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 C

Explanation

A. While taking vital signs can provide useful information about the client's overall condition, it does not directly address the immediate concern of potential hypoglycemia. The priority is to assess blood glucose levels, as this will guide further actions.
B. Glucagon is used for severe hypoglycemia when the client is unable to consume glucose orally. However, before administering glucagon, it is essential to confirm hypoglycemia by checking the blood glucose level. This ensures that glucagon is only used when absolutely necessary.
C. Checking the blood glucose level will quickly determine whether the client is experiencing hypoglycemia. If the blood glucose is low, appropriate treatment (such as administering glucose or a fast-acting carbohydrate) can be initiated. If it’s within normal limits, other potential causes for the symptoms can be explored.

D. While it may be necessary to notify the physician depending on the outcome of the blood glucose reading or if the client’s condition worsens, it is not the first action. Immediate assessment of blood glucose is essential to determine the appropriate course of action.

A. weight gain of 40 lbs. (18 kg) over the past 2 months B. currently prescribed aripiprazole, a second-generation antipsychotic agent C. sits & plays video games for 10-14 hours per day D. frequently eats salads with grilled chicken E. random blood glucose was 218 mg/dL with labs drawn 1 month ago

Correct Answer is ["B","C","E"]

Explanation

A. While rapid weight gain is a concern, it's important to consider the underlying cause. If the weight gain is medication-related (as in option B), it's a significant risk factor. However, if it's due to other factors like increased appetite or decreased activity, it might not be as directly linked to diabetes risk.
B. Many antipsychotic medications, including aripiprazole, have been linked to metabolic side effects like weight gain, increased blood glucose levels, and dyslipidemia. These metabolic changes can increase the risk of developing type 2 diabetes.
C. A sedentary lifestyle is a well-known risk factor for type 2 diabetes. Reduced physical activity can lead to insulin resistance, a condition where the body's cells become less responsive to insulin.
D. A diet rich in vegetables and lean protein is generally healthy and can help prevent chronic diseases. This option does not directly increase the risk of type 2 diabetes.
E. A random blood glucose level above 200 mg/dL is indicative of diabetes. This is a clear marker of impaired glucose metabolism and a significant risk factor for type 2 diabetes.

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