Drugs do not metabolize the same way in all people. For what patient would a nurse expect to assess for an alteration in drug metabolism?

A) Increased calcium: Sympathetic activation typically does not cause a direct increase in calcium levels. Calcium levels are more influenced by factors like parathyroid hormone (PTH) and vitamin D, or conditions such as bone disease or renal issues. Although some stress responses can lead to changes in calcium metabolism, an increase in calcium is not a typical response to sympathetic activation.

B) Decreased sodium: While sodium imbalances can occur in various conditions, the sympathetic nervous system does not directly cause a decrease in sodium. The body's handling of sodium is more influenced by factors like kidney function and the renin-angiotensin-aldosterone system. Stress-related changes in sodium levels are less likely to cause a significant decrease in sodium, making this an unlikely focus in monitoring.

C) Decreased potassium: During stress, the body releases catecholamines (like epinephrine) as part of the sympathetic nervous response, which stimulates the movement of potassium into cells. This can result in a transient decrease in serum potassium levels (hypokalemia). Monitoring for decreased potassium is important, as low potassium can lead to cardiac arrhythmias and muscle weakness, which are particularly concerning after surgery or trauma.

D) Increased chloride: Chloride is typically maintained in balance with sodium, and while it may shift in certain conditions, sympathetic activation does not directly lead to increased chloride levels. Most chloride imbalances are secondary to changes in sodium, acid-base disturbances, or kidney function. Therefore, an increase in chloride is less likely in this scenario.

A) Decreased sweating, decreased BP, and increased heart rate: This combination does not reflect a typical stress response. In stressful or threatening situations, the body activates the sympathetic nervous system, leading to increased sweating, elevated blood pressure, and other physiological changes, rather than a decrease in blood pressure.
B) Increased sweating, decreased respiratory rate, and increased BP: In a stressful situation, sweating would indeed increase due to the activation of the sympathetic nervous system. However, the respiratory rate would typically increase, not decrease, as the body prepares for the "fight or flight" response. Increased blood pressure is expected, but decreased respiratory rate does not align with this response.
C) Pupil constriction, increased respiratory rate, and decreased heart rate: Pupil constriction is not characteristic of the "fight or flight" response; instead, pupil dilation occurs as part of the body's preparation to react to a threat. Increased respiratory rate and heart rate are typically seen during stress, but decreased heart rate would not be expected in such a situation.
D) Increased blood pressure, increased heart rate, and pupil dilation: This is the correct response. When faced with a threatening situation, the body activates the sympathetic nervous system, triggering the "fight or flight" response. This includes increased blood pressure and heart rate to prepare the body for action, as well as pupil dilation (mydriasis) to enhance vision and perception of the environment. These changes help the body respond quickly to a perceived danger.