What clinical manifestation(s) should the nurse expect in a client with uncontrolled diabetes mellitus and ketoacidosis? (SELECT ALL THAT APPLY)

mental status = lethargic, oriented X 3 but unsure of reason for presenting for care

arterial blood gas pH 7.47/ pCO2-40/HCO3-33/ pa02 = 95

arterial blood gas pH=7.31/pCO2-34/HCO3-17/pa02=98

heart rate=52, regular

respiratory rate = 31, deep

Answer and Explanation

Correct Answer : A,C,E

A.   Lethargy can occur in DKA due to the effects of hyperglycemia, acidosis, and dehydration. Even if the client is oriented, confusion about the reason for care suggests an altered mental state, which can be common in DKA.
B.   This ABG indicates alkalosis (pH > 7.45), which is not typical for DKA. In DKA, we would expect a lower pH (acidosis). This set of values does not align with the expected clinical picture of DKA.
C.   This ABG shows a pH of 7.31, indicating acidosis. The low HCO3 (17) supports metabolic acidosis, which is characteristic of DKA. This finding is consistent with the expected laboratory results in a patient experiencing DKA.
D.   A heart rate of 52 (bradycardia) is not a common finding in DKA. In fact, tachycardia (elevated heart rate) is typically observed due to dehydration and compensatory mechanisms. Bradycardia would not be expected in this context.
E.   A respiratory rate of 31, particularly if deep (known as Kussmaul respirations), is a classic sign of metabolic acidosis, including DKA. Kussmaul respirations are the body’s attempt to compensate for acidosis by increasing carbon dioxide elimination.

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Correct Answer is D

Explanation

A. This time falls shortly after the onset of NPH insulin. While hypoglycemia could start to occur around this time, it is less likely to be at its peak.
B. This time is past the peak range of NPH insulin. The likelihood of hypoglycemia is lower as the insulin effect would be tapering off.
C. This time is well past the usual duration of NPH insulin. By this point, the risk of hypoglycemia would be significantly decreased.
D. This time falls within the peak action of NPH insulin (approximately 4-12 hours post-administration). This is when hypoglycemia is most likely to occur due to the greatest effect of the insulin.

A. monitor the client closely until dinner arrives. B. have the client drink 4 oz. of orange juice. C. give the client 3 tbsp. of sugar dissolved in 4 oz. of grape juice to drink. D. have the client dissolve a small piece of hard candy in their mouth.

Correct Answer is B

Explanation

A. While monitoring is important, doing nothing to address the hypoglycemia is not safe. A blood glucose level of 50 mg/dL is low and requires immediate intervention to prevent more severe hypoglycemic symptoms or complications.
B. This is a suitable option for treating mild to moderate hypoglycemia. Orange juice is a quick source of carbohydrates and can effectively raise blood glucose levels. Four ounces typically provides enough sugar to help increase the client's blood glucose level before dinner is served.
C. While this option would also effectively raise blood glucose, it is more complicated than simply having the client drink orange juice. The sugar may take additional time to dissolve, and grape juice may not be readily available. In an acute situation, simplicity and speed are key.
D. While hard candy can raise blood glucose levels, it may take longer to dissolve and provide sufficient glucose quickly compared to liquid sources like orange juice or grape juice. Additionally, the amount of candy needed may not be clear, making this a less reliable option in an urgent situation.

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What clinical manifestation(s) should the nurse expect in a client with uncontrolled diabetes mellitus and ketoacidosis? (SELECT ALL THAT APPLY)

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Naxlex Comprehensive Predictor Exams

A client receives 20 units of isophane insulin suspension (NPH) insulin at 0730. The nurse teaches the client that signs of hypoglycemia are most likely to occur at what time?

Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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