A nurse working in an emergency department is reviewing laboratory results of a client who is unconscious and has fruity odor to his breath. The nurse suspects diabetic ketoacidosis. Which of the following results should the nurse expect for this acid-base imbalance?

Bicarbonate 26 mEq/L

Serum pH 7.32

Creatinine 1.2 mg/dL

BUN 20 mg/dL

Answer and Explanation

The Correct Answer is B

A) Bicarbonate 26 mEq/L: A bicarbonate level of 26 mEq/L is within the normal range (22-28 mEq/L) and does not indicate metabolic acidosis, which is characteristic of diabetic ketoacidosis (DKA). In DKA, bicarbonate levels are usually decreased due to buffering of the excess acids.

B) Serum pH 7.32: A serum pH of 7.32 is indicative of acidemia, which is consistent with metabolic acidosis seen in DKA. The pH is typically lower than the normal range (7.35-7.45) in DKA due to the accumulation of ketoacids.

C) Creatinine 1.2 mg/dL: A creatinine level of 1.2 mg/dL is slightly elevated but does not specifically indicate metabolic acidosis. Elevated creatinine may suggest renal impairment but is not directly linked to the acid-base disturbance seen in DKA.

D) BUN 20 mg/dL: A blood urea nitrogen (BUN) level of 20 mg/dL is elevated and may indicate dehydration or kidney dysfunction but does not specifically diagnose the acid-base imbalance associated with DKA. In DKA, bicarbonate and pH levels are more directly affected.

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Correct Answer is D

Explanation

A) Drink 8 oz of milk when hypoglycemia develops:
While consuming a fast-acting carbohydrate is important during hypoglycemia, 8 oz of milk may not be the most effective choice. Typically, glucose tablets or juice are recommended as they provide a quicker absorption of sugar into the bloodstream.

B) Initiate a 1,400-calorie diet daily:
Caloric needs should be individualized based on the adolescent’s age, weight, activity level, and overall health. A fixed 1,400-calorie diet might not be appropriate for every adolescent and could lead to insufficient energy intake or excessive restriction.

C) Rotate the insulin injection site to a different area of the body with every other injection:
While rotating injection sites is important to prevent lipodystrophy, it is generally recommended to use different sites within the same area (such as different spots on the abdomen) rather than entirely different areas of the body with each injection. This ensures consistent absorption of insulin.

D) Keep unopened insulin refrigerated at 4.44° C (40° F):
Unopened insulin should be stored in the refrigerator to maintain its potency until it is ready to be used. This temperature range ensures the insulin remains stable and effective for use.

A. Fever B. Hypernatremia C. Hypertension D. Hypoglycemia

Correct Answer is B

Explanation

A) Fever: Myxedema coma is characterized by hypothermia rather than fever. The client with myxedema coma may experience a lowered body temperature, reflecting the severe hypothyroidism associated with this condition.

B) Hypernatremia: Hypernatremia, or elevated sodium levels, is a common finding in myxedema coma. This occurs due to impaired renal function and decreased aldosterone levels, leading to an imbalance in electrolytes, including sodium.

C) Hypertension: Typically, myxedema coma presents with hypotension rather than hypertension. The condition is associated with decreased cardiac output and low blood pressure, not elevated blood pressure.

D) Hypoglycemia: In myxedema coma, hypoglycemia is not typically expected. Instead, patients may experience hypoglycemia due to reduced metabolic rate and decreased glycogen stores. However, hyperglycemia is more commonly observed in other endocrine disorders, not specifically in myxedema coma.

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A nurse working in an emergency department is reviewing laboratory results of a client who is unconscious and has fruity odor to his breath. The nurse suspects diabetic ketoacidosis. Which of the following results should the nurse expect for this acid-base imbalance?

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