The nurse prepares to administer regular insulin to a diabetic client whose blood glucose level is 950.

The provider prescribed regular insulin 1 unit/hr intravenously.

Regular insulin is available in a bag containing 10 units of regular insulin in 100 mL solution.

How many milliliters per hour should the nurse set the intravenous pump? Round answer to the nearest whole number.

Evaluating a cervical spine injury for neurogenic shock requires knowledge of autonomic nervous system disruption. Specifically, loss of sympathetic tone below the level of injury must be identified. Differentiating neurogenic shock from spinal shock involves assessing hemodynamic parameters and thermoregulation.

Choice A rationale

Neurogenic shock involves loss of sympathetic vascular tone, causing massive vasodilation and hypotension. Unchecked parasympathetic activity leads to bradycardia. Normal heart rate is 60 to 100. Warm, pink skin results from peripheral blood pooling due to vasodilation.

Choice B rationale

Hyperactive reflexes are characteristic of the later stages of spinal cord injury after spinal shock resolves. They do not indicate the acute hemodynamic collapse seen in neurogenic shock, which specifically targets the cardiovascular regulatory systems.

Choice C rationale

Loss of sensation and movement defines spinal shock or the initial cord injury itself. While present in neurogenic shock, these findings are not specific to the autonomic failure that characterizes the life-threatening hemodynamic instability of shock.

Choice D rationale

Spasticity occurs due to upper motor neuron damage after the initial period of areflexia. This is a chronic or subacute finding and is not associated with the acute cardiovascular distributive failure seen in neurogenic shock.

This question requires knowledge of acid-base balance and pathophysiology of chronic kidney disease. Understanding how impaired renal function leads to metabolic acidosis through decreased hydrogen ion excretion and reduced bicarbonate regeneration is essential to identify the correct values.

Choice A rationale

A pH of 7.55 and HCO3 of 30 indicate metabolic alkalosis. Normal pH is 7.35 to 7.45 and HCO3 is 22 to 28 mEq/L. Renal failure typically results in acid accumulation, not excess base.

Choice B rationale

A pH of 7.30 and PaCO2 of 50 indicate respiratory acidosis. In renal failure, the lungs typically compensate for metabolic acid by hyperventilating to lower PaCO2, which is the opposite of the hypoventilation shown here.

Choice C rationale

A pH of 7.50 and PaCO2 of 32 indicate respiratory alkalosis. This state occurs when the patient hyperventilates excessively, leading to an alkaline pH, which does not align with the metabolic acidosis expected in renal disease.

Choice D rationale

Chronic kidney disease causes metabolic acidosis. A pH of 7.25 and HCO3 of 19 mEq/L demonstrate low pH and low bicarbonate. The PaCO2 of 30 mm Hg reflects respiratory compensation for the primary metabolic acid-base imbalance.