The nurse is caring for a client who has developed metabolic alkalosis. Which intervention would be a priority for the nurse to implement?

In this scenario, the client is exhibiting signs of severe respiratory distress, which could indicate worsening acute heart failure and potential respiratory failure.

a. Check MAR for antianxiety medication: While anxiety may exacerbate the client's symptoms, the priority at this moment is to address the acute respiratory distress and ensure adequate oxygenation. Checking the medication administration record (MAR) for antianxiety medication can be done later but is not the immediate priority.

b. Ask when the dyspnea started: While obtaining a thorough history is important for understanding the onset and progression of the client's symptoms, it is not the first action to take in this critical situation. The client's current condition requires immediate intervention to ensure adequate oxygenation and stabilization.

c. Notify the provider: Notifying the provider is important, especially in a situation where the client's condition is deteriorating rapidly. However, this action may take some time, and the priority is to address the client's immediate needs first.

d. Increase oxygen from 3L/minute to 5L/minute: This is the most appropriate action to take first. The client is showing signs of severe respiratory distress with cyanosis and increased work of breathing. Increasing the oxygen flow rate from 3L/minute to 5L/minute can help improve oxygenation and alleviate hypoxemia, which is crucial in the management of acute heart failure exacerbation.

a. Warfarin: Warfarin is an anticoagulant medication used to prevent blood clot formation. While it is commonly prescribed for certain cardiac conditions such as atrial fibrillation or mechanical heart valves to prevent thromboembolic events, it does not directly improve the force of cardiac contraction. Therefore, warfarin is not the appropriate medication for improving cardiac contraction in a client with pulmonary edema.

b. Enalapril: Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used to manage hypertension and heart failure. While ACE inhibitors can help reduce preload and afterload on the heart, leading to improved cardiac function over time, they do not directly improve the force of cardiac contraction acutely. Therefore, enalapril is not the appropriate medication for improving cardiac contraction in a client with pulmonary edema.

c. Bumetanide: Bumetanide is a loop diuretic medication used to promote diuresis and reduce fluid overload in conditions such as heart failure and pulmonary edema. While reducing fluid overload can indirectly improve cardiac function by reducing preload on the heart, loop diuretics do not directly improve the force of cardiac contraction.

d. Dobutamine: Dobutamine is a positive inotropic medication that directly stimulates beta-1 adrenergic receptors in the heart, leading to increased myocardial contractility (force of cardiac contraction) and improved cardiac output. It is commonly used in the treatment of acute heart failure, including pulmonary edema, to enhance cardiac function and reduce symptoms of congestion.