The nurse assesses a client who has a possible gastritis. Which assessment findings indicates that, the client has chronic gastritis? (Select all that applies)

A. There are crackles audible throughout bilateral lung fields: The presence of crackles in both lungs indicates fluid overload and pulmonary edema, a life-threatening complication of hypertonic saline infusion. Rapid intervention, including slowing or stopping the infusion and notifying the healthcare provider, is necessary to prevent respiratory compromise.

B. The blood pressure increases from 120/80 to 142/94: A moderate rise in blood pressure may indicate increased intravascular volume from the hypertonic saline, but it is not immediately life-threatening. It requires monitoring but is less urgent than pulmonary edema.

C. There is slight sediment and blood in the client’s urine: Minor hematuria or sediment may indicate irritation or a pre-existing condition but does not require immediate action in the context of rapid sodium correction. Monitoring and follow-up are appropriate.

D. The client’s radial pulse is 105 beats/minute: Mild tachycardia can result from hypertonic fluid infusion or mild stress. While it warrants monitoring, it is not as urgent as the development of pulmonary edema, which can rapidly compromise oxygenation and perfusion.

A. Metoprolol (Lopressor) 12.5 mg orally daily: Beta-blockers like metoprolol can sometimes cause mild hyperkalemia, but they are not associated with significant potassium loss. This medication is unlikely to be the cause of the client’s hypokalemia.

B. Ibuprofen (Motrin) 400 mg every 6 hours: NSAIDs may cause fluid retention or hyperkalemia in some cases, but they are not known to lower potassium levels significantly. They are not the priority concern in this scenario.

C. Oral digoxin (Lanoxin) 0.25 mg daily: Digoxin toxicity risk increases significantly in the presence of hypokalemia. A serum potassium of 3.0 mEq/L greatly enhances the potential for digoxin-induced arrhythmias, making it critical to alert the healthcare provider immediately.

D. Lantus insulin 24 U subcutaneously every evening: Insulin promotes intracellular potassium shift, but long-acting insulin like Lantus given once daily is unlikely to cause acute hypokalemia. While monitoring is needed, it is not the most urgent concern compared with digoxin toxicity risk.