A client treated for type 2 diabetes mellitus for eight years arrives to the clinic describing elevated blood glucose readings intermittently for the past two months. Which information requires further assessment by the nurse?

Reference Range:

Blood Urea Nitrogen (BUN) [10 to 20 mg/dL (3.6 to 7.1 mmol/L)]

White Blood Cell (WBC) 15,000 to 10,000/mm3 (5 to 10 x 109/L)] Blood Glucose [74 to 106 mg/dL (4.1 to 5.9 mmol/L)] Potassium [3.5 to 5 mEq/L (3.5 to 5 mmol/L)]

Fasting serum glucose 140 mg/dL (7.8 mmol/L).

White blood cell count 11,000/mm3 (11 x 109/L).

Blood urea nitrogen 26 mg/dL (9.28 mmol/L).

Potassium 3.5 mEq/L (3.5 mmol/L).

Answer and Explanation

The Correct Answer is C

A. A fasting serum glucose of 140 mg/dL is above the normal reference range (74–106 mg/dL) and indicates hyperglycemia. This finding aligns with the client’s report of intermittent elevated blood glucose and reflects ongoing diabetes management concerns, but it is expected in the context of poorly controlled type 2 diabetes and does not necessarily indicate an acute complication.

B. A WBC of 11,000/mm³ is slightly above the reference range (5,000–10,000/mm³). Mild leukocytosis can occur due to infection, stress, or inflammation. While it warrants observation, it is not as immediately concerning as significant renal function changes.

C. A BUN of 26 mg/dL is elevated above the reference range of 10–20 mg/dL. This suggests possible impaired kidney function, which is particularly important in a client with long-standing diabetes, as chronic hyperglycemia can lead to diabetic nephropathy. Further assessment is required, including evaluation of creatinine, glomerular filtration rate (GFR), hydration status, and medication review, because renal impairment can have serious consequences.

D. A potassium level of 3.5 mEq/L is at the lower end of the reference range (3.5–5 mEq/L) but is still considered normal. No immediate intervention is required unless trends show a downward pattern or the client has symptoms of hypokalemia.

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Correct Answer is D

Explanation

A. Jaundice is not associated with DKA. It typically indicates liver dysfunction or hemolysis. Clients with DKA do not develop jaundice as part of the metabolic derangement caused by hyperglycemia, ketosis, and dehydration.

B. Peripheral edema is also not expected in DKA. Edema usually results from fluid overload, heart failure, or kidney disease. In contrast, DKA is characterized by severe dehydration caused by osmotic diuresis from high blood glucose, along with vomiting and sometimes diarrhea. Therefore, fluid accumulation in the tissues is unlikely.

C. Respiratory depression is not a characteristic finding in DKA. Instead, clients often exhibit Kussmaul respirations, which are deep, rapid breaths that help the body compensate for metabolic acidosis by blowing off carbon dioxide. Respiratory depression would be abnormal and may indicate another problem, such as CNS depression or sedation.

D. Hypotension is the most expected finding in DKA. It results from significant fluid loss and decreased intravascular volume due to polyuria, vomiting, and dehydration. Hypotension is an early indicator of severity and requires prompt fluid resuscitation to maintain organ perfusion and prevent shock. It is a key priority for nursing assessment and intervention in clients with DKA.

A. The nurse manager should be updated on the client's status. B. The impending signs of death should be documented. C. The client's status should be conveyed to the chaplain. D. The client's need for pain medication should be determined.

Correct Answer is D

Explanation

A. Updating the nurse manager is important for overall care coordination, but it is not the immediate priority when a client is showing signs of imminent death. Administrative updates do not directly address the client’s comfort or symptom management.

B. Documenting signs of impending death is required for legal and professional purposes, but it is secondary to ensuring the client’s comfort. Documentation can be done after immediate needs are addressed.

C. Notifying the chaplain may provide spiritual support for the client and family, but this is not the priority nursing intervention. Spiritual care is important but should follow interventions that address physical comfort and symptom relief.

D. Determining the client’s need for pain medication is correct. When a client is nearing death, relief of pain and other distressing symptoms is the priority intervention. The nurse should assess for discomfort, anxiety, dyspnea, or other symptoms and administer prescribed medications to ensure a peaceful and comfortable passing, in accordance with palliative and end-of-life care standards.

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