A nurse is calculating fluid input for a client who is receiving a continuous IV infusion of 0.9% sodium chloride at 125 mL/hr and cefazolin 50 mL IV bolus every 4 hr. How many mL did the client receive per IV infusion over the past 24 hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A. “I seem to be bruising more easily,”: Easy bruising is not a typical adverse effect of lisinopril. Bruising may indicate a hematologic issue or another medication effect, but it is unrelated to ACE inhibitor therapy.

B. "I have to urinate frequently.": Increased urination is not commonly associated with lisinopril. Diuretics, rather than ACE inhibitors, are more likely to cause polyuria. This statement does not indicate an adverse effect of lisinopril.

C. "I have a nagging, dry cough.": A persistent, dry cough is a well-known adverse effect of ACE inhibitors like lisinopril. It occurs due to the accumulation of bradykinin in the respiratory tract, and it can be bothersome enough to require medication adjustment or substitution.

D. "I have a heightened sense of taste.": Altered taste perception is not a common adverse effect of lisinopril. While some medications can affect taste, this is not characteristic of ACE inhibitors and is unlikely to be related to the client’s current therapy.

Rationale for correct choices

• Oxygen saturation: The client’s oxygen saturation is 93% on room air, indicating mild hypoxemia. In the context of chest pain, dyspnea, diaphoresis, and cool skin, addressing oxygenation is the priority to ensure adequate tissue perfusion and prevent further cardiac compromise. Supplemental oxygen may stabilize oxygen levels while other interventions are implemented.

• ECG results: The 12-lead ECG shows tachycardia with ST-segment elevation and T-wave changes, indicating acute myocardial ischemia or infarction. After stabilizing oxygenation, rapid evaluation of ECG findings is crucial to determine the need for urgent interventions such as reperfusion therapy or cardiac monitoring. Timely ECG interpretation guides lifesaving care.

Rationale for incorrect choices

• Pain level: While the client reports severe chest pain (7/10), pain management is important but secondary to addressing oxygenation and assessing for myocardial injury. Pain relief should occur after stabilizing vital physiological parameters.

• Diabetes: The client’s blood glucose is 103 mg/dL, within normal limits. Immediate diabetes management is not urgent in acute cardiac compromise. Ongoing monitoring is appropriate but not a first-priority intervention.

• Lipid profile: Elevated cholesterol and triglycerides indicate long-term cardiovascular risk but do not require immediate action during an acute ischemic event. Assessment of ECG and stabilization of oxygenation take precedence.

• X-ray findings: Chest x-ray is clear, showing no acute pulmonary compromise. While helpful for baseline assessment, it does not directly influence immediate management of acute myocardial ischemia. Immediate cardiac and oxygenation interventions are higher priority.