A nurse is reviewing guidelines to prevent diabetic ketoacidosis (DKA) during periods of illness with a client who has type 1 diabetes mellitus. Which of the following instructions should the nurse include in the teaching?

Choice A reason: Blood glucose below 40 mg/dL indicates hypoglycemia, not DKA, which is characterized by hyperglycemia (typically >250 mg/dL) due to insulin deficiency, driving ketogenesis. Hypoglycemia may occur during DKA treatment but is not an expected initial manifestation of the condition.

Choice B reason: Malignant hypertension is not a feature of DKA. DKA may cause hypotension from dehydration due to osmotic diuresis, not extreme hypertension. Malignant hypertension is associated with other conditions, like renal disease, making this an incorrect manifestation for DKA.

Choice C reason: Kussmaul breathing, rapid and deep respirations, is a hallmark of DKA, compensating for metabolic acidosis (pH <7.35) from ketone accumulation. This respiratory effort lowers PaCO2 to buffer hydrogen ions, making it a key clinical sign expected in DKA patients.

Choice D reason: Fetor hepaticus, a musty breath odor, is associated with liver failure, not DKA. DKA causes fruity breath from acetone, a ketone byproduct of fat metabolism, making fetor hepaticus an incorrect manifestation for this metabolic condition.

Choice A reason: Metoclopramide promotes gastric motility and is used for nausea or gastroparesis. It does not address bleeding esophageal varices, which require vasoconstriction to reduce portal hypertension. Its prokinetic effects may worsen bleeding by increasing gastric pressure, making this choice inappropriate for this condition.

Choice B reason: Vancomycin is an antibiotic for bacterial infections, like MRSA or C. difficile. It has no role in managing bleeding esophageal varices, which stem from portal hypertension and require hemodynamic stabilization, not infection control, making this choice irrelevant for the client’s condition.

Choice C reason: Octreotide, a somatostatin analog, reduces portal vein pressure by constricting splanchnic blood vessels, decreasing blood flow to varices. This controls bleeding in esophageal varices, a complication of liver disease, making it the preferred medication and the correct choice for this scenario.

Choice D reason: Famotidine, an H2 receptor blocker, reduces gastric acid for ulcers or GERD. It does not address the vascular cause of bleeding varices, which requires portal pressure reduction. It may be adjunctive but is not primary, making this choice incorrect.