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 A

Explanation

A) Fatigue and weakness:

Correct. The client's hemoglobin and hematocrit levels are below the reference ranges, indicating mild anemia. Anemia, characterized by low red blood cell count or hemoglobin levels, can lead to symptoms such as fatigue, weakness, and shortness of breath, as the body's oxygen-carrying capacity is reduced. Fatigue and weakness are common manifestations of anemia and are indicative of tissue hypoxia due to decreased oxygen delivery.

B) Cardiac dysrhythmias:

While severe anemia can lead to cardiac complications, such as dysrhythmias, the client's hemoglobin and hematocrit levels are only slightly below the reference ranges, indicating mild anemia. Cardiac dysrhythmias are more commonly associated with severe anemia or acute changes in hemoglobin levels rather than the mild anemia indicated in this scenario.

C) Fever and infection:

Anemia is not typically associated with fever and infection. While anemia may occur secondary to chronic inflammatory conditions or certain infections, the client's symptoms of fatigue and weakness are more directly related to the decreased oxygen-carrying capacity of the blood due to mild anemia.

D) Decreased clotting time:

Anemia is not directly associated with changes in clotting time. While severe anemia can lead to alterations in platelet function and clotting factors, the client's hemoglobin and hematocrit levels are only slightly below the reference ranges, indicating mild anemia. Decreased clotting time is not a typical manifestation of mild anemia.

A. Herpes simplex virus. B. Vulvovaginitis. C. Human papillomavirus (HPV). D. Chronic yeast infections.

Correct Answer is C

Explanation

A. Herpes simplex virus:

While herpes simplex virus (HSV) infection is a sexually transmitted infection that can cause genital ulcers and lesions, it is not directly associated with an increased risk of cervical cancer. However, individuals with genital herpes may have an increased risk of acquiring human papillomavirus (HPV), which is a significant risk factor for cervical cancer.

B. Vulvovaginitis:

Vulvovaginitis refers to inflammation or infection of the vulva and vagina and can be caused by various factors, including bacterial, fungal, or viral infections. While chronic inflammation or infection may contribute to cellular changes in the cervix, it is not a direct risk factor for cervical cancer.

C. Human papillomavirus (HPV):

Human papillomavirus (HPV) infection is the most significant risk factor for developing cervical cancer. Certain high-risk strains of HPV, particularly HPV types 16 and 18, are strongly associated with the development of cervical dysplasia and cervical cancer. Persistent infection with high-risk HPV strains can lead to cellular changes in the cervix, eventually progressing to cervical cancer.

D. Chronic yeast infections:

Chronic yeast infections, also known as recurrent vulvovaginal candidiasis, are caused by the overgrowth of Candida species in the vaginal area. While chronic yeast infections can cause discomfort and recurrent symptoms, they are not directly linked to an increased risk of cervical cancer. However, chronic irritation or inflammation in the genital area may increase the susceptibility to other infections, including HPV.

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