A nurse is caring for a client who is 12 hr postoperative and has a chest tube to a disposable water-seal drainage system with suction. The nurse should intervene for which of the following observations?

A. "Test your blood glucose level every 8 hours.": This is incorrect. During illness, blood glucose levels should be checked more frequently, typically every 2 to 4 hours, to closely monitor for hyperglycemia and prevent diabetic ketoacidosis (DKA). Checking every 8 hours may not be frequent enough, especially if the client is ill or experiencing stress, both of which can affect blood sugar.
B. "Check your urine for ketones when blood glucose levels are greater than 240 mg/dL.": This is the correct instruction. When blood glucose levels exceed 240 mg/dL, it is important to check for ketones in the urine. The presence of ketones can indicate the development of DKA, and early detection can prevent the condition from worsening.
C. "Withhold your usual daily dose of insulin.": This is incorrect. Insulin should never be withheld during periods of illness unless specifically instructed by a healthcare provider. Withholding insulin can increase the risk of DKA, as the body will continue to break down fat for energy in the absence of insulin, leading to ketosis.
D. "Drink 240 to 360 milliliters of calorie-free liquids every 8 hours.": This is not entirely correct. While staying hydrated is important, the recommendation is generally to drink more frequently, ideally 8 ounces of fluid every hour to stay well-hydrated. It is also recommended to drink fluids that contain some carbohydrates (such as electrolyte-containing drinks) to help manage blood glucose levels during illness.

A. A peak flow of more than 40% would indicate that the patient's asthma is not in an acute exacerbation. This patient's symptoms, such as confusion and inability to speak, suggest a severe asthma attack, and the peak flow would likely be much lower.
B. Bradycardia is not typically associated with severe asthma exacerbations. Tachycardia is more commonly observed as the body attempts to compensate for hypoxia.
C. Loud and prominent wheezing is usually seen in less severe cases of asthma. In this case, the inability to speak and confusion suggest severe respiratory distress, where wheezing might be diminished or absent due to poor air movement.
D. Deteriorating arterial blood gas (ABG) results, with low oxygen levels (hypoxemia) and elevated carbon dioxide levels (hypercapnia), would be expected in a patient with severe asthma exacerbation. These signs indicate respiratory failure and the need for urgent intervention.