A nurse is providing teaching about foot care for a client who has type 2 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?

Rationale:

A. Weigh the client daily: Clients with Cushing’s syndrome are at risk for rapid weight gain due to fluid retention and fat redistribution. Daily weights help monitor fluid balance and detect worsening edema or fluid overload early.

B. Monitor for postural hypotension: Cushing’s syndrome is typically associated with hypertension caused by fluid retention and increased sensitivity to catecholamines. Postural hypotension is more often seen in conditions with cortisol deficiency, such as Addison’s disease.

C. Monitor for an irregular heart rate: Excess cortisol can cause hypokalemia, which predisposes clients to cardiac dysrhythmias and irregular heart rates. Monitoring cardiac rhythm is essential to prevent complications from electrolyte imbalances.

D. Assess for neck vein distention: While fluid retention occurs in Cushing’s syndrome, neck vein distention is not a typical hallmark sign. Jugular vein distention is more closely associated with right-sided heart failure rather than cortisol excess alone.

E. Assess blood glucose level: Cortisol increases gluconeogenesis and reduces insulin sensitivity, leading to hyperglycemia. Clients with Cushing’s syndrome require close glucose monitoring to manage steroid-induced diabetes and prevent complications.

Rationale:

A. NPH insulin: NPH is an intermediate-acting insulin with a slower onset and longer duration, making it unsuitable for emergency treatment of diabetic ketoacidosis. It is typically used for maintenance therapy rather than acute management.

B. Insulin detemir: Detemir is a long-acting basal insulin that provides steady glucose control over many hours. It does not have a rapid onset of action, so it is not appropriate for correcting severe hyperglycemia in DKA.

C. Insulin glargine: Glargine is another long-acting insulin used for baseline control of glucose. Because it has no peak and a very slow onset, it cannot quickly lower glucose or ketone levels during acute DKA.

D. Regular insulin: Regular insulin is the treatment of choice for DKA because it can be administered intravenously, providing rapid onset of action. This allows for effective reduction of blood glucose, correction of acidosis, and reversal of ketosis in acute situations.