A nurse is caring for a patient with long history of chronic obstructive pulmonary disease (COPD) who develops cor pulmonale.
The nurse should monitor the patient for which expected finding if heart failure is present?

Choice A rationale

Alcoholism is a common cause of hypomagnesemia due to poor dietary intake, increased renal excretion, and gastrointestinal losses. Chronic alcohol consumption leads to malnutrition and loss of magnesium through the urine, contributing to low magnesium levels.

Choice B rationale

Dehydration typically leads to hemoconcentration, which can elevate, rather than decrease, magnesium levels. Thus, it is not usually associated with low magnesium levels.

Choice C rationale

Kidney failure generally causes hypermagnesemia, not hypomagnesemia, because the kidneys cannot efficiently excrete magnesium, leading to its accumulation in the blood.

Choice D rationale

Excessive magnesium intake would result in hypermagnesemia, not hypomagnesemia, as the body accumulates more magnesium than it can excrete.

Choice C rationale

Administering another nitroglycerin tablet is appropriate if the client's chest pain has not been fully relieved after the initial dose. Nitroglycerin helps to dilate blood vessels, improving blood flow to the heart and relieving angina. A second dose can be given if the pain persists, following the protocol for managing chest pain.

Choice A rationale

Obtaining an ECG is important for diagnosing and monitoring cardiac conditions; however, in this immediate context, further pain relief takes precedence. After ensuring pain relief, an ECG can be performed to assess the client's cardiac status.

Choice B rationale

Calling the Rapid Response Team is unnecessary if the client’s chest pain severity has already decreased. The priority should be to continue managing the chest pain with additional nitroglycerin if needed and monitoring the client's response.

Choice D rationale

Initiating a peripheral IV might be required for administering medications or fluids, but it is not the immediate action needed in this scenario. The priority is to provide additional pain relief with nitroglycerin.