A nurse in an emergency department is caring for a client who has diabetic ketoacidosis (DKA) and a blood glucose level of 925 mg/dL. The nurse should anticipate which of the following prescriptions from the provider?

Choice A: Drainage of clear fluid from the ears is not an expected finding for a client who has an epidural hematoma, but rather a sign of a basilar skull fracture, which is a different type of head injury. The clear fluid is cerebrospinal fluid (CSF), which leaks from the brain through the fractured skull.

Choice B: Alternating periods of alertness and unconsciousness is an expected finding for a client who has an epidural hematoma, because it indicates a rapid increase in intracranial pressure (ICP) due to bleeding between the dura mater and the skull. The client may have a brief loss of consciousness at the time of injury, followed by a lucid interval, and then a rapid deterioration of mental status.

Choice C: Narrowing pulse pressure is not an expected finding for a client who has an epidural hematoma, but rather a sign of increased ICP due to any cause. Pulse pressure is the difference between systolic and diastolic blood pressure. As ICP rises, it compresses the brainstem and causes bradycardia and hypertension, resulting in a decreased pulse pressure.

Choice D: Extensive bruising in the mastoid area is not an expected finding for a client who has an epidural hematoma, but rather a sign of a basilar skull fracture, which is a different type of head injury. The bruising is also known as Batle's sign, and it occurs due to blood pooling behind the ear.

Choice A Reason: This choice is correct because verifying the prescribed ventilator settings daily is an important intervention to ensure that the client is receiving adequate ventilation and oxygenation. The ventilator settings include parameters such as tidal volume, respiratory rate, fraction of inspired oxygen (FiO2), positive end-expiratory pressure (PEEP), and peak inspiratory pressure (PIP). The nurse should check that the settings match the prescription and report any changes or alarms to the provider.

Choice B Reason: This choice is incorrect because applying restraints if the client becomes agitated is not a recommended intervention to prevent complications. Restraints may cause injury, infection, or psychological distress to the client and increase the risk of ventilator-associated pneumonia (VAP). The nurse should use alternative methods to manage agitation, such as sedation, analgesia, or environmental modification.

Choice C Reason: This choice is correct because administering pantoprazole as prescribed is an important intervention to prevent complications. Pantoprazole is a proton pump inhibitor (PPI) that reduces the production of stomach acid and prevents gastroesophageal reflux disease (GERD) and stress ulcers. These conditions can cause aspiration, bleeding, or infection in clients who are receiving mechanical ventilation.

Choice D Reason: This choice is incorrect because repositioning the endotracheal tube to the opposite side of the mouth daily is not a recommended intervention to prevent complications. Repositioning the endotracheal tube may cause trauma, bleeding, or displacement of the tube, which can compromise the airway and ventilation of the client. The nurse should secure the tube with tape or a device and check its position regularly using chest x-ray or end-tidal CO2 monitoring.

Choice E Reason: This choice is correct because elevating the head of the bed to at least 30° is an important intervention to prevent complications. Elevatin the head of the bed helps to reduce the risk of aspiration, which is the inhalation of gastric contents or secretions into the lungs. Aspiration can cause pneumonia, atelectasis, or respiratory failure in clients who are receiving mechanical ventilation.