The nurse is reviewing the client's medical record.

A nurse is reviewing the client's diagnostic results and vital signs. Which of the following actions should the nurse take? Select all that apply.

A. A palpable thrill at the fistula site: A palpable thrill is a normal finding that indicates proper blood flow through the arteriovenous fistula. The absence of a thrill would be concerning, as it may suggest clotting or dysfunction of the vascular access.

B. Hyperglycemia: Hemodialysis does not typically cause hyperglycemia. Clients with diabetes may experience fluctuations in blood glucose levels, but dialysis itself is more commonly associated with hypoglycemia due to the removal of glucose from the bloodstream.

C. Altered mental status: Neurological changes such as confusion, restlessness, or decreased responsiveness may indicate dialysis disequilibrium syndrome (DDS). This complication results from rapid fluid and solute shifts, leading to cerebral edema. It is a serious condition requiring immediate intervention.

D. Decrease in weight: A decrease in weight following hemodialysis is expected due to fluid removal. Clients are weighed before and after dialysis to monitor fluid balance, and weight loss after treatment indicates effective fluid removal rather than a complication.

• Anticipate client to be prepped for cardiac catheterization: Given the client's diagnosis of myocardial infarction and persistent chest pain, cardiac catheterization may be necessary for evaluating coronary artery patency and determining the need for potential interventions such as angioplasty or stenting. Prepping the client for this procedure is appropriate.
• Assist with a continuous heparin infusion: Heparin is often used in acute coronary syndrome management to prevent thrombus formation and reduce the risk of further myocardial injury. Initiating a continuous heparin infusion may be indicated following an assessment of the client’s condition and provider orders.
• Encourage the client to ambulate: While early ambulation is important for recovery and preventing complications, in the acute phase of a myocardial infarction, clients should be closely monitored and may require bed rest initially. Encouraging ambulation should only occur once the client is stable and after consulting with the healthcare provider.
• Anticipate an increased dosage of metoprolol: Metoprolol is typically administered to manage heart rate and blood pressure, but the dosage should be based on the client’s current vital signs and response to treatment. If the client’s heart rate remains elevated or if there are signs of ongoing ischemia, an increased dosage may be necessary, but this should be based on provider orders rather than an automatic assumption.
• Obtain a prescription for client to be NPO: Clients scheduled for procedures such as cardiac catheterization often require NPO status to prevent aspiration during sedation. Additionally, if the client is experiencing nausea, keeping them NPO can prevent further complications.
• Request a prescription for an antibiotic: There is no indication of an infection or a need for antibiotic therapy. Antibiotics are typically not indicated for the management of myocardial infarction unless there is a concurrent infection. Therefore, requesting an antibiotic prescription is not appropriate.