A nurse is assessing a client who has type 1 diabetes mellitus and has a blood glucose level of 550 mg/dL. Which of the following should the nurse assess the client for if diabetic ketoacidosis (DKA) is suspected?
Dizziness
Nervousness
Mental status changes
Cool, clammy skin
The Correct Answer is C
Choice A reason: Dizziness can be a symptom of DKA due to dehydration; however, it is not as specific as mental status changes.
Choice B reason: Nervousness is not a specific symptom of DKA and can be related to high blood glucose levels rather than DKA itself.
Choice C reason: Mental status changes such as confusion or altered consciousness are significant indicators of DKA and require immediate medical atention.
Choice D reason: Cool, clammy skin is not typically associated with DKA; instead, DKA can present with dry skin and mouth due to dehydration.
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Related Questions
Correct Answer is ["B","C","D"]
Explanation
Choice A rationale: Potassium is primarily excreted by the kidneys. While adequate renal function is necessary, the standard minimum urine output for adults is 30 mL/hour rather than 1 mL/kg/hour.
Choice B rationale: Low potassium levels (2.5 mEq/L) require long-term management. Educating the client on potassium-rich foods like bananas and potatoes helps prevent future depletion and supports overall electrolyte balance.
Choice C rationale: Severe hypokalemia and rapid IV replacement increase the risk of lethal cardiac dysrhythmias. Continuous ECG monitoring is vital to detect life-threatening changes in cardiac conduction and rhythm.
Choice D rationale: Following intravenous replacement, serum levels must be re-evaluated to confirm the effectiveness of the treatment and ensure the client does not develop iatrogenic hyperkalemia.
Choice E rationale: Dextrose stimulates insulin secretion, which causes an intracellular shift of potassium. This can lead to a further decrease in serum potassium levels, worsening the client's hypokalemia.
Correct Answer is ["B","D","E","F"]
Explanation
Choice A reason: Frothy urine is not a typical symptom of pyelonephritis; it is more associated with proteinuria or nephrotic syndrome.
Choice B reason: Lower abdominal pain can be a symptom of pyelonephritis due to in?ammation and infection in the kidneys.
Choice C reason: Hypertension is not a direct symptom of pyelonephritis, although it can be associated with chronic kidney disease.
Choice D reason: A fish-type urine odor can be present in pyelonephritis due to the presence of bacteria.
Choice E reason: Mental confusion can occur, especially in severe cases or in elderly patients with pyelonephritis.
Choice F reason: A weak urine stream may be present if there is swelling or obstruction in the urinary tract due to infection.
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