A nurse is providing education to a client with newly diagnosed type 2 diabetes mellitus. Which statement by the client indicates a need for further teaching?

Choice A rationale
Hypercalcemia is characterized by increased calcium levels in the blood, often due to increased absorption of calcium from the gut. However, in chronic kidney disease (CKD), the kidneys’ ability to activate vitamin D is impaired, leading to decreased calcium absorption from the gut, not increased. Therefore, hypercalcemia is not a typical sign of CKD1.
Choice B rationale
A positive Chvostek’s sign is indicative of hypocalcemia, which is a common symptom in CKD. The kidneys’ reduced ability to activate vitamin D leads to decreased calcium absorption from the gut, resulting in low calcium levels in the blood. This hypocalcemia can cause neuromuscular irritability, leading to a positive Chvostek’s sign.
Choice C rationale
Tetany is a condition characterized by muscle cramps and spasms, often due to hypocalcemia. In CKD, hypocalcemia occurs due to the kidneys’ inability to activate vitamin D, leading to decreased calcium absorption from the gut. This hypocalcemia can cause hyperexcitability of nerves and muscles, resulting in tetany.
Choice D rationale
Hyperphosphatemia is characterized by high phosphate levels in the blood. In CKD, the kidneys’ ability to excrete phosphate is impaired, leading to its accumulation in the blood. However, this is not directly related to the inability to absorb phosphate from the gut but rather the kidneys’ reduced excretion capacity.

Choice A rationale
Elevated blood ammonia levels are a common consequence of liver dysfunction, particularly in conditions like cirrhosis and alcoholic liver disease. The liver is responsible for converting ammonia, a byproduct of protein metabolism, into urea, which is then excreted by the kidneys. When the liver is damaged, it cannot effectively perform this function, leading to elevated blood ammonia levels. High ammonia levels can cross the blood-brain barrier and cause hepatic encephalopathy, which manifests as confusion, memory loss, and asterixis (a flapping tremor of the hands). These neurological symptoms are consistent with the patient’s presentation.
Choice B rationale
An increased white blood cell count typically indicates an infection or inflammation. While infections can occur in patients with liver disease due to a compromised immune system, the symptoms described (increased blood glucose, blurred vision, memory loss, and asterixis) are more indicative of hepatic encephalopathy rather than an infection.
Choice C rationale
Elevated blood urea nitrogen (BUN) levels can occur in liver disease, but they are more commonly associated with kidney dysfunction. BUN is a measure of the amount of nitrogen in the blood that comes from the waste product urea. While liver dysfunction can affect BUN levels, the symptoms described are more specifically related to elevated ammonia levels and hepatic encephalopathy.
Choice D rationale
A decreased platelet count, or thrombocytopenia, is a common finding in liver disease due to splenic sequestration and decreased production of thrombopoietin. However, thrombocytopenia does not directly cause the neurological symptoms described in the patient. The symptoms of increased blood glucose, blurred vision, memory loss, and asterixis are more specifically related to elevated ammonia levels and hepatic encephalopathy.