A nurse is caring for a client who has diabetes mellitus and cool, clammy skin. The client begins having a seizure. Which of the following treatments should the nurse administer?

A. Temperature of 38° C (100.4° F): An elevated temperature may indicate infection, which is a potential complication of TPN due to the risk of central line-associated bloodstream infections. However, fever is not a sign of fluid volume overload.

B. Urinary output of 20 mL in the past hour: Oliguria (low urine output) is more commonly associated with dehydration or renal impairment rather than fluid volume overload. In fluid overload, urine output may initially increase if kidney function is normal.

C. +1 pedal pulses: Weak pulses can indicate poor circulation, hypovolemia, or peripheral vascular disease. In fluid overload, bounding pulses rather than weak pulses are typically observed due to increased intravascular volume.

D. S3 heart sound: An S3 heart sound (ventricular gallop) occurs when excess fluid volume causes rapid ventricular filling, leading to abnormal heart sounds. This finding is a classic sign of fluid volume overload and can indicate heart failure or significant fluid retention.

• Anticipate client to be prepped for cardiac catheterization: Given the client's diagnosis of myocardial infarction and persistent chest pain, cardiac catheterization may be necessary for evaluating coronary artery patency and determining the need for potential interventions such as angioplasty or stenting. Prepping the client for this procedure is appropriate.
• Assist with a continuous heparin infusion: Heparin is often used in acute coronary syndrome management to prevent thrombus formation and reduce the risk of further myocardial injury. Initiating a continuous heparin infusion may be indicated following an assessment of the client’s condition and provider orders.
• Encourage the client to ambulate: While early ambulation is important for recovery and preventing complications, in the acute phase of a myocardial infarction, clients should be closely monitored and may require bed rest initially. Encouraging ambulation should only occur once the client is stable and after consulting with the healthcare provider.
• Anticipate an increased dosage of metoprolol: Metoprolol is typically administered to manage heart rate and blood pressure, but the dosage should be based on the client’s current vital signs and response to treatment. If the client’s heart rate remains elevated or if there are signs of ongoing ischemia, an increased dosage may be necessary, but this should be based on provider orders rather than an automatic assumption.
• Obtain a prescription for client to be NPO: Clients scheduled for procedures such as cardiac catheterization often require NPO status to prevent aspiration during sedation. Additionally, if the client is experiencing nausea, keeping them NPO can prevent further complications.
• Request a prescription for an antibiotic: There is no indication of an infection or a need for antibiotic therapy. Antibiotics are typically not indicated for the management of myocardial infarction unless there is a concurrent infection. Therefore, requesting an antibiotic prescription is not appropriate.