The nurse is triaging a client with type 1 diabetes mellitus who presented to the emergency department with increased lethargy and Kussmaul respirations. A blood glucose test reveals a level of 525 mg/dL (28 mmol/L). Which laboratory results are consistent with diabetic ketoacidosis (DKA)?

Reference Ranges

Blood Glucose [74 to 106 mg/dL (4.1 to 5.9 mmol/L)]

pH [7.35 to 7.45]

HCO3- [21 to 28 mEq/L (21 to 28 mmol/L)]

Arterial blood pH 7.5 and bicarbonate level 32 mEq/L (32 mmol/L).

Arterial blood pH 7.42 and bicarbonate level 18 mEq/L (18 mmol/L).

Arterial blood pH 7.25 and bicarbonate level 10 mEq/L (10 mmol/L).

Arterial blood pH 7.38 and bicarbonate level 29 mEq/L (29 mmol/L).

Answer and Explanation

The Correct Answer is C

DKA is a serious complication of diabetes mellitus characterized by hyperglycemia, ketosis, and metabolic acidosis. The laboratory results consistent with DKA include:

Elevated blood glucose level: A blood glucose level of 525 mg/dL (28 mmol/L) is significantly elevated and consistent with DKA.

Low arterial blood pH: A decreased arterial blood pH indicates acidosis, which is characteristic of DKA. Normal arterial blood pH ranges from 7.35 to 7.45.

Low bicarbonate (HCO3-) level: A low bicarbonate level indicates metabolic acidosis, which is also characteristic of DKA. Normal bicarbonate levels range from 21 to 28 mEq/L (21 to 28 mmol/L).

Among the options provided:

A) Arterial blood pH 7.5 and bicarbonate level 32 mEq/L (32 mmol/L):

This pH and bicarbonate level are indicative of alkalosis, which is not consistent with DKA.

B) Arterial blood pH 7.42 and bicarbonate level 18 mEq/L (18 mmol/L):

This pH is within the normal range, and the bicarbonate level is slightly decreased but not indicative of metabolic acidosis consistent with DKA.

C) Arterial blood pH 7.25 and bicarbonate level 10 mEq/L (10 mmol/L):

Correct. This pH is decreased, indicating acidosis, and the bicarbonate level is significantly below the normal range, consistent with metabolic acidosis characteristic of DKA.

D) Arterial blood pH 7.38 and bicarbonate level 29 mEq/L (29 mmol/L):

While the pH is within the normal range, the bicarbonate level is elevated, which is not consistent with metabolic acidosis seen in DKA.

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Correct Answer is C

Explanation

Smoking is a well-established risk factor for lung cancer, and the pathophysiological process underlying this association involves the exposure of the lungs to carcinogenic agents present in tobacco smoke. Here's why option C is the correct choice:

A) Vasoconstrictive properties of nicotine reduce oxygenation and stimulate metabolism:

While nicotine is a primary addictive component of tobacco smoke and can lead to vasoconstriction, reduced oxygenation, and increased metabolism, these effects primarily contribute to cardiovascular diseases associated with smoking, such as coronary artery disease and stroke, rather than the development of lung cancer.

B) Drug addiction changes the neurochemical messages in the brain causing cravings:

This statement addresses the addictive nature of nicotine and its impact on neurochemistry, leading to cravings and dependence. While addiction is a significant aspect of tobacco use, it does not directly explain the pathophysiological process by which smoking causes lung cancer.

C) Carcinogenic agents in tobacco alter cellular cytology, morphology, and function of the lung:

Correct. Tobacco smoke contains numerous carcinogenic compounds, such as polycyclic aromatic hydrocarbons (PAHs), nitrosamines, and benzene, which can directly damage the DNA of lung cells. This DNA damage can lead to mutations and alterations in cellular cytology, morphology, and function, ultimately contributing to the development of lung cancer.

D) Risk for comorbidities increase incidence of chronic diseases and decrease longevity:

While smoking is associated with an increased risk of various comorbidities and chronic diseases, such as cardiovascular diseases, respiratory diseases, and certain cancers, this option does not specifically address the pathophysiological process of lung cancer development.

A. Myocardial infarction one year ago. B. Occasional use of antacids. C. Chronic renal insufficiency. D. Shortness of breath with exertion.

Correct Answer is C

Explanation

A. Myocardial infarction one year ago:

A myocardial infarction (MI) that occurred one year ago is not directly related to the current acid-base imbalance described in the scenario. While a history of MI may have implications for the client's overall cardiovascular health and management, it is not the most likely cause of the acid-base imbalance indicated by the laboratory results.

B. Occasional use of antacids:

Occasional use of antacids is unlikely to cause the acid-base imbalance described in the scenario. Antacids primarily work by neutralizing gastric acid and are not typically associated with significant alterations in acid-base status, especially when used intermittently.

C. Chronic renal insufficiency:

Chronic renal insufficiency is the most likely cause of the acid-base imbalance indicated by the laboratory results. A low hemoglobin level suggests anemia, which can occur in chronic kidney disease due to decreased erythropoietin production. An elevated creatinine clearance indicates impaired kidney function, as the kidneys are clearing creatinine at a faster rate than normal. Decreased urine specific gravity suggests the kidneys' inability to concentrate urine properly, which is a common finding in renal insufficiency. Renal insufficiency can lead to metabolic acidosis due to the kidneys' decreased ability to excrete acid and regulate bicarbonate levels.

D. Shortness of breath with exertion:

Shortness of breath with exertion, a symptom commonly seen in COPD exacerbations, is unlikely to directly cause the acid-base imbalance described in the scenario. While respiratory distress can lead to respiratory acidosis, which is characterized by elevated carbon dioxide levels and decreased pH, the laboratory results indicate metabolic rather than respiratory acidosis.

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