A nurse in a community clinic is caring for a client who has systemic lupus erythematosus (SLE). Which of the following statements by the client should the nurse determine is the priority?

Rationale:

• Troponin I level: An elevated troponin I level indicates myocardial cell injury and is a key diagnostic marker for MI. Even a value at the upper limit of normal (0.03 ng/mL) warrants concern, especially with accompanying symptoms.
• ECG result – sinus tachycardia: Sinus tachycardia is nonspecific but may occur in both MI and angina due to pain, anxiety, or sympathetic stimulation. However, more definitive MI-related changes like ST elevation or Q waves would provide clearer diagnostic value.
• Heart rate: A heart rate of 116/min is elevated and may represent the body’s response to pain, hypoxia, or stress. This can be seen in both angina and MI, though persistent or worsening tachycardia in MI may indicate hemodynamic instability.
• Heart palpitations: Palpitations are common during episodes of angina and are often due to increased sympathetic tone or transient arrhythmias. They are usually mild and resolve with rest or nitroglycerin in stable angina.
• Blood pressure: A blood pressure of 158/92 mm Hg indicates hypertension, a known trigger and risk factor for angina. Elevated BP increases myocardial oxygen demand, potentially precipitating chest pain in those with coronary artery disease.

Rationale:

A. "Cauliflower is a good dietary choice”. Cauliflower is a gas-forming vegetable that can increase abdominal discomfort in clients with gallbladder disease. It is not typically recommended during symptomatic periods or recovery from cholelithiasis.

B. "Increase the amount of egg yolks in your diet." Egg yolks are high in cholesterol and fat, which can trigger gallbladder contractions and worsen symptoms in clients with cholelithiasis. These should be limited or avoided.

C. "Select desserts such as angel-food cake." Angel-food cake is low in fat and cholesterol, making it an appropriate dessert option for individuals with gallbladder disease. Low-fat and non-irritating foods are key to managing symptoms.

D. "Eat choice or prime cuts of meat." Choice or prime cuts tend to have a higher fat content. High-fat meats can exacerbate symptoms by stimulating bile production and gallbladder contractions, which should be avoided in cholelithiasis.