A nurse is reviewing the laboratory report of a client who has diabetic ketoacidosis (DKA) Which of the following findings should the nurse expect?

Serum glucose 600 mg/dL.

Serum bicarbonate 28 mEq/L.

Serum potassium 2.5 mEq/L.

Serum sodium 150 mEq/L.

Answer and Explanation

The Correct Answer is A

Choice A reason:

Serum glucose 600 mg/dL. This is an expected finding for a client who has diabetic ketoacidosis (DKA) DKA results from a deficiency of insulin, which leads to hyperglycemia and ketosis. The normal range for serum glucose is 70 to 110 mg/dL.

Choice B reason:

Serum bicarbonate 28 mEq/L. This is not an expected finding for a client who has DKA. A client who has DKA experiences ketosis, which results in ketones in the urine and blood. The nurse should expect a client who has DKA to have an HCO3- less than 15 mEq/L. This decreased value is due to an increased production of ketones, which results in metabolic acidosis. The normal range for serum bicarbonate is 22 to 26 mEq/L.

Choice C reason:

Serum potassium 2.5 mEq/L. This is not an expected finding for a client who has DKA. A client who has DKA experiences osmotic diuresis and subsequent dehydration, which can cause electrolyte imbalances. The nurse should expect a client who has DKA to have elevated serum potassium levels due to the movement of potassium from the intracellular to the extracellular space in response to acidosis. The normal range for serum potassium is 3.5 to 5 mEq/L.

Choice D reason:

Serum sodium 150 mEq/L. This is not an expected finding for a client who has DKA. A client who has DKA experiences osmotic diuresis and subsequent dehydration, which can cause electrolyte imbalances. The nurse should expect a client who has DKA to have decreased serum sodium levels due to the dilutional effect of excess glucose in the blood. The normal range for serum sodium is 136 to 145 mEq/L.

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Correct Answer is C

Explanation

Choice A reason:

U waves are not a sign of high potassium level, but rather of low potassium level (hypokalemia) Hypokalemia can cause ST segment depression, T wave flattening or inversion, and prominent U waves.

Choice B reason:

Absent P waves are not a sign of high potassium level, but rather of a severe conduction block or atrial fibrillation. High potassium level can cause P wave widening or flattening, and PR prolongation, but not complete disappearance of P waves.

Choice C reason:

Elevated T waves are the most common and earliest sign of high potassium level (hyperkalemia) Hyperkalemia can cause tall, peaked, symmetric T waves that may merge with the QRS complex. This is the correct answer.

Choice D reason:

Inverted QRS complexes are not a sign of high potassium level, but rather of ventricular arrhythmias or myocardial infarction. High potassium level can cause QRS widening and bizarre QRS morphology, but not inversion.

A. Shave the hair around the insertion site. B. Obtain informed consent from the patient. C. Administer prophylactic antibiotics to the patient. D. Place the patient in Trendelenburg position.

Correct Answer is D

Explanation

Choice A reason: Shaving the hair around the insertion site is not recommended because it can cause skin irritation and increase the risk of infection.

Choice B reason:

Obtaining informed consent from the patient is important, but it is not a step that the nurse should perform before inserting the catheter. Informed consent should be obtained by the physician or advanced practice nurse who will perform the procedure.

Choice C reason:

Administering prophylactic antibiotics to the patient is not a routine practice for central venous catheter insertion. Antibiotics may be indicated for patients with certain risk factors, such as immunosuppression, but they should be prescribed by the physician or advanced practice nurse.

Choice D reason:

Placing the patient in Trendelenburg position is an important step that the nurse should perform before inserting the catheter. This position helps to distend the jugular vein and reduce the risk of air embolism during catheter insertion.

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