A client with type 2 diabetes normally achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the client has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment?

Stress has likely caused an increase in the client's blood sugar levels.

The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars.

The client has likely overstimulated her ability to control her diabetes using non-pharmacologic measures.

Alterations in bile metabolism and release have likely caused hyperglycemia.

Answer and Explanation

The Correct Answer is A

A. Stress has likely caused an increase in the client's blood sugar levels:
This statement is accurate. Stress, especially related to surgery, can lead to increased levels of stress hormones, such as cortisol and catecholamines, which can elevate blood sugar levels. Surgery is a physiological stressor that can impact glucose metabolism.

B. The client's volatile fluid balance surrounding surgery has likely caused unstable blood sugars:
This is the most appropriate choice. Surgery, anesthesia, and changes in fluid balance can affect blood glucose levels. The stress response to surgery can lead to fluctuations in blood sugar, and patients may need insulin during this period.

C. The client has likely overstimulated her ability to control her diabetes using non-pharmacologic measures:
This statement is not accurate. Overstimulation is not a common cause of the need for insulin in the context of surgery. The stress and physiological changes associated with surgery are more likely contributors.

D. Alterations in bile metabolism and release have likely caused hyperglycemia:
While alterations in metabolism can impact glucose regulation, in the context of surgery, the primary factors are the stress response, changes in fluid balance, and potential alterations in the ability to eat or drink normally rather than specific effects on bile metabolism.

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Correct Answer is B

Explanation

A. Metabolic Acidosis
Metabolic acidosis is characterized by a low pH and low bicarbonate (HCO3) level. In this case, the pH is low (indicating acidosis), but the bicarbonate level is within the normal range, which is inconsistent with metabolic acidosis.

B. Respiratory Acidosis
This is correct. Respiratory acidosis is characterized by an elevated partial pressure of carbon dioxide (PaCO2), leading to a decrease in pH. The ABG values in this case indicate elevated PaCO2 and a low pH, consistent with respiratory acidosis.

C. Metabolic Alkalosis
Metabolic alkalosis is characterized by a high pH and high bicarbonate (HCO3) level. In this case, the pH is low (indicating acidosis), which is inconsistent with metabolic alkalosis.

D. Respiratory Alkalosis
Respiratory alkalosis is characterized by a low partial pressure of carbon dioxide (PaCO2) and a high pH. In this case, the PaCO2 is elevated, which is inconsistent with respiratory alkalosis.

A. pH 7.28, pCO2 36, HCO3 23 B. pH 7.52, pCO2 28, HCO3 25 C. pH 7.25, pCO2 50, HCO3 22 D. pH7.35, pCO2 40, HCO3 24

Correct Answer is C

Explanation

A. pH 7.28, pCO2 36, HCO3 23:
Explanation: The pH is low, indicating acidosis. However, the pCO2 is within the normal range, which is not consistent with respiratory acidosis. The HCO3 is slightly low but not significantly, and this doesn't align with typical findings in respiratory acidosis.

B. pH 7.52, pCO2 28, HCO3 25:
Explanation: The pH is high, indicating alkalosis. The pCO2 is below the normal range, which is not consistent with respiratory acidosis. The HCO3 is within the normal range, and these values are not typical for respiratory acidosis.

C. pH 7.25, pCO2 50, HCO3 22:
Explanation: The pH is low, indicating acidosis. The pCO2 is elevated, which is typical in respiratory acidosis. The HCO3 is within the normal range, suggesting uncompensated respiratory acidosis.

D. pH 7.35, pCO2 40, HCO3 24:
Explanation: The pH is within the normal range, and both pCO2 and HCO3 are normal. These values do not indicate acidosis.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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