A nurse is teaching a client who has a new prescription for montelukast to treat asthma. Which of the following statements by the client indicates an understanding of the teaching?

Rationale:

• Skin turgor: In DKA, dehydration is a common result due to fluid loss from excessive urination and hyperglycemia. Decreased skin turgor, or slight tenting, is an indicator of dehydration. HHS is characterized by severe hyperglycemia and profound dehydration, leading to significant fluid deficits and impaired skin turgor.
• Blood glucose greater than expected reference range: Both DKA and HHS present with elevated blood glucose levels. The client's blood glucose level of 468 mg/dL is higher than the expected range. However, blood glucose levels tend to be much higher in HHS, sometimes exceeding 1000 mg/dL, while DKA usually ranges between 250–600 mg/dL.
• Blood pH: A blood pH of 7.30 is low and indicative of acidosis, which is a hallmark of DKA. In DKA, the body produces ketones as a byproduct of fat metabolism, which causes the blood pH to drop, leading to metabolic acidosis. HHS typically does not cause significant acidosis, and pH is generally within normal limits.
• Creatinine greater than expected reference range: Elevated creatinine levels suggest kidney impairment, which is common in DKA and HHS due to severe dehydration and osmotic diuresis. Dehydration significantly impairs renal perfusion and function, leading to elevated creatinine and BUN levels.
• Urine ketones: Ketones form when the body starts breaking down fat for energy due to a lack of insulin, which is characteristic of DKA. In HHS, the body does not typically produce significant amounts of ketones, as some insulin is still present and inhibiting fat metabolism.

Rationale:

A. Obtain the client's vital signs: While vital signs are important after a seizure, they are not the priority during the event. The first action should focus on protecting the client from injury and ensuring their airway remains open.

B. Notify the rapid response team: Notifying the rapid response team is not the first step. The nurse should prioritize ensuring the client’s safety during the seizure, including turning them on their side to prevent aspiration or injury.

C. Perform a neurologic check: A neurologic check is important after the seizure has ended to assess for changes in mental status or neurological function. However, during the seizure, the immediate priority is to ensure the client’s safety and airway.

D. Turn the client on their side: This priority action during a tonic-clonic seizure helps maintain the airway, prevents aspiration, and allows any secretions to drain from the mouth. Ensuring safety during the seizure is crucial before performing other assessments.