A nurse is caring for a client following application of a cast. Which of the following actions should the nurse take first?

Rationale:

A. ½ cup apple juice: Apple juice contains a relatively low amount of potassium, making it a poor choice for correcting hypokalemia. It typically provides less than 150 mg per half-cup serving.

B. ½ cup steamed cauliflower: Cauliflower is low in potassium compared to other vegetables. While healthy, it does not significantly contribute to raising potassium levels in the body.

C. 1 cup boiled white rice: White rice has minimal potassium content, especially when boiled. It is not effective in increasing potassium and is typically suitable for clients requiring low-potassium diets.

D. 1 cup cantaloupe: Cantaloupe is high in potassium, offering around 400–500 mg per cup. It is among the best fruit sources for replenishing potassium and is appropriate for clients with mild hypokalemia.

Rationale for Correct Choices:

• Decreased cardiac output: The client is post–myocardial infarction and experiences chest pain with minimal exertion, tachycardia (HR 112/min), and signs of anxiety and fear. These findings suggest that myocardial function may be compromised. Decreased cardiac output is a significant risk in post-MI clients due to potential for reinfarction, ischemia, or left ventricular dysfunction.
• Respiratory failure: The client has COPD, an elevated respiratory rate (32/min), and oxygen saturation of 87% on room air, which indicates significant hypoxemia. The productive cough, fatigue, and shortness of breath increase the risk for decompensation into respiratory failure without prompt oxygen therapy and pulmonary support.

Rationale for Incorrect Choices:

• Pancytopenia: This condition involves a reduction in red blood cells, white blood cells, and platelets. There is no evidence of bone marrow suppression, recent chemotherapy, or hematologic disorder in this client’s history.
• Neurogenic shock: Neurogenic shock results from spinal cord injury or disruption of sympathetic nervous system control. The client has no evidence of trauma or spinal pathology, and the elevated heart rate contradicts the expected bradycardia of neurogenic shock.
• Hepatic encephalopathy: This is caused by liver dysfunction, typically in clients with advanced liver disease. There are no signs of altered mental status, liver disease, or elevated ammonia levels in this case.