A nurse is caring for a client who has acute kidney injury (AKI). Which of the following arterial blood gas values would the nurse expect this client to have?

Choice A Reason: This choice is incorrect because oral hypoglycemic medications are not effective for treating DKA. Oral hypoglycemic medications are drugs that lower the blood glucose level by stimulating insulin secretion or increasing insulin sensitivity. They may be used for clients who have type 2 diabetes mellitus, but they do not work for clients who have type 1 diabetes mellitus or DKA.

Choice B Reason: This choice is correct because 0.9% sodium chloride IV bolus is an effective treatment for DKA. 0.9% sodium chloride is an isotonic solution that contains the same concentration of solutes as blood plasma. It may be used for clients who have fluid loss, dehydration, or shock. In DKA, the body breaks down fat for energy due to insulin deficiency or resistance, resulting in high levels of ketones and acids in the blood. This causes osmotic diuresis, dehydration, electrolyte imbalance, and metabolic acidosis. Therefore, administering 0.9% sodium chloride IV bolus can help to restore fluid volume and correct electrolyte imbalance.

Choice C Reason: This choice is incorrect because dextrose 5% in 0.45% sodium chloride is not indicated for treating DKA. Dextrose 5% in 0.45% sodium chloride is a hypertonic solution that contains more solutes than blood plasma. It may be used for clients who have hyponatremia, cerebral edema, or malnutrition, but it can worsen hyperglycemia and osmotic diuresis in clients who have DKA.

Choice D Reason: This choice is incorrect because glucocorticoid medications are not indicated for treating DKA. Glucocorticoid medications are drugs that mimic the effects of cortisol, a hormone that regulates stress response and inflammation. They may be used for clients who have allergic reactions, asthma, or autoimmune diseases, but they can increase blood glucose levels and inhibit insulin action in clients who have DKA.

Choice A Reason: This choice is incorrect because inserting a central line is not a priority action for a client who has a sucking chest wound. A central line is a catheter that is inserted into a large vein in the neck, chest, or groin to administer fluids, medications, or blood products. It may be indicated for clients who have hypovolemia, sepsis, or shock, but it does not address the underlying cause of the client's respiratory distress.

Choice B Reason: This choice is incorrect because removing the dressing to inspect the wound may worsen the client's condition. A sucking chest wound is an open wound in the chest wall that allows air to enter and exit the pleural cavity with each breath. This creates a positive pressure in the pleural space that collapses the lung on the affected side and shifts the mediastinum to the opposite side, impairing the ventilation and circulation of both lungs. Therefore, the nurse should apply an occlusive dressing that covers three sides of the wound and allows air to escape but not enter the pleural cavity. Removing the dressing may allow more air to enter and increase the risk of tension pneumothorax, which is a life-threatening complication.

Choice C Reason: This choice is correct because administering oxygen via nasal cannula may help to improve the client's oxygenation and ventilation. A nasal cannula is a device that delivers oxygen through two prongs that fit into the nostrils. It can provide oxygen at low flow rates (1 to 6 L/min) and low concentrations (24 to 44 percent). The nurse should monitor the client's respiratory rate, pulse oximetry, and arterial blood gases to assess the effectiveness of oxygen therapy.

Choice D Reason: This choice is incorrect because raising the foot of the bed to a 90° angle may worsen the client's respiratory distress. This position may increase the pressure on the diaphragm and reduce the lung expansion. It may also decrease the venous return and cardiac output, leading to hypotension and shock. Therefore, the nurse should position the client in a semi-Fowler's position (30 to 45° angle) or high-Fowler's position (60 to 90° angle) to facilitate breathing and prevent further complications.