after infection resolution heal by tertiary (delayed primary) intention, not second intention. In tertiary healing, the wound is initially left open and later closed surgically once infection or contamination subsides.

“The wound edges have been approximated and stitched together.”: When wound edges are brought together and sutured, it is healing by first intention. This type of healing occurs in clean surgical incisions with minimal tissue loss, allowing faster recovery and minimal scarring.

“The wound was contaminated by debris and can’t be closed at all.”: While contaminated wounds may initially be left open, the statement is inaccurate because such wounds can still heal by second or tertiary intention once cleaned. Complete inability to close the wound is not characteristic of any specific healing process.

CPR: While CPR must be started immediately, defibrillation is the treatment that can convert the rhythm back to a normal sinus rhythm.

Cardioversion: Cardioversion is synchronized electrical shock used for patients who have an unstable, pulsing rhythm (like unstable a-fib or unstable v-tach. Since the patient is pulseless, defibrillation (an unsynchronized shock) is required.

Amiodarone: Amiodarone is an antiarrhythmic medication used after the first few defibrillation attempts (and epinephrine) if the shockable rhythm persists. It is not the priority first-line intervention.

Nitroglycerin: Nitroglycerin acts as a vasodilator that relieves chest pain by improving myocardial oxygen supply. Its adverse effects include hypotension, headache, and reflex tachycardia, but it does not cause bronchospasm or wheezing.

Heparin: Heparin is an anticoagulant that prevents clot formation in unstable angina. Its side effects are mainly related to bleeding and thrombocytopenia, not bronchoconstriction or airway irritation. The client’s symptoms are inconsistent with heparin-induced reactions.

Morphine: Morphine decreases myocardial oxygen demand by reducing preload and afterload. It may cause respiratory depression but does not cause wheezing or bronchospasm. The client’s audible wheezing suggests airway constriction rather than central respiratory suppression.

Decrease IV Fluids to 75 mL/hr and recheck hemodynamic parameters: Decreasing fluids would worsen the client’s hypovolemia. Low CVP and PAWP values indicate inadequate preload and circulating volume, suggesting the need for fluid resuscitation, not restriction.

Administer furosemide (Lasix) 20 mg IVP: Furosemide is a diuretic that promotes fluid excretion and is used in cases of fluid overload or pulmonary congestion. Given this client’s low filling pressures and tachycardia, diuresis would worsen hypovolemia.

Monitor hemodynamic monitoring parameters again in one hour: While ongoing monitoring is important, delayed intervention in the presence of clear hypovolemia can lead to shock and organ dysfunction. Active fluid resuscitation is necessary before re-evaluation of parameters.