A nurse is providing discharge teaching to a patient who has undergone a mitral valve replacement with a mechanical prosthesis. Which statement by the patient indicates a need for further teaching?

A. Administer an injection of epinephrine stat: The patient’s symptoms are classic signs of anaphylaxis, a severe IgE-mediated hypersensitivity reaction. Epinephrine is the first-line treatment because it stimulates alpha-1 receptors (causing vasoconstriction to reduce edema and hypotension) and beta-2 receptors (producing bronchodilation). Immediate intramuscular administration prevents airway obstruction and cardiovascular collapse.

B. Administer oxygen 4 liters via nasal cannula: Supplemental oxygen supports oxygenation during respiratory distress but does not reverse the underlying pathophysiology of anaphylaxis. It does not address airway edema, bronchospasm, or vasodilation. Oxygen is an important adjunct after epinephrine, but it is not the priority intervention in a rapidly progressing allergic reaction.

C. Administer albuterol 2 puffs stat: Albuterol is a beta-2 agonist that provides bronchodilation and may help relieve bronchospasm. However, it does not reduce laryngeal edema or counteract systemic vasodilation and hypotension. In anaphylaxis, albuterol is considered secondary therapy and should not delay epinephrine administration.

D. Have the patient in high Fowler's position in the bed: Positioning may help ease breathing effort by optimizing lung expansion. However, it does not treat airway edema, bronchoconstriction, or the systemic vasodilatory effects of anaphylaxis. Supportive measures such as positioning are important but must follow immediate administration of epinephrine.

A. Potassium replacement: Potassium replacement is essential in diabetic ketoacidosis (DKA) because insulin therapy drives potassium into cells, potentially causing hypokalemia. However, potassium correction is secondary; if the patient is severely dehydrated or hypotensive, fluid resuscitation takes priority to restore perfusion before potassium administration.

B. Dextrose infusion: Dextrose infusion is indicated later in DKA management when blood glucose drops to prevent hypoglycemia during insulin therapy. At a blood glucose of 540 mg/dL, dextrose is not indicated and would worsen hyperglycemia if given initially.

C. Fluid resuscitation: The patient presents with hyperglycemia, nausea, vomiting, and fruity breath, consistent with DKA. Hyperglycemia causes osmotic diuresis, leading to severe dehydration and hypovolemia. Restoring intravascular volume with isotonic fluids is the priority intervention to improve perfusion, prevent shock, and facilitate subsequent insulin therapy.

D. Insulin SQ: Insulin therapy is critical for correcting hyperglycemia and ketoacidosis. However, administering insulin before correcting volume depletion can worsen hypotension and compromise renal perfusion. Fluid resuscitation must precede insulin in the initial management of DKA.