The nurse is caring for a patient with multiple sclerosis (MS) who complains of fatigue. What does the nurse include in the care plan to teach the patient to reduce fatigue?

Rationale:

A. Ertugliflozin is an SGLT2 inhibitor, which increases glucose excretion in the urine and naturally increases urinary output (polyuria). Fluid restriction is not recommended, as it can worsen dehydration, hypotension, or electrolyte imbalance. Adequate hydration is important.

B. Ertugliflozin typically causes mild reductions in blood pressure due to osmotic diuresis and natriuresis. Hypertension is not a common adverse effect.

C. SGLT2 inhibitors increase urinary glucose excretion, which creates an environment conducive to genital fungal infections (candidiasis). Patients should be taught to: Monitor for itching, discharge, redness, or discomfort, report symptoms promptly and practice good hygiene to help prevent infections

D. SGLT2 inhibitors may actually cause mild diuresis and volume loss, not fluid retention. Swelling or edema is not expected and should be evaluated if it occurs, as it may indicate another condition.

Rationale:

A. There is no evidence of airway obstruction, secretion retention, or respiratory compromise in the assessment findings. Although acetone breath is present, it is a metabolic odor from ketones, not an indication of airway compromise. This diagnosis does not address the most urgent physiologic risk.

B. While dry skin and poor turgor are noted, these are symptoms of dehydration, not acute skin breakdown. Skin integrity issues are a secondary concern, not the immediate priority.

C. Although acetone breath suggests ketone accumulation, there is no evidence of hypoxia, cyanosis, or respiratory distress. The client may have compensatory Kussmaul respirations (deep, rapid breathing) due to metabolic acidosis, but gas exchange is not the primary threat at this stage.

D. The client exhibits classic signs of severe dehydration: Polyuria, polydipsia, polyphagia – signs of uncontrolled hyperglycemia (likely diabetic ketoacidosis), Orthostatic hypotension – indicates decreased intravascular volume, Dry, warm skin with poor turgor – indicates fluid loss from the extracellular compartment

Fluid replacement is the highest priority intervention, as hypovolemia can lead to shock, organ hypoperfusion, and death. Immediate IV fluids (typically isotonic saline) are essential before insulin therapy, to restore circulation and correct electrolyte imbalances safely.