A nurse is teaching a client who has diabetes mellitus and receives 25 units of NPH insulin every morning if their blood glucose level is above 200 mg/dL. Which of the following information should the nurse include?

The correct answer is c. 2,525 mL.

Choice A reason:

1,350 mL is calculated by considering only the lactated Ringer’s IV intake. The calculation is as follows:

• Lactated Ringer’s IV at 150 mL/hr for 9 hr: 150 mL/hr × 9 hr = 1,350 mL. This option does not include the intake from cefazolin, packed RBCs, sodium chloride boluses, or famotidine.

Choice B reason:

1,600 mL is not a correct calculation based on the given intake. This value does not accurately sum up any combination of the provided intake components.

Choice C reason:

2,525 mL is the correct total intake. The detailed calculation is:

• Lactated Ringer’s IV at 150 mL/hr for 9 hr: 150 mL/hr × 9 hr = 1,350 mL.
• Cefazolin in 100 mL of 0.9% sodium chloride: 100 mL.
• Two units of packed RBCs: 275 mL + 250 mL = 525 mL.
• Two IV bolus infusions of 250 mL of 6.0% sodium chloride: 250 mL + 250 mL = 500 mL.
• Famotidine in 50 mL of 0.9% sodium chloride: 50 mL.

Adding these together: 1,350 mL + 100 mL + 525 mL + 500 mL + 50 mL = 2,525 mL.

Choice D reason:

2,100 mL is not a correct calculation based on the given intake. This value does not accurately sum up any combination of the provided intake components.

Choice A reason: This is correct because hemoglobin A1C level reflects the average blood glucose level over the past 2 to 3 months. It is a reliable indicator of the patient's glycemic control and adherence to the antidiabetic therapy. The goal for most patients with type 2 diabetes is to keep the hemoglobin A1C level below 7%.

Choice B reason: This is incorrect because serum insulin level is not a good measure of the patient's adherence to the antidiabetic therapy, as it may vary depending on the type, dose, and timing of the insulin or oral antidiabetic agents. Serum insulin level may also be affected by other factors, such as stress, infection, or exercise.

Choice C reason: This is incorrect because fingerstick fasting blood glucose level only reflects the blood glucose level at a single point in time. It does not provide information about the patient's long-term glycemic control or adherence to the antidiabetic therapy. Fingerstick fasting blood glucose level may also be influenced by the patient's diet, activity, or medication intake before the test.

Choice D reason: This is incorrect because hemoglobin level is not related to the patient's adherence to the antidiabetic therapy, as it measures the amount of oxygen-carrying protein in the red blood cells. Hemoglobin level may be affected by conditions such as anemia, dehydration, or blood loss.