A client comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. What would the nurse suspect the patient has?

A. Stress has likely caused an increase in the client's blood sugar levels:
This statement is accurate. Stress, especially related to surgery, can lead to increased levels of stress hormones, such as cortisol and catecholamines, which can elevate blood sugar levels. Surgery is a physiological stressor that can impact glucose metabolism.

B. The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars:
This is the most appropriate choice. Surgery, anesthesia, and changes in fluid balance can affect blood glucose levels. The stress response to surgery can lead to fluctuations in blood sugar, and patients may need insulin during this period.

C. The client has likely overstimulated her ability to control her diabetes using non-pharmacologic measures:
This statement is not accurate. Overstimulation is not a common cause of the need for insulin in the context of surgery. The stress and physiological changes associated with surgery are more likely contributors.

D. Alterations in bile metabolism and release have likely caused hyperglycemia:
While alterations in metabolism can impact glucose regulation, in the context of surgery, the primary factors are the stress response, changes in fluid balance, and potential alterations in the ability to eat or drink normally rather than specific effects on bile metabolism.

A. The need to monitor urine for the presence of albumin:
Explanation: Monitoring urine for albumin is more associated with microvascular complications, particularly diabetic nephropathy. When the kidneys are affected, albumin may leak into the urine. This is not a macrovascular complication.

B. The relationship between kidney function and blood glucose levels:
Explanation: The relationship between kidney function and blood glucose levels is important, but it is more directly related to microvascular complications, particularly diabetic nephropathy. High blood glucose levels over time can damage the small blood vessels in the kidneys.

C. The need for frequent eye examinations for clients with diabetes:
Explanation: This is related to microvascular complications, specifically diabetic retinopathy. Changes in the small blood vessels of the retina can lead to vision problems. While important, it's not directly addressing macrovascular complications.

D. The fact that clients with diabetes have an elevated risk of myocardial infarction:
Explanation: This is the correct answer. Macrovascular complications involve large blood vessels and are associated with conditions such as coronary artery disease, which increases the risk of myocardial infarction in individuals with diabetes.