A nurse is assessing a client who has a history of substance abuse.

Which of the following findings should the nurse report to the provider immediately?

Urine ketones 3+

Rationale: Urine ketones 3+ indicate a high level of ketones in the urine, which is a sign of diabetic ketoacidosis (DKA), a life-threatening complication of diabetes mellitus. DKA occurs when the body breaks down fat for energy due to insufficient insulin, resulting in the production of acidic ketones that cause metabolic acidosis. The nurse should report this value to the provider as a priority and prepare to administer intravenous fluids, insulin, and electrolytes as prescribed.

Incorrect options:

A) Hemoglobin A1c 8.5% - Hemoglobin A1c is a measure of the average blood glucose level over the past 2 to 3 months. A value of 8.5% indicates poor glycemic control and an increased risk of complications, but it is not an emergency.

B) Blood glucose 180 mg/dL - Blood glucose is a measure of the amount of glucose in the blood at a given time. A value of 180 mg/dL indicates hyperglycemia, which is common in clients who have diabetes mellitus, but it is not an emergency.

D) Serum creatinine 1.2 mg/dL - Serum creatinine is a measure of the amount of creatinine, a waste product of muscle metabolism, in the blood. A value of 1.2 mg/dL is within the normal range for adults and does not indicate any problem.

Inspect the nail beds and lips for a bluish hue.

Rationale: Cyanosis is a bluish discoloration of the skin and mucous membranes due to inadequate oxygenation of the blood. In clients who have dark skin, cyanosis may be difficult to detect by visual inspection of the skin alone. The nurse should inspect the nail beds and lips for a bluish hue, as these areas are more sensitive to changes in oxygen saturation.

Incorrect options:

B) Palpate the skin for warmth and moisture - This technique may help to assess for other skin conditions, such as dehydration or infection, but it does not indicate cyanosis.

C) Compare the skin color with a standardized color chart - This technique may help to assess for other skin conditions, such as jaundice or anemia, but it does not indicate cyanosis.

D) Observe the skin for pallor or ashiness - This technique may help to assess for other skin conditions, such as shock or hypovolemia, but it does not indicate cyanosis.