A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus. The nurse determines that teaching has been effective when the client identifies which of the following manifestations of hypoglycemia? (Select all that apply.)

Choice A reason: Phosphate 5.7 mg/dL is an elevated value, as the normal range is 2.5 to 4.5 mg/dL. Hypoparathyroidism causes low levels of parathyroid hormone (PTH), which regulates calcium and phosphorus balance in the body. Low PTH leads to low calcium and high phosphorus levels in the blood.

Choice B reason: Vitamin D 25 ng/mL is a normal value, as the normal range is 20 to 50 ng/mL. Hypoparathyroidism does not directly affect vitamin D levels, but vitamin D supplements may be given to help increase calcium absorption and lower phosphorus levels in the blood.

Choice C reason: Calcium 9.8 mg/dL is a normal value, as the normal range is 8.6 to 10.2 mg/dL. Hypoparathyroidism causes low levels of parathyroid hormone (PTH), which regulates calcium and phosphorus balance in the body. Low PTH leads to low calcium and high phosphorus levels in the blood. However, calcium levels may be normal or near- normal in some cases of hypoparathyroidism, especially if the condition is mild or well-controlled with treatment.

Choice D reason: Magnesium 1.8 mEq/L is a normal value, as the normal range is 1.5 to 2.5 mEq/L. Hypoparathyroidism does not directly affect magnesium levels, but magnesium deficiency can cause or worsen hypoparathyroidism, as magnesium is needed for PTH secretion and action. Magnesium supplements may be given to correct magnesium deficiency and improve PTH function.

Choice A: Weigh the client weekly. This is incorrect because the client receiving PN should be weighed daily, not weekly, to monitor fluid balance and nutritional status. The nurse should also measure the client’s intake and output, blood glucose, electrolytes, and other laboratory values daily.

Choice B: Reduce the rate of the solution gradually to discontinue. This is correct because the nurse should taper off the PN solution slowly to prevent rebound hypoglycemia, which can occur when the high concentration of glucose in the PN solution is abruptly stopped. The nurse should follow the provider’s orders or the facility’s protocol for reducing and discontinuing PN.

Choice C: Remove solution from refrigerator 2 hr before infusion. This is incorrect because the nurse should remove the PN solution from the refrigerator 30 to 60 minutes before infusion, not 2 hr, to allow it to reach room temperature. Infusing a cold solution can cause discomfort, vasoconstriction, and impaired absorption of nutrients.

Choice D: Shake the solution before hanging if there is a layer of fat present on the top. This is incorrect because the nurse should not shake the PN solution at all, as this can cause fat emulsion droplets to coalesce and form large particles that can clog the filter or cause embolism. The nurse should gently invert or roll the PN solution container to mix it if there is any separation of components.