A nurse is caring for a female client following abdominal surgery.

Select the 2 findings that the nurse should recognize as expected findings.

• Decrease the client’s oxygen to 1 L/min via nasal cannula: The client’s oxygen saturation has decreased to 90% on 2 L/min, indicating hypoxemia. Reducing oxygen flow could worsen tissue hypoxia and increase the risk of organ dysfunction. Oxygen therapy should be maintained or adjusted to achieve adequate saturation, not reduced without medical indication.

• Hold the client’s metoprolol: Metoprolol is a beta-blocker essential for rate control in atrial fibrillation and for improving heart failure outcomes. Holding the medication could worsen tachycardia, reduce cardiac output, and exacerbate heart failure symptoms. Continuation is necessary unless contraindications such as severe bradycardia or hypotension develop.

• Restrict the client’s fluid intake to 2 L per day: The client’s weight has increased by 1.8 kg (4 lb) in one day, indicating fluid retention due to worsening heart failure. Limiting fluid intake helps reduce preload and manage edema. Fluid restriction is a standard intervention in acute decompensated heart failure to prevent further fluid overload and pulmonary congestion.

• Weigh the client daily: Daily weights are critical for monitoring fluid status in clients with heart failure. Rapid weight gain signals worsening fluid retention, guiding diuretic adjustments and other interventions. This allows early detection of exacerbations and reduces the risk of hospitalization.

• Increase the dosage of furosemide: The client exhibits signs of fluid overload: weight gain, decreased oxygen saturation, elevated BNP, and atrial fibrillation. Increasing the loop diuretic helps remove excess fluid, reduce pulmonary congestion, and improve oxygenation. Adjustments must be guided by the client’s renal function, electrolytes, and blood pressure.

• Begin a 24-hour urine collection for the client: A 24-hour urine collection is not immediately necessary for acute fluid management in heart failure. While it may provide data on kidney function, daily weights, intake/output monitoring, and electrolytes are more practical for assessing volume status and guiding treatment in this context.

A. Respiratory alkalosis: The client’s arterial pH is 7.30, indicating acidemia rather than alkalemia. Respiratory alkalosis is not expected in hyperglycemic crises; instead, metabolic acidosis may develop due to ketone accumulation and dehydration.

B. Hypotension: The client’s blood pressure is 96/65 mm Hg, which is lower than normal, likely related to dehydration from osmotic diuresis caused by severe hyperglycemia. Ongoing fluid loss increases the risk of hypotension, making it an important complication to monitor and manage promptly.

C. Septic shock: While the client has a recent history of bronchitis and pneumonia, there is no current evidence of infection such as fever, tachypnea, or elevated WBCs. Although infection could precipitate hyperglycemia, septic shock is not an immediate complication indicated by the current findings.

D. Cardiac arrhythmias: The client has a potassium level of 5.5 mEq/L, which is elevated. Hyperkalemia increases the risk of cardiac arrhythmias, especially in combination with dehydration and acidosis, making close cardiac monitoring necessary.

E. Renal failure: Elevated BUN (21 mg/dL) and creatinine (1.7 mg/dL) suggest impaired renal perfusion or acute kidney injury secondary to dehydration from osmotic diuresis. The client is at risk of progression to renal failure if fluid and electrolyte imbalances are not corrected.

F. Cerebral edema: Cerebral edema is often caused by an overly rapid drop in effective serum osmolarity during treatment, primarily when blood glucose is lowered too quickly. The rapid shift in fluid from the bloodstream to the brain cells can cause swelling.