A nurse is providing care for a client who has diabetes mellitus. Which of the following laboratory findings indicates the client most likely to be diagnosed with diabetic ketoacidosis (DKA)?

A. Urinary urgency: Urinary urgency is not typically a primary symptom of renal calculi. While it can occur if the stone is near the bladder or if there is an associated urinary tract infection (UTI), it is not directly linked to the presence of kidney stones. The more common symptoms include pain and hematuria.
B. Flank pain: Flank pain is one of the hallmark symptoms of renal calculi. It occurs when the stone obstructs or irritates the renal pelvis or the ureter, causing intense pain. This pain typically radiates from the lower back or side toward the groin, depending on the stone's location. It is a significant indicator of renal calculi.
C. Gastrointestinal upset: Gastrointestinal upset can occur, but it is not specific to renal calculi. It may be a secondary symptom, such as nausea or vomiting, which can happen when pain from kidney stones is intense. However, gastrointestinal symptoms are not a primary diagnostic feature of renal calculi.
D. Fever: Fever can occur in the presence of renal calculi, especially if the stone causes an obstruction that leads to infection, such as a urinary tract infection or pyelonephritis. A fever is a sign that the infection has likely reached the kidneys, and it is a critical symptom to monitor.
E. Incontinence: Incontinence is not a typical symptom of renal calculi. While stones may cause discomfort or urgency, they do not generally lead to incontinence. Incontinence is more commonly associated with other urinary tract issues, such as infections or neurological disorders.

A. The glomerular filtration rate decreases because there is a reduction of blood flow to the kidneys:
Reduced renal perfusion causes prerenal acute kidney injury, not acute tubular necrosis (ATN). In ATN, the injury is intrarenal, specifically within the tubules, rather than being due to reduced blood flow to the kidneys.
B. The glomerular filtration rate decreases because there is obstruction leading to the filtration system backing up and eventually shutting the kidneys down: This describes postrenal acute kidney injury, typically due to obstruction in the urinary tract, such as stones or enlarged prostate. It is not the underlying mechanism in acute tubular necrosis, which is a type of intrarenal injury.
C. The glomerular filtration rate decreases because inflammatory cells invade the already damaged kidneys: While inflammation may be present in certain renal conditions, acute tubular necrosis primarily involves ischemic or toxic injury to tubular epithelial cells, not immune cell invasion. Inflammatory cell infiltration is more characteristic of interstitial nephritis.
D. The glomerular filtration rate decreases because there is injury to the renal tubular cells:
In acute tubular necrosis, the primary damage is to the tubular epithelial cells, leading to cellular death and sloughing. This impairs the kidney’s ability to reabsorb and filter properly, resulting in a drop in glomerular filtration rate due to tubular dysfunction and obstruction.