An older client with dementia who is refusing to allow an unlicensed assistive personnel (UAP) bathe her is becoming increasingly agitated and stating the UAP wants to hurt her and tie her up. Which approach should the nurse use with the client?​​​​​​

Choice A rationale:

Correcting electrolytes that are out of normal range is a crucial goal of therapy for this client. In diabetic ketoacidosis (DKA), the body’s cells are unable to use glucose for energy due to a lack of insulin. This leads to the breakdown of fat for energy, producing ketones as a by-product. Ketones are acidic and can cause the blood’s pH to decrease, leading to metabolic acidosis. This process also leads to an increased production and excretion of electrolytes such as potassium and sodium. Therefore, correcting these electrolyte imbalances is a key goal of therapy.

Choice B rationale:

While promoting oxygenation to tissues is generally important in critical care, it is not a specific goal in the management of DKA. The primary issues in DKA are metabolic in nature, including hyperglycemia, ketosis, and acidosis.

Choice C rationale:

Preventing hyperventilation is not a specific goal in the management of DKA. Hyperventilation in DKA is a compensatory mechanism for metabolic acidosis (Kussmaul breathing). The body tries to expel more carbon dioxide to reduce the acidity of the blood.

Choice D rationale:

Reversing dehydration is another important goal of therapy for this client. In DKA, high blood glucose levels lead to osmotic diuresis, where water is drawn into the urine from the blood, leading to dehydration. This can cause hypotension and reduced tissue perfusion. Therefore, reversing dehydration through fluid replacement is a key part of treatment.

Choice E rationale:

Replacing insulin is a fundamental goal of therapy for this client. Insulin deficiency is the primary cause of DKA. Insulin allows glucose to enter cells where it can be used for energy, preventing the breakdown of fat for energy and the subsequent production of ketones.

Choice F rationale:

Providing respiratory support may be necessary in severe cases of DKA where the patient’s compensatory respiratory efforts are insufficient to maintain adequate gas exchange. However, it is not one of the primary goals of therapy in DKA management.

Choice A rationale:

"Phobias are characterized by persistent and irrational fear" (Choice A) is an accurate statement. Phobias are defined by the presence of an intense and irrational fear of a specific object or situation. This fear is persistent and often leads to avoidance behaviors, which can significantly impact the individual's daily life.

Choice B rationale:

"Phobias can be caused by biological factors only" (Choice B) is an inaccurate statement. Phobias can have various causes, including both biological and psychological factors. While there may be genetic predispositions to certain phobias, psychological factors, such as traumatic experiences or learned behaviors, can also contribute to the development of phobias.

Choice C rationale:

"Phobias can be diagnosed based on physical symptoms" (Choice C) is an inaccurate statement. Phobias are typically diagnosed based on the individual's reported symptoms, such as intense fear and avoidance behaviors. There are no specific physical symptoms that directly indicate the presence of a phobia.

Choice D rationale:

"Phobias can be managed with medication alone" (Choice D) is an inaccurate statement. Medication alone is not considered the primary treatment for phobias. While medications like selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines may be prescribed to alleviate anxiety symptoms, the most effective treatment for phobias is psychotherapy, particularly exposure therapy or cognitive-behavioral therapy. These therapies address the root causes of the phobia and help individuals learn to manage their fear.