A nurse is assessing a client with suspected diabetic ketoacidosis (DKA). Which laboratory finding is most indicative of this condition?
Blood pH of 7.45
Serum bicarbonate of 12 mEq/L
Blood glucose of 200 mg/dL
Serum potassium of 5.5 mEq/L
The Correct Answer is B
Choice A reason: A blood pH of 7.45 is normal or slightly alkalotic, not indicative of DKA, which causes metabolic acidosis due to ketone accumulation. DKA typically presents with a pH below 7.35, reflecting acid-base imbalance from ketoacid production, making this finding inconsistent with DKA.
Choice B reason: A serum bicarbonate of 12 mEq/L indicates metabolic acidosis, a hallmark of DKA. Ketoacids produced from fat metabolism in uncontrolled hyperglycemia consume bicarbonate, lowering its levels, confirming DKA’s acid-base disturbance and making this the most indicative laboratory finding.
Choice C reason: A blood glucose of 200 mg/dL is elevated but not specific to DKA, which typically involves glucose levels above 250 mg/dL, often much higher. This level could indicate hyperglycemia but does not confirm the severe metabolic acidosis characteristic of DKA.
Choice D reason: Serum potassium of 5.5 mEq/L suggests hyperkalemia, common in DKA due to acidosis shifting potassium extracellularly. However, it is less specific than low bicarbonate, as hyperkalemia can occur in other conditions, and bicarbonate directly reflects DKA’s acidotic state.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Glargine is a long-acting insulin providing basal coverage, not suitable for acute diabetic ketoacidosis (DKA). DKA, indicated by confusion, flushing, and acetone breath, requires rapid correction of hyperglycemia and acidosis. Glargine’s slow onset cannot address acute metabolic decompensation effectively, making it inappropriate for this scenario.
Choice B reason: Regular insulin is short-acting, ideal for treating diabetic ketoacidosis, as indicated by confusion, flushing, and acetone breath. It rapidly lowers blood glucose and corrects acidosis by facilitating glucose uptake and inhibiting ketogenesis, addressing the acute metabolic crisis effectively through intravenous administration.
Choice C reason: NPH is an intermediate-acting insulin, unsuitable for acute DKA management. Its slower onset and prolonged action do not provide the rapid glucose and ketone correction needed in DKA, where confusion and acetone breath indicate severe metabolic acidosis requiring immediate intervention with short-acting insulin.
Choice D reason: Detemir, a long-acting insulin, is used for basal glucose control, not acute DKA. Its gradual onset does not address the urgent need to correct hyperglycemia and ketosis in a patient with confusion and acetone breath, which require rapid-acting insulin to stabilize metabolic derangements quickly.
Correct Answer is C
Explanation
Choice A reason: Yellow discoloration of the skin indicates jaundice, caused by elevated bilirubin due to impaired liver function in cirrhosis. It is a common finding but not caput medusae, which specifically refers to vascular changes around the umbilicus due to portal hypertension, making this incorrect.
Choice B reason: Swollen lymph nodes are not associated with caput medusae. Lymphadenopathy may occur in infections or malignancies but not as a direct result of cirrhosis. Caput medusae involves dilated veins, not lymph nodes, caused by portal hypertension shunting blood to superficial veins.
Choice C reason: Caput medusae is the presence of distended, tortuous veins around the umbilicus, resulting from portal hypertension in cirrhosis. Increased portal vein pressure forces blood into collateral veins, creating a radiating pattern resembling a jellyfish head, making this the accurate description of the finding.
Choice D reason: Dark tarry stools (melena) indicate gastrointestinal bleeding, often from esophageal varices in cirrhosis due to portal hypertension. While a serious finding, it is unrelated to caput medusae, which is a visible vascular phenomenon on the abdomen, not a gastrointestinal symptom.
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