The physician orders an opioid analgesic for a client with a traumatic injury. The nurse would monitor the client closely for which of the following as the priority

Compartment syndrome is a surgical emergency where increased interstitial pressure within a closed fascial space compromises neurovascular perfusion. This leads to muscle ischemia and eventual necrosis if the pressure is not relieved via an emergent fasciotomy. The hallmark clinical sign is pain out of proportion to the injury that is not relieved by standard analgesic medications.

A. Arrange for a STAT assessment of the client's serum calcium levels: Calcium imbalances can cause muscular tetany but are not the underlying cause of compartment hypertension following a traumatic fracture. Monitoring electrolytes does not address the mechanical obstruction of blood flow within the humeral muscle groups. This action delays the critical intervention needed to salvage the limb from ischemic death.

B. Perform active range of motion exercises: Attempting to move the affected limb increases the pressure within the compartment and exacerbates the ischemic pain. Passive stretching of the muscles is used as a diagnostic test to elicit pain, but active exercise is contraindicated. Physical exertion during a suspected vascular crisis further depletes the minimal oxygen available to the dying tissues.

C. Contact the primary provider immediately: The nurse must provide a rapid notification because the window for tissue salvage is typically less than 6 hours. This allows the surgeon to perform a fasciotomy to decompress the area and restore arterial and venous circulation. Delaying this communication can result in permanent nerve damage, Volkmann's contracture, or the need for amputation.

D. Assess the client's joint function symmetrically: While bilateral assessment is a standard nursing practice, it is a secondary priority when the clinical symptoms of compartment syndrome are already present. Symmetrical comparison will confirm the deficit but does not alter the immediate need for surgical consultation. The nurse should focus on documenting paresthesia and pulselessness while awaiting the provider’s arrival.

The timing of a snack for a client on NPH insulin must correspond with the medication's peak action time to prevent hypoglycemia. Since NPH is an intermediate-acting insulin, its maximal effect typically occurs 4 to 12 hours after the subcutaneous injection. Providing a complex carbohydrate and protein snack during this window ensures that exogenous glucose is available to offset the nadir in blood sugar.

A. 0730: This is only 30 minutes after the injection, a time when NPH has not yet begun to exert a significant clinical effect. The onset of NPH occurs approximately 1.5 to 4 hours after administration. A snack at this time would likely cause transient hyperglycemia without serving its intended protective purpose during the insulin peak.

B. 0900: At 2 hours post-injection, the NPH is just beginning its onset of action and is far from its maximal glucose-lowering capacity. Monitoring for hypoglycemic symptoms usually begins later in the morning. Offering a snack this early does not provide the necessary metabolic buffer required during the late afternoon when the insulin concentration is highest.

C. 1500: This time is 8 hours after the 0700 dose, placing it directly within the 4 to 12-hour peak window of NPH insulin. A mid-afternoon snack is essential to counteract the strongest insulin effect and prevent a drop in plasma glucose. This timing is a standard intervention in diabetic care to maintain glycemic stability throughout the day.

D. 1230: While 5.5 hours after the dose is approaching the peak, 1500 is a more appropriate time to cover the sustained peak of intermediate insulin. Many patients eat lunch around 1230, which provides some glucose, but an additional snack at 1500 is often needed. The pharmacodynamic duration of NPH necessitates coverage well into the late afternoon.