The nurse would assess for which clinical manifestations in a client suspected of having diabetic ketoacidosis? (Select all that apply)

Glucose level at least 600 mg/dL

Fruity, acetone smell to the breath

Absence of ketones in the urine

Polyuria and polydipsia

Rapid, deep breathing.

Answer and Explanation

Correct Answer : B,D,E

Choice A Reason:
A glucose level of at least 600 mg/dL is more indicative of hyperglycemic hyperosmolar state (HHS) rather than diabetic ketoacidosis (DKA). While both conditions involve high blood sugar levels, DKA is typically characterized by blood glucose levels that are high but not as extreme as those seen in HHS1.

Choice B Reason:
A fruity, acetone smell to the breath is a classic sign of DKA. This odor is due to the presence of ketones, particularly acetone, which is exhaled. It’s one of the key clinical manifestations that can help in the diagnosis of DKA.

Choice C Reason:
The absence of ketones in the urine would not be consistent with a diagnosis of DKA. One of the hallmarks of DKA is the presence of ketones in the urine, resulting from the breakdown of fats due to a lack of insulin.

Choice D Reason:
Polyuria (excessive urination) and polydipsia (excessive thirst) are symptoms of DKA. They occur as the body tries to eliminate excess glucose through the urine, which can lead to dehydration and the need to drink more fluids.

Choice E Reason:
Rapid, deep breathing, also known as Kussmaul respiration, is a compensatory mechanism for the acidosis seen in DKA. The body attempts to correct the acidic pH by exhaling more carbon dioxide.

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Correct Answer is A

Explanation

Choice a reason:
Including yogurt in the diet can be beneficial for a client experiencing diarrhea related to antibiotic therapy. Yogurt contains probiotics, which are live microorganisms that can provide health benefits when consumed. These probiotics can help restore the balance of good bacteria in the gut that antibiotics may have disrupted, potentially reducing the duration and severity of diarrhea. However, it's important to choose yogurts that contain active probiotics and to be aware that some individuals may not tolerate dairy well during a bout of diarrhea.

Choice b reason:
Administering famotidine 20 mg daily may help with symptoms of gastritis or peptic ulcers but is not directly related to treating antibiotic-associated diarrhea. Famotidine is a histamine-2 blocker used to reduce stomach acid and is not typically used as a treatment for diarrhea. It should be noted that if a patient is experiencing severe diarrhea, the underlying cause should be addressed rather than just managing symptoms.

Choice c reason:
Testing stool for occult blood is generally not a standard intervention for antibiotic-related diarrhea unless there is a suspicion of gastrointestinal bleeding or an infection like C. difficile, which can cause more severe colitis. Occult blood tests are more commonly used for screening for colorectal cancer or diagnosing conditions that cause gastrointestinal bleeding.

Choice d reason:
Arranging for IV administration of the antibiotic instead of the oral route may be considered if the client has severe diarrhea that prevents the absorption of oral medications or if the client is unable to tolerate oral intake[^10^]¹¹¹²¹³¹⁴. However, many antibiotics have excellent oral bioavailability, and switching from IV to oral antibiotics when appropriate can be just as effective and is often preferred due to convenience and lower risk of complications.

A. 1200 B. 1000 C. 0900 D. 1100

Correct Answer is C

Explanation

Choice A Reason
Monitoring for hypoglycemia at 1200 is not optimal because it is well past the peak action time of insulin aspart, which occurs approximately 45–90 minutes after administration. By noon, the insulin's effects are waning, and the risk of hypoglycemia is lower compared to the peak action period.

Choice B Reason
Monitoring at 1000 might still catch the tail end of the peak action time, but it is not the most likely time for hypoglycemia to occur. The nurse could miss the initial signs of hypoglycemia if monitoring starts two hours after administration.

Choice C Reason
0900 is the most appropriate time for the nurse to monitor for hypoglycemia. Insulin aspart has a rapid onset of action, peaking in about 45–90 minutes, and the effects last for 3–5 hours. Monitoring one hour after administration aligns with the start of the peak action time, when hypoglycemia is most likely to occur.

Choice D Reason
Monitoring at 1100 is less ideal because it is nearing the end of the peak action period. While there is still a risk for hypoglycemia, the highest risk would have been earlier, closer to the peak action time.

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The nurse would assess for which clinical manifestations in a client suspected of having diabetic ketoacidosis? (Select all that apply)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse would include which teaching or intervention in the care plan of a client experiencing diarrhea related to antibiotic therapy?

Correct Answer is A

Explanation

A client receives the morning dose of 10 units of insulin aspart at 0800. At what time would the nurse monitor for hypoglycemia?

Correct Answer is C

Explanation

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