A nurse is assessing a client. Which of the following findings should the nurse identify as an indication of respiratory failure?

• Blood glucose greater than expected reference range: Both DKA and HHS present with significant hyperglycemia. In DKA, glucose is typically moderately elevated (250–600 mg/dL), while HHS usually shows extreme hyperglycemia (>600 mg/dL). Hyperglycemia is a hallmark finding in both conditions, driving osmotic diuresis and dehydration.

• Skin turgor: Dehydration from osmotic diuresis is common in both DKA and HHS, resulting in poor skin turgor. Fluid loss occurs due to polyuria and inadequate intake, contributing to hypotension, tachycardia, and electrolyte imbalances in both conditions.

• Urine ketones: Urine ketones are characteristic of DKA due to lipolysis and ketogenesis caused by insulin deficiency. HHS typically has minimal to absent ketone production because some insulin is present, preventing significant fat breakdown.

• Creatinine greater than expected reference range: Elevated creatinine occurs in both DKA and HHS due to dehydration and pre-renal azotemia from hypovolemia. This reflects impaired renal perfusion and is a marker for severity of fluid deficit in both conditions.

• Blood pH: Metabolic acidosis (low pH) is a defining feature of DKA due to accumulation of ketoacids. HHS usually maintains a near-normal pH because ketosis is minimal, so acidosis is typically absent or mild.

A. "The best way to treat your cancer is chemotherapy.": This response is directive and does not explore the client’s perspective or provide an opportunity for discussion. It may make the client feel dismissed and does not promote therapeutic communication or informed decision-making.

B. “I have never heard of any holistic treatment that is effective”: This statement invalidates the client’s preference and can damage trust. It focuses on the nurse’s opinion rather than understanding the client’s beliefs, limiting collaborative care and shared decision-making.

C. "Tell me what you know about chemotherapy.": This response encourages the client to share their knowledge and concerns, allowing the nurse to clarify misconceptions and provide education. It fosters an open, therapeutic dialogue and helps the client make an informed choice about treatment options.

D. "You should ask your provider about your plan.": While consulting the provider is important, this response shifts responsibility away from the nurse and does not address the client’s concerns directly. It misses the opportunity to assess understanding and provide immediate support or education.