The nurse is preparing to administer sodium polystyrene sulfonate (Kayexalate) rectally to a patient with an irregular pulse and weakness of the lower extremities.
What laboratory finding does the nurse determine is the reason for this treatment?

Choice A rationale

Monitoring blood glucose levels more frequently is critical when a client with type 1 diabetes is taking prednisone, as corticosteroids can raise blood glucose levels and potentially cause hyperglycemia.

Choice B rationale

Increasing sodium intake is not recommended for clients with type 1 diabetes and is unrelated to the management of prednisone-induced hyperglycemia.

Choice C rationale

Stopping all other diabetes medications is inappropriate and can lead to uncontrolled blood glucose levels. Adjustments may be needed, but discontinuation is not advised without medical supervision.

Choice D rationale

Skipping meals to prevent hyperglycemia is not a safe practice for clients with type 1 diabetes. Maintaining a balanced diet and monitoring blood glucose levels is essential.

Condition: Myocardial infarction.

2 actions:

Administer oxygen via nasal cannula 2 L/min,

Request a prescription for aspirin 325 mg.

2 parameters:

Vital signs,

Electrocardiogram (ECG) rhythm.

Rationale for correct condition: A myocardial infarction is indicated by the elevated troponin levels and ST elevation on the ECG. The client’s symptoms of chest pain, elevated heart rate, and low oxygen saturation support this diagnosis. Prompt identification and treatment are crucial to minimize heart damage. The medical history of hypertension and coronary artery disease increases the likelihood. Immediate interventions can significantly improve outcomes.

Rationale for actions: Administer oxygen to improve oxygenation and reduce myocardial workload. Requesting aspirin helps prevent further clot formation. Morphine alleviates pain but may obscure symptoms, making it less urgent. Nitroglycerin relieves chest pain by vasodilation but is secondary. Verapamil is less immediate for acute myocardial infarction management. Vital signs reflect hemodynamic status and response to treatment. ECG rhythm detects ongoing ischemia or arrhythmias. Monitoring WBC count is less relevant acutely. Platelet count is stable; not the focus in immediate management.

Rationale for parameters: Vital signs ensure hemodynamic stability and detect hypotension or shock. ECG rhythm monitors arrhythmias and ongoing ischemia, critical in myocardial infarction. WBC count indicates infection or inflammation, less immediate concern. Platelet count is important for bleeding risks but less immediate. Chronic stable angina presents with predictable, non-severe pain. Ischemic stroke symptoms differ; focus on neurological deficits. Cardiogenic shock would present with more severe hypotension and signs of organ failure.